A quarterly publication of the Autism Research Institute

The Autism Research Review International is quarterly publication of the Autism Research Institute

Spring, 2021 | Number 2, Volume 35

New study: Epidural anesthesia during labor not linked to ASD

Exposure to epidural anesthesia during delivery does not increase a child’s risk for developing autism spectrum disorder (ASD), according to a new, large-scale study. 

In earlier research (see ARRI 2020, Volume 4), Chunyuan Qiu and colleagues examined data on 147,895 children delivered vaginally either with or without epidural labor analgesia (ELA). The researchers found that 1.9% of the children exposed to ELA were diagnosed with ASD, compared to 1.3% of unexposed children. They concluded, “This study suggests that exposure to epidural analgesia for vaginal delivery may be associated with increased risk of autism in children.” 

The new study, by Elizabeth WallWieler and colleagues, included 123,175 children born between 2005 and 2016 and followed until 2019. All of the children in the study were born via vaginal delivery and were single births. The researchers identified all children at least 18 months of age with at least one inpatient or outpatient diagnosis of ASD. 

Overall, 38.2% of the children were exposed to ELA. Of the children exposed to epidurals during labor, 2.1% later received a diagnosis of ASD, compared with 1.7% of children not exposed to epidurals. However, this study controlled for a far greater number of factors than the previous study, and the researchers note, “There were substantial differences in maternal sociodemographic, preexisting, pregnancy-related, and birthspecific covariates between births who were exposed vs nonexposed to ELA.” When the researchers controlled for these factors, senior study author Alexander Butwick says, “We did not find evidence for any genuine link between having an epidural and putting your baby at increased risk of autism spectrum disorder.” 

Examining sibling pairs, the researchers found that the ASD risk in exposed children was slightly higher than in unexposed children. Again, however, when the researchers controlled for sociodemographic, pre-pregnancy, and perinatal factors, they found no association between ASD and epidural exposure. 

They conclude, “Results of this population-based cohort study, including an analysis of exposure-discordant siblings, found no association between ELA and offspring risk of ASD.”


“Association of epidural labor analgesia with offspring risk of autism spectrum disorders,” Elizabeth Wall-Wieler, Brian Bateman, Ana Hanlon-Dearman, Leslie Roos, and Alexander Butwick, JAMA Pediatrics, April 19, 2021 (free online). Address: Elizabeth WallWieler, Department of Community Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, MB R3E 3P5, Canada, [email protected]


“Epidural use at birth not linked to autism risk, study finds,” news release, Stanford University Medical Center, April 19, 2021.