Association of labour epidural analgesia exposure with infant neurodevelopment: secondary analysis of a prospective cohort study.

Abstract

Evidence regarding the safety of labour epidural analgesia for infant neurodevelopment remains scarce. We conducted a secondary analysis of the Jiangsu Birth Cohort (JBC) to assess the association between labour epidural analgesia exposure and infant neurodevelopment across five domains: cognition, receptive communication, expressive communication, fine motor, and gross motor. This secondary analysis included singleton vaginal births from data prospectively collected between 1 November 2017 and 1 October 2022. At 1 yr of age, trained paediatricians assessed infant neurodevelopment using the Bayley Scales of Infant and Toddler Development Screening Test, Third Edition (Bayley-III Screening Test). Infants with raw scores below domain-specific thresholds were classified as 'emerging or at risk'. Associations between maternally self-selected labour epidural analgesia exposure and infant neurodevelopment were analysed using generalised linear models adjusted for confounders. Among 1811 mother-infant dyads, 1224 (67.6%) received labour epidural analgesia. Labour epidural analgesia exposure was not associated with classification as emerging or at risk in any domain (cognition: adjusted risk ratio [aRR] 1.24; 95% confidence interval [CI] 0.89-1.74, P=0.205; receptive communication: aRR 0.78; 95% CI 0.58-1.04, P=0.095; expressive communication: aRR 1.03; 95% CI 0.59-1.81, P=0.904; fine motor: aRR 0.75; 95% CI 0.38-1.50, P=0.417; gross motor: aRR 0.89; 95% CI 0.57-1.38, P=0.594). The duration of labour epidural analgesia was also not associated with neurodevelopmental outcomes. Our findings do not support an association between labour epidural analgesia exposure and increased neurodevelopmental risk at 1 yr of age. These results provide valuable insights, although the CIs and risk ratios underscore the need for larger studies with careful interpretation of clinical significance.