Epidurals during C-section and Autism: What is the connection

The multifaceted and complicated neurodevelopmental conditions known as autism spectrum disorders (ASDs) are typically identified in the early years of life. ASDs are considered to have both a genetic predisposition and environmental effects as their origin. The prevalence of ASDs has been rising globally as a result of broader diagnostic criteria, and researchers are currently looking for the modifiable causes. The most popular type of anaesthesia used during labour and delivery is epidural analgesia (ELA), which effectively relieves pain. 

The most popular type of anaesthesia used during childbirth is epidural analgesia (ELA), which effectively relieves pain throughout labour. The Cochrane study from 2018 states that ELA with a low concentration of local anaesthetic has no devastating effect on the proportions of Caesarean section, long-term backache, or postnatal outcomes. The efficacy of the technique is well-discussed and proven. But in 2020, Qiu et al. released a population-based study showing a link between the use of epidurals during  C-section and the likelihood of ASD in newborns, which raised a lot of questions.

Recent Research on ASD and Epidurals

• The only study yet to demonstrate a meaningful link is that by Qiu et al., which found a 37% increase in the probability of ASD causes in offspring exposed to ELA. Numerous flaws in the study by Qiu et al. were pointed out by specialists, who also harshly criticised it. Hanley et al., for instance, voiced concerns regarding the use of diagnostic codes to diagnose children with ASD because current research indicates that they have poor accuracy when doing so, making the study subject to bias.

• The researchers also concentrated on the social and health differences between the populations studied as well as the absence of a maternal and familial history of ASD in the possible effects. For example, women who chose to use epidurals had more risk factors for ASD, such as old age, pregnancy complications, diabetes, and obesity. 

• Another study highlighted the correlation between mother anxiety and depression and the application of ELA and the higher risk of ASD as an example. Therefore, subjectivity may have contributed to the reported link between ELA and ASD. Lee et al. and Kern-Goldberg et al. expressed similar concerns in addition to the absence of discussion of the labour problems.

• The last issue was raised by Lee et al., who noted that the findings from a single hospital centre might not be generally applicable, especially considering the significant role that factors both genetic and environmental play in ASD. Additionally, it's important to note that other researchers employed diagnostic codes to identify children with ASD, which made their studies just as prone to error as the one by Qiu et al. The study was flawed because some significant confounders, such as maternal and family history of ASD or labour problems, were not taken into account, according to the most common explanation for the disparity in the results.

The Uptake

 According to the current literature evaluation, there is no conclusive evidence linking the use of epidural anaesthetic during birth with the later onset of autism spectrum condition in the offspring. Therefore, when choosing a delivery pain management strategy, the individual risk of ASD should not be taken into account. 

Moreover, we should interpret these results cautiously since they were inadequate to prove causation, and because observational studies have intrinsic methodological flaws. Even though the epidemiological link between epidurals and ASD in children has received extensive study, its biological plausibility has received less consideration. Considering this subject is expected to continue to be of interest to researchers, medical professionals, and patients, more research should be done on it.