Neuraxial labor analgesia for vaginal delivery and its effects on childhood learning disabilities

Randall Flick, Kunmoo Lee, Ryan E. Hofer, Charles W. Beinborn, Ellen M. Hambel, Melissa K. Klein, Paul W. Gunn, Robert T. Wilder, Slavica K Katusic, Darrell R. Schroeder, David Oman Warner, Juraj Sprung

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

BACKGROUND: In prior work, children born to mothers who received neuraxial anesthesia for cesarean delivery had a lower incidence of subsequent learning disabilities compared with vaginal delivery. The authors speculated that neuraxial anesthesia may reduce stress responses to delivery, which could affect subsequent neurodevelopmental outcomes. To further explore this possibility, we examined the association between the use of neuraxial labor analgesia and development of childhood learning disabilities in a population-based birth cohort of children delivered vaginally. METHODS: The educational and medical records of all children born to mothers residing in the area of 5 townships of Olmsted County, Minnesota from 1976 to 1982 and remaining in the community at age 5 years were reviewed to identify those with learning disabilities. Cox proportional hazards regression was used to compare the incidence of learning disabilities between children delivered vaginally with and without neuraxial labor analgesia, including analyses adjusted for factors of either potential clinical relevance or that differed between the 2 groups in univariate analysis. RESULTS: Of the study cohort, 4684 mothers delivered children vaginally, with 1495 receiving neuraxial labor analgesia. The presence of childhood learning disabilities in the cohort was not associated with use of labor neuraxial analgesia (adjusted hazard ratio, 1.05; 95%confidence interval, 0.85-1.31; P = 0.63). CONCLUSION: The use of neuraxial analgesia during labor and vaginal delivery was not independently associated with learning disabilities diagnosed before age 19 years. Future studies are needed to evaluate potential mechanisms of the previous finding indicating that the incidence of learning disabilities is lower in children born to mothers via cesarean delivery under neuraxial anesthesia compared with vaginal delivery.

Original languageEnglish (US)
Pages (from-to)1424-1431
Number of pages8
JournalAnesthesia and Analgesia
Volume112
Issue number6
DOIs
StatePublished - Jun 2011

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Learning Disorders
Analgesia
Mothers
Anesthesia
Incidence
Statistical Factor Analysis
Medical Records
Cohort Studies
Parturition
Confidence Intervals
Population

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Flick, R., Lee, K., Hofer, R. E., Beinborn, C. W., Hambel, E. M., Klein, M. K., ... Sprung, J. (2011). Neuraxial labor analgesia for vaginal delivery and its effects on childhood learning disabilities. Anesthesia and Analgesia, 112(6), 1424-1431. https://doi.org/10.1213/ANE.0b013e3181f2ecdd

Neuraxial labor analgesia for vaginal delivery and its effects on childhood learning disabilities. / Flick, Randall; Lee, Kunmoo; Hofer, Ryan E.; Beinborn, Charles W.; Hambel, Ellen M.; Klein, Melissa K.; Gunn, Paul W.; Wilder, Robert T.; Katusic, Slavica K; Schroeder, Darrell R.; Warner, David Oman; Sprung, Juraj.

In: Anesthesia and Analgesia, Vol. 112, No. 6, 06.2011, p. 1424-1431.

Research output: Contribution to journalArticle

Flick, R, Lee, K, Hofer, RE, Beinborn, CW, Hambel, EM, Klein, MK, Gunn, PW, Wilder, RT, Katusic, SK, Schroeder, DR, Warner, DO & Sprung, J 2011, 'Neuraxial labor analgesia for vaginal delivery and its effects on childhood learning disabilities', Anesthesia and Analgesia, vol. 112, no. 6, pp. 1424-1431. https://doi.org/10.1213/ANE.0b013e3181f2ecdd
Flick, Randall ; Lee, Kunmoo ; Hofer, Ryan E. ; Beinborn, Charles W. ; Hambel, Ellen M. ; Klein, Melissa K. ; Gunn, Paul W. ; Wilder, Robert T. ; Katusic, Slavica K ; Schroeder, Darrell R. ; Warner, David Oman ; Sprung, Juraj. / Neuraxial labor analgesia for vaginal delivery and its effects on childhood learning disabilities. In: Anesthesia and Analgesia. 2011 ; Vol. 112, No. 6. pp. 1424-1431.
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abstract = "BACKGROUND: In prior work, children born to mothers who received neuraxial anesthesia for cesarean delivery had a lower incidence of subsequent learning disabilities compared with vaginal delivery. The authors speculated that neuraxial anesthesia may reduce stress responses to delivery, which could affect subsequent neurodevelopmental outcomes. To further explore this possibility, we examined the association between the use of neuraxial labor analgesia and development of childhood learning disabilities in a population-based birth cohort of children delivered vaginally. METHODS: The educational and medical records of all children born to mothers residing in the area of 5 townships of Olmsted County, Minnesota from 1976 to 1982 and remaining in the community at age 5 years were reviewed to identify those with learning disabilities. Cox proportional hazards regression was used to compare the incidence of learning disabilities between children delivered vaginally with and without neuraxial labor analgesia, including analyses adjusted for factors of either potential clinical relevance or that differed between the 2 groups in univariate analysis. RESULTS: Of the study cohort, 4684 mothers delivered children vaginally, with 1495 receiving neuraxial labor analgesia. The presence of childhood learning disabilities in the cohort was not associated with use of labor neuraxial analgesia (adjusted hazard ratio, 1.05; 95{\%}confidence interval, 0.85-1.31; P = 0.63). CONCLUSION: The use of neuraxial analgesia during labor and vaginal delivery was not independently associated with learning disabilities diagnosed before age 19 years. Future studies are needed to evaluate potential mechanisms of the previous finding indicating that the incidence of learning disabilities is lower in children born to mothers via cesarean delivery under neuraxial anesthesia compared with vaginal delivery.",
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AU - Klein, Melissa K.

AU - Gunn, Paul W.

AU - Wilder, Robert T.

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AU - Schroeder, Darrell R.

AU - Warner, David Oman

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