Anesthesia for cesarean delivery and learning disabilities in a population-based birth cohort

Juraj Sprung, Randall Flick, Robert T. Wilder, Slavica K Katusic, Tasha L. Pike, Mariella Dingli, Stephen J. Gleich, Darrell R. Schroeder, William J. Barbaresi, Andrew C. Hanson, David Oman Warner

Research output: Contribution to journalArticle

138 Citations (Scopus)

Abstract

BACKGROUND: Anesthetics administered to immature brains may cause histopathological changes and long-term behavioral abnormalities. The association between perinatal exposure to anesthetics during Cesarean delivery (CD) and development of learning disabilities (LD) was determined in a population-based birth cohort. METHODS: The educational and medical records of all children born to mothers residing in five townships of Olmsted County, Minnesota from 1976-1982 and remaining in the community at age 5 were reviewed to identify those with LDs. Cox proportional hazards regression was used to compare rates of LD between children delivered vaginally and via CD (with general or regional anesthesia). RESULTS: Of the 5,320 children in this cohort, 497 were delivered via CD (under general anesthesia n = 193, and regional anesthesia n = 304). The incidence of LD depended on mode of delivery (P = 0.050, adjusted for sex, birth weight, gestational age, exposure to anesthesia before age 4 yr, and maternal education). LD risk was similar in children delivered by vagina or CD with general anesthesia, but was reduced in children receiving CD with regional anesthesia (hazard ratio = 0.64, 95% confidence interval 0.44 to 0.92; P = 0.017 for comparison of CD under regional anesthesia compared to vaginal delivery). CONCLUSION: Children exposed to general or regional anesthesia during CD are not more likely to develop LD compared to children delivered vaginally, suggesting that brief perinatal exposure to anesthetic drugs does not adversely affect long-term neurodevelopmental outcomes. The risk of LD may be lower in children delivered by CD whose mothers received regional anesthesia.

Original languageEnglish (US)
Pages (from-to)302-310
Number of pages9
JournalAnesthesiology
Volume111
Issue number2
DOIs
StatePublished - Aug 2009

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Learning Disorders
Conduction Anesthesia
Anesthesia
Parturition
General Anesthesia
Population
Anesthetics
Mothers
Vagina
Birth Weight
Gestational Age
Medical Records
Confidence Intervals
Education
Incidence
Brain

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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Anesthesia for cesarean delivery and learning disabilities in a population-based birth cohort. / Sprung, Juraj; Flick, Randall; Wilder, Robert T.; Katusic, Slavica K; Pike, Tasha L.; Dingli, Mariella; Gleich, Stephen J.; Schroeder, Darrell R.; Barbaresi, William J.; Hanson, Andrew C.; Warner, David Oman.

In: Anesthesiology, Vol. 111, No. 2, 08.2009, p. 302-310.

Research output: Contribution to journalArticle

Sprung, J, Flick, R, Wilder, RT, Katusic, SK, Pike, TL, Dingli, M, Gleich, SJ, Schroeder, DR, Barbaresi, WJ, Hanson, AC & Warner, DO 2009, 'Anesthesia for cesarean delivery and learning disabilities in a population-based birth cohort', Anesthesiology, vol. 111, no. 2, pp. 302-310. https://doi.org/10.1097/ALN.0b013e3181adf481
Sprung, Juraj ; Flick, Randall ; Wilder, Robert T. ; Katusic, Slavica K ; Pike, Tasha L. ; Dingli, Mariella ; Gleich, Stephen J. ; Schroeder, Darrell R. ; Barbaresi, William J. ; Hanson, Andrew C. ; Warner, David Oman. / Anesthesia for cesarean delivery and learning disabilities in a population-based birth cohort. In: Anesthesiology. 2009 ; Vol. 111, No. 2. pp. 302-310.
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AU - Dingli, Mariella

AU - Gleich, Stephen J.

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N2 - BACKGROUND: Anesthetics administered to immature brains may cause histopathological changes and long-term behavioral abnormalities. The association between perinatal exposure to anesthetics during Cesarean delivery (CD) and development of learning disabilities (LD) was determined in a population-based birth cohort. METHODS: The educational and medical records of all children born to mothers residing in five townships of Olmsted County, Minnesota from 1976-1982 and remaining in the community at age 5 were reviewed to identify those with LDs. Cox proportional hazards regression was used to compare rates of LD between children delivered vaginally and via CD (with general or regional anesthesia). RESULTS: Of the 5,320 children in this cohort, 497 were delivered via CD (under general anesthesia n = 193, and regional anesthesia n = 304). The incidence of LD depended on mode of delivery (P = 0.050, adjusted for sex, birth weight, gestational age, exposure to anesthesia before age 4 yr, and maternal education). LD risk was similar in children delivered by vagina or CD with general anesthesia, but was reduced in children receiving CD with regional anesthesia (hazard ratio = 0.64, 95% confidence interval 0.44 to 0.92; P = 0.017 for comparison of CD under regional anesthesia compared to vaginal delivery). CONCLUSION: Children exposed to general or regional anesthesia during CD are not more likely to develop LD compared to children delivered vaginally, suggesting that brief perinatal exposure to anesthetic drugs does not adversely affect long-term neurodevelopmental outcomes. The risk of LD may be lower in children delivered by CD whose mothers received regional anesthesia.

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