Association of Labor Epidural Analgesia, Oxytocin Exposure, and Risk of Autism Spectrum Disorders in Children
Authors' conclusion
The findings of this cohort study suggest an association between maternal LEA and ASD risk in children, and the risk appeared to be further increased if oxytocin was also administered. Oxytocin exposure without LEA exposure was not associated with ASD risk in children.
Study context
- Population
- Singleton vaginal births in a single integrated health care system in Southern California, 2008–2017, followed up to December 31, 2021
- Participants
- 205,994 singleton vaginal births
- Exposure
- Maternal labor epidural analgesia (LEA) and/or oxytocin during labor and delivery vs no exposure
- Outcome
- Child's clinical diagnosis of ASD during follow-up and at age of diagnosis
Methodological detailssingle integrated health care system, Cox proportional hazards regression, covariate-adjusted
- Single integrated health care system
- Cox proportional hazards regression, covariate-adjusted
Main finding
As reported in the abstract
Child ASD
Each group vs no exposureHazard ratio (95% CI)
LEA alone
1.20(1.09–1.32)
Both LEA and oxytocin
1.30(1.20–1.42)
Oxytocin alone
0.90(0.78–1.04)
LEAindependent of oxytocin exposure
1.28(1.18–1.38)
Oxytocinadjusted for LEA exposure; not significant
1.05(0.99–1.12)
- Autism spectrum disorders (ASD) diagnosed during follow-up (whole cohort)
- 5146 (2.5%)
- Significant interaction of LEA and oxytocin on child ASD risk
- P = 0.02 for interaction
Observational data: associations, not effects.
Further findings
Exposure rates
- Exposed to maternal LEA
- 153 880 (74.7%)
- Exposed to oxytocin
- 117 808 (57.2%)
- Oxytocin exposure among LEA-exposed children
- 67.7%
- Oxytocin exposure among LEA-unexposed children
- 26.1%
Original publication
Association of Labor Epidural Analgesia, Oxytocin Exposure, and Risk of Autism Spectrum Disorders in Children. JAMA Netw Open. Published 3 July 2023. doi:10.
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