Introduction: Labour epidural analgesia is the most effective method for intrapartum pain relief and is associated with improved maternal outcomes. However, concerns have been raised regarding potential associations between labour epidural analgesia and adverse psycho-emotional outcomes in children. Evidence from large epidemiological studies is inconsistent and potential biological mechanisms remain unclear. Maternal immune activation during pregnancy may play a role. We aimed to investigate behavioural and psycho-emotional outcomes in children of mothers who received epidural analgesia during labour, accounting for perinatal mental health, sociodemographic characteristics and cytokine profiles.
Methods: Singleton vaginal births from the Biology, Affect, Stress, Imaging and Cognition study were included. Child behavioural outcomes were assessed by Child Behavioural Checklist scores at 18 months, 6 years and 11 years postpartum in the U-BIRTH follow-up cohort, with higher scores indicating more behavioural difficulties. The main exposure was maternal use of labour epidural analgesia. Maternal data were collected from questionnaires and medical records.
Results: Among 1962 mother-child dyads, 726 (37%) received labour epidural analgesia. Younger maternal age; lower resilience; inflammatory diseases; primiparity; antenatal depression; fear of childbirth; and longer duration of labour were associated with higher Child Behavioural Checklist scores at 18 months postpartum. In crude analysis, labour epidural analgesia correlated with higher Child Behavioural Checklist scores at 18 months postpartum; however, this association was not significant after adjusting for confounders. Among those with lower expression of TNFSF14 and CXCL6 cytokines, labour epidural analgesia use was associated with higher Child Behavioural Checklist scores.
Discussion: Use of epidural analgesia during labour was not found to be independently associated with adverse child behavioural outcomes. Variations in maternal cytokine profiles among those choosing labour epidural analgesia or not may influence susceptibility to early behavioural differences. Replication in larger cohorts and further exploration of additional immune biomarker dynamics during pregnancy are warranted.
Keywords: CBCL scores; labour epidural analgesia; late gestation cytokines; postpartum depression; resilience.
What we did: We studied almost 2000 mothers and their children to see if using an epidural for pain relief during labour was linked to children's behaviour later in life. We looked at children's behaviour when they were 18 months old, 6 years old and 11 years old using standard behaviour questionnaires. We also collected information about the mothers, such as their mental health, background and levels of certain immune system chemicals in their blood.
Why did we do it: Epidurals are very good at reducing pain during childbirth, but some people worry they might affect a child's emotional or behaviour development. Past studies have given mixed results, and it is not clear why an epidural would cause any effect. We wanted to find out if epidurals were linked to children's behaviour after taking into account other important things, such as the mother's health stress, and immune system activity during pregnancy.
What we found: At first, children whose mothers had an epidural seemed to have slightly more behaviour difficulties at 18 months. However, after we allowed for other factors like the mother's age, mental health, fear of childbirth and length of labour, the epidural itself was not linked to worse behaviour in children. Some children whose mothers had certain immune system patterns did show small differences in behaviour, but overall, epidurals were not found to cause behaviour problems in children. This suggests epidurals are not harmful to children's emotional or behaviour development, although more research is needed to understand how the immune system in pregnancy might play a role.
© 2026 The Author(s). Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.