The impact of neuraxial labour analgesia on neurodevelopmental disorders in offspring: a systematic review and meta-analysis.

Abstract

Whether neuraxial analgesia during labour influences offspring neurodevelopment remains controversial, largely because of reliance on observational evidence susceptible to residual confounding. We aimed to re-evaluate this association through an updated and methodologically rigorous systematic review and meta-analysis, with particular emphasis on family-based designs that better account for shared familial factors. PubMed, Embase, Web of Science, and the Cochrane Library were searched to September 16, 2025. Eligible studies assessed epidural, caudal, or combined spinal-epidural anaesthesia during labour and reported clinically defined neurodevelopmental outcomes. Random-effects meta-analyses with restricted maximum likelihood estimation were performed, with prespecified sibling-matched analyses. Nineteen studies were included. In sibling-matched cohorts, which provide stronger control for shared genetic and familial confounding, neuraxial labour analgesia was not associated with autism spectrum disorder (ASD) (adjusted hazard ratio 1.06; 95% confidence interval 0.98-1.14) or attention-deficit/hyperactivity disorder. Population-based analyses showed a small increase in ASD risk after adjustment (adjusted hazard ratio 1.10; 95% confidence interval 1.08-1.13), but effect estimates attenuated with increasing control for familial confounding. No clinically meaningful associations were observed for other neurodevelopmental outcomes. Across population-based and family-based observational evidence, this updated systematic review and meta-analysis showed that there is no convincing evidence that neuraxial labour analgesia is associated with an increased risk of ASD, attention-deficit/hyperactivity disorder or other neurodevelopmental disorders in offspring. PROSPERO (CRD420251148665).