Neuraxial labor analgesia for vaginal delivery and its effects on childhood learning disabilities.
BACKGROUND
In prior work, children born to mothers who received neuraxial anesthesia for cesarean delivery had a lower incidence of subsequent learning disabilities compared with vaginal delivery. The authors speculated that neuraxial anesthesia may reduce stress responses to delivery, which could affect subsequent neurodevelopmental outcomes. To further explore this possibility, we examined the association between the use of neuraxial labor analgesia and development of childhood learning disabilities in a population-based birth cohort of children delivered vaginally.


METHODS
The educational and medical records of all children born to mothers residing in the area of 5 townships of Olmsted County, Minnesota from 1976 to 1982 and remaining in the community at age 5 years were reviewed to identify those with learning disabilities. Cox proportional hazards regression was used to compare the incidence of learning disabilities between children delivered vaginally with and without neuraxial labor analgesia, including analyses adjusted for factors of either potential clinical relevance or that differed between the 2 groups in univariate analysis.


RESULTS
Of the study cohort, 4684 mothers delivered children vaginally, with 1495 receiving neuraxial labor analgesia. The presence of childhood learning disabilities in the cohort was not associated with use of labor neuraxial analgesia (adjusted hazard ratio, 1.05; 95%confidence interval, 0.85-1.31; P = 0.63).


CONCLUSIONS
The use of neuraxial analgesia during labor and vaginal delivery was not independently associated with learning disabilities diagnosed before age 19 years. Future studies are needed to evaluate potential mechanisms of the previous finding indicating that the incidence of learning disabilities is lower in children born to mothers via cesarean delivery under neuraxial anesthesia compared with vaginal delivery.
Flick
Randall P
RP
Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Lee
Kunmoo
K
Hofer
Ryan E
RE
Beinborn
Charles W
CW
Hambel
Ellen M
EM
Klein
Melissa K
MK
Gunn
Paul W
PW
Wilder
Robert T
RT
Katusic
Slavica K
SK
Schroeder
Darrell R
DR
Warner
David O
DO
Sprung
Juraj
J
D000328:Adult; D016362:Analgesia, Obstetrical / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007743:Labor, Obstetric / Q000187:drug effects / Q000502:physiology*; D007859:Learning Disabilities / Q000139:chemically induced* / Q000209:etiology; D008297:Male; D011247:Pregnancy; D016016:Proportional Hazards Models; D012044:Regression Analysis; D016896:Treatment Outcome
D000701:Analgesics, Opioid