A quarterly publication of the Autism Research Institute

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

Fall, 2021 | Number 4, Volume 35

Two new studies suggest no significant association between epidural anesthesia and ASD

Two new studies indicate that there is no significant association between the use of epidural anesthesia during delivery and the odds of a child developing an autism spectrum disorder (ASD). 

The studies, along with a previous one by Elizabeth Wall-Wieler in 2021 (see ARRI 2021, No. 2), reached conclusions that differed from a 2020 study by Chunyuan Qiu and colleagues (see ARRI 2020, No. 4). In the 2020 study, researchers found that epidural analgesia given to women during vaginal delivery may increase the risk of autism spectrum disorders (ASD) in their children. 

One of the new studies, by Gillian Hanley and colleagues, examined data on 388,254 children born in British Columbia. The researchers detected a small association between epidurals and autism, with 1.53% of epidural-exposed children and 1.26% of unexposed children receiving a later ASD diagnosis. However, further analyses cast doubt on this association. For instance, when the researchers analyzed data from women who had multiple children, including at least one child with ASD and one without, they found that these women were no more likely to have had an epidural when giving birth to the child with ASD than they were when giving birth to a child without it. 

The second new study, by Anders Pretzmann Mikkelsen and colleagues, analyzed data from 479,178 children in Denmark. In this study, which controlled for a family history of autism and for a maternal history of psychiatric disorders, the researchers found an incidence rate of 23.1 cases of autism per 10,000 person-years in the epidural-exposed group, compared to 18.5 per 10,000 person-years in the unexposed group. This, they say, indicates that “maternal exposure to epidural analgesia during labor was not significantly associated with autism spectrum disorder in offspring.” 

In the earlier study in April 2021, WallWieler and colleagues found that 2.1% of children exposed to epidurals later received a diagnosis of ASD, compared with 1.7% of children not exposed to epidurals. However, when the researchers controlled for a wide variety of variables, they no longer detected an association between ASD and epidural exposure.


“Association of epidural analgesia during labor and delivery with autism spectrum disorder in offspring,” Gillian E. Hanley, Celeste Bickford, Angie Ip, Nancy Lanphear, Bruce Lanphear, Whitney Weikum, Lonnie Zwaigenbaum, and Tim F. Oberlander, Journal of the American Medical Association, September 28, 2021 (online). Address: Gillian Hanley, [email protected]


“Association of labor epidural analgesia with autism spectrum disorder in children,” Anders Pretzmann Mikkelsen, Iben Katinka Greiber, Nikolai Madrid Scheller, and Øjvind Lidegaard, Journal of the American Medical Association, September 28, 2021 (online). Address: Anders Pretzmann Mikkelsen, Department of Gynaecology and Obstetrics, Juliane Marie Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark, [email protected]


“No link between epidurals and autism, two studies confirm,” Laura Dattaro, Spectrum News, September 28, 2021. 


“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]


“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].