Lack of evidence that epidural pain relief during labour causes autism spectrum disorder: a position statement of the Ca
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POSITION STATEMENT
Lack of evidence that epidural pain relief during labour causes autism spectrum disorder: a position statement of the Canadian Anesthesiologists’ Society Absence de preuve voulant que le recours a` la pe´ridurale pour soulager la douleur durant le travail cause le trouble du spectre de l’autisme . Valerie Zaphiratos, MD, MSc, FRCPC on Dolores M. McKeen, MD, MSc, FRCPC behalf of the Canadian Anesthesiologists’ Society Received: 17 October 2020 / Accepted: 21 October 2020 Ó Canadian Anesthesiologists’ Society 2020
Annually, millions of women worldwide give birth and benefit from epidural labour pain relief without complications. In Canada, over 360 000 women gave birth and over 60% received epidural labour pain relief in 2018-19.1 The Canadian Anesthesiologists’ Society (CAS) representing over 2,500 anesthesiologists, along with the CAS Obstetric Section, the Canadian Pediatric Anesthesia Society (CPAS), a sub-section of CAS, the Society for Obstetrics and Gynecology of Canada (SOGC), and the Canadian Paediatric Society (CPS) raise concerns with the findings of the study ‘‘Association Between Epidural Analgesia During Labor and Risk of Autism Spectrum Disorders in Offspring,’’ published on October 12th in JAMA Pediatrics.2 Those authors present a retrospective longitudinal database study of 147,895 children in a single American health system and conclude that there is an association between epidural pain relief in women delivering vaginally and subsequent autism spectrum disorder in their children. However, the true relationship between epidural pain relief and autism spectrum disorder has not been ascertained due to multiple methodological limitations in the study.
D. M. McKeen, MD, MSc, FRCPC (&) IWK Women’s & Obstetric Department of Anesthesia, Dalhousie University, Halifax, NS, Canada e-mail: [email protected] V. Zaphiratos, MD, MSc, FRCPC University of Montreal, Montreal, QC, Canada
The two study groups, women who received epidural pain relief and those who did not, were different in many ways and did not have the same health issues, socioeconomic status, or child characteristics. In addition, the details on pregnancy and delivery complications of these women, as well as other possible causes for autism, were not addressed in the article. No information is provided regarding the type and dose of the epidural medication administered. This article suggests potential danger associated with epidural analgesia without providing causal evidence. This could lead to potential harm and unnecessary guilt among pregnant women if they decide to opt for epidural pain relief, or in those whom epidural placement may be medically indicated to ensure the safety of both mother and baby. The CAS, SOGC, and CPS reassure women, families, and health care providers that an association between labour epidural pain relief and autism spectrum disorder does not imply causation. Only randomized-controlled trials and their meta-analyses can confidently determine causation. Epidural labour analgesia is the
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