Anesthesia for cesarean delivery and learning disabilities in a population-based birth cohort.
BACKGROUND
Anesthetics administered to immature brains may cause histopathological changes and long-term behavioral abnormalities. The association between perinatal exposure to anesthetics during Cesarean delivery (CD) and development of learning disabilities (LD) was determined in a population-based birth cohort.


METHODS
The educational and medical records of all children born to mothers residing in five townships of Olmsted County, Minnesota from 1976-1982 and remaining in the community at age 5 were reviewed to identify those with LDs. Cox proportional hazards regression was used to compare rates of LD between children delivered vaginally and via CD (with general or regional anesthesia).


RESULTS
Of the 5,320 children in this cohort, 497 were delivered via CD (under general anesthesia n = 193, and regional anesthesia n = 304). The incidence of LD depended on mode of delivery (P = 0.050, adjusted for sex, birth weight, gestational age, exposure to anesthesia before age 4 yr, and maternal education). LD risk was similar in children delivered by vagina or CD with general anesthesia, but was reduced in children receiving CD with regional anesthesia (hazard ratio = 0.64, 95% confidence interval 0.44 to 0.92; P = 0.017 for comparison of CD under regional anesthesia compared to vaginal delivery).


CONCLUSIONS
Children exposed to general or regional anesthesia during CD are not more likely to develop LD compared to children delivered vaginally, suggesting that brief perinatal exposure to anesthetic drugs does not adversely affect long-term neurodevelopmental outcomes. The risk of LD may be lower in children delivered by CD whose mothers received regional anesthesia.
Sprung
Juraj
J
Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA.
Flick
Randall P
RP
Wilder
Robert T
RT
Katusic
Slavica K
SK
Pike
Tasha L
TL
Dingli
Mariella
M
Gleich
Stephen J
SJ
Schroeder
Darrell R
DR
Barbaresi
William J
WJ
Hanson
Andrew C
AC
Warner
David O
DO
D000328:Adult; D000765:Anesthesia, Conduction / Q000009:adverse effects*; D000768:Anesthesia, General / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D002585:Cesarean Section; D002648:Child; D015331:Cohort Studies; D036861:Delivery, Obstetric; D004522:Educational Status; D005260:Female; D006801:Humans; D007361:Intelligence Tests; D053208:Kaplan-Meier Estimate; D007859:Learning Disabilities / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D011297:Prenatal Exposure Delayed Effects; D016016:Proportional Hazards Models