Behavioural and neuropsychological outcomes in children exposed in utero to maternal labour epidural analgesia

Br J Anaesth. 2024 Aug;133(2):334-343. doi: 10.1016/j.bja.2024.02.036. Epub 2024 May 3.


Background: Recent studies report conflicting results regarding the relationship between labour epidural analgesia (LEA) in mothers and neurodevelopmental disorders in their offspring. We evaluated behavioural and neuropsychological test scores in children of mothers who used LEA.

Methods: Children enrolled in the Raine Study from Western Australia and delivered vaginally from a singleton pregnancy between 1989 and 1992 were evaluated. Children exposed to LEA were compared with unexposed children. The primary outcome was the parent-reported Child Behaviour Checklist (CBCL) reporting total, internalising, and externalising behavioural problem scores at age 10 yr. Score differences, an increased risk of clinical deficit, and a dose-response based on the duration of LEA exposure were assessed. Secondary outcomes included language, motor function, cognition, and autistic traits.

Results: Of 2180 children, 850 (39.0%) were exposed to LEA. After adjustment for covariates, exposed children had minimally increased CBCL total scores (+1.41 points; 95% confidence interval [CI] 0.09 to 2.73; P=0.037), but not internalising (+1.13 points; 95% CI -0.08 to 2.34; P=0.066) or externalising (+1.08 points; 95% CI -0.08 to 2.24; P=0.068) subscale subscores. Increased risk of clinical deficit was not observed for any CBCL score. For secondary outcomes, score differences were inconsistently observed in motor function and cognition. Increased exposure duration was not associated with worse scores in any outcomes.

Conclusions: Although LEA exposure was associated with slightly higher total behavioural scores, there was no difference in subscores, increased risk of clinical deficits, or dose-response relationship. These results argue against LEA exposure being associated with consistent, clinically significant neurodevelopmental deficits in children.

Keywords: behaviour; labour epidural analgesia; neurodevelopment; neurotoxicity; obstetric anaesthesia.

MeSH terms

  • Adult
  • Analgesia, Epidural* / adverse effects
  • Analgesia, Obstetrical / adverse effects
  • Analgesia, Obstetrical / methods
  • Child
  • Child Behavior / drug effects
  • Child Behavior Disorders / epidemiology
  • Child Behavior Disorders / etiology
  • Child, Preschool
  • Female
  • Humans
  • Male
  • Neurodevelopmental Disorders / epidemiology
  • Neuropsychological Tests*
  • Pregnancy
  • Prenatal Exposure Delayed Effects*
  • Western Australia / epidemiology