Labor Epidurals Do Not Cause Autism; Safe for Mothers and Infants, say Anesthesiology, Obstetrics, and Pediatric Medical Societies

The Society for Obstetric Anesthesia and Perinatology (SOAP), the American Society of Anesthesiologists (ASA), the Society for Pediatric Anesthesia (SPA), the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) aim to clearly reassure pregnant women that the article, “Association Between Epidural Analgesia During Labor and Risk of Autism Spectrum Disorders in Offspring,” a new retrospective database study published in JAMA Pediatrics on October 12^th, 2020 does not provide credible scientific evidence that labor epidurals for pain relief cause autism.

SOAP, ASA, SPA, ACOG and SMFM recognize the potential for this article to create anxiety among pregnant women who face a decision of whether or not to receive an epidural for childbirth. While this concern is certainly understandable, these five medical societies that represent more than 100,000 physicians want to assure the public that an association between a mother’s use of epidural analgesia during childbirth, and her infant’s risk of developing autism does not imply causation. In the scientific literature, the finding of an association between a treatment and an outcome does not prove the treatment caused the outcome.

“Neuraxial analgesia is the gold standard for labor pain relief,” said Ruth Landau, M.D., Virginia Apgar Professor of Anesthesiology and president of SOAP. “We should not stop providing labor epidurals, and if anything, epidurals improve maternal and neonatal outcomes.”

Millions of women worldwide benefit from epidural pain relief every year and give birth without any complications to mother or baby. There are many medical indications for analgesia and anesthesia during labor and delivery. In the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor. Importantly, in this study many of the details about the course of these deliveries are not available. There are multiple other possible causes of autism that the study does not address.

Additionally, while the authors speculate about mechanisms (like maternal fever) that could explain a link between epidural pain relief and autism, none of these are plausible or confirmed in the analysis. Epidural analgesia involves administering small amounts of dilute local anesthetics and opioids into the mother’s epidural space.  Very low levels of these drugs are transferred to the infant, and there is no evidence that these very low levels of drug exposure cause any harm to an infant’s brain.

We urge women to continue to choose safe ways to relieve pain, including epidurals, for a positive childbirth experience.  Our organizations will continue to foster research and education in all aspects of childbirth care, including the safety of labor analgesia for mother and child.

About the Society for Obstetric Anesthesia and Perinatology
The Society for Obstetric Anesthesia and Perinatology is a non-profit educational, research and scientific medical organization founded in 1968, and is the largest association of obstetric anesthesiologists, obstetricians, and neonatologists, who work together to advance the health and wellbeing of pregnant women and their newborns.

About the American Society of Anesthesiologists
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 54,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

About the Society for Pediatric Anesthesia
The Society for Pediatric Anesthesia advances the safety and quality of anesthesia care, perioperative care, and pain management in children by educating clinicians, supporting research, and fostering collaboration among clinicians, patient families, and professional organizations worldwide.

About the American College of Obstetricians and Gynecologists
The American College of Obstetricians and Gynecologists (ACOG) is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 60,000 members, ACOG strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care.www.acog.org

About the Society for Maternal-Fetal Medicine
Established in 1977, the Society for Maternal-Fetal Medicine (SMFM) is a non-profit, membership organization based in Washington, DC. With more than 5,000 physicians, scientists and women's health professionals around the world, the Society supports the clinical practice of maternal-fetal medicine by providing education, promoting research, and engaging in advocacy to optimize the health of high-risk pregnant women and their babies.

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