A quarterly publication of the Autism Research Institute

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

Fall, 2020 | Number 4, Volume 34

Study suggests that epidurals may slightly increase ASD risk

Epidural analgesia given to women during vaginal delivery may slightly increase the risk of autism spectrum disorders (ASD) in their children, according to a new study. 

Chunyuan Qiu and colleagues examined data on 147,895 children delivered vaginally either with or without epidural analgesia. The researchers found that 1.9% of the children exposed to epidural analgesia were diagnosed with ASD, compared to 1.3% of unexposed children. The increase in risk remained significant when the researchers controlled for other variables, and it rose with the number of hours of exposure. While women who receive epidural analgesia during long labors have an elevated incidence of fever, controlling for fever did not change the results of the study. 

The researchers conclude, “This study suggests that exposure to epidural analgesia for vaginal delivery may be associated with increased risk of autism in children,” adding that additional research is needed to confirm their findings and determine possible mechanisms. 

However, several organizations representing anesthesiologists and obstetricians have criticized the study, saying 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.” They argue that “if anything, epidurals improve maternal and neonatal outcomes,” stating that “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.” 


“Association between epidural analgesia during labor and risk of autism spectrum disorders in offspring,” Chunyuan Qiu, Jane C. Lin, Jiaxiao M. Shi, Ting Chow, Vimal N. Desai, Vu T. Nguyen, Robert J. Riewerts, R. Klara Feldman, Scott Segal, and Anny H. Xiang, JAMA Pediatrics, October 12, 2020 (online). Address: Anny H. Xiang, Department of Research and Evaluation, Kaiser Permanente Southern California, 100 South Los Robles Avenue, Pasadena, CA 91101, [email protected]