title: Neuraxial labor analgesia for vaginal delivery and its effects on childhood learning disabilities.
abstract: 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.
authors.affiliation: Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Randall P
authors.initials: RP
authors.lastname: Flick
authors.forename: Kunmoo
authors.initials: K
authors.lastname: Lee
authors.forename: Ryan E
authors.initials: RE
authors.lastname: Hofer
authors.forename: Charles W
authors.initials: CW
authors.lastname: Beinborn
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Hambel
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Klein
authors.forename: Paul W
authors.initials: PW
authors.lastname: Gunn
authors.forename: Robert T
authors.initials: RT
authors.lastname: Wilder
authors.forename: Slavica K
authors.initials: SK
authors.lastname: Katusic
authors.forename: Darrell R
authors.initials: DR
authors.lastname: Schroeder
authors.forename: David O
authors.initials: DO
authors.lastname: Warner
authors.forename: Juraj
authors.initials: J
authors.lastname: Sprung
mesh_terms: 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
chemical_list: D000701:Analgesics, Opioid