Joint Statement of the Society for Obstetric Anesthesia and Perinatology, American Society of Anesthesiologists, Society for Pediatric Anesthesia, American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine
The Society for Obstetric Anesthesia and Perinatology (SOAP), the American Society of Anesthesiologists (ASA), the Society for Pediatric Anesthesia (SPA), the American College of Obstetricians and Gynecologists (ACOG), and the Society for Maternal-Fetal Medicine (SMFM) aim to clearly reassure pregnant women that the article “Association Between Epidural Analgesia During Labor and Risk of Autism Spectrum Disorders in Offspring,” a new retrospective database study published in JAMA Pediatrics on October 12th, 2020 does not provide credible scientific evidence that labor epidurals for pain relief cause autism.
SOAP, ASA, SPA, ACOG, and SMFM recognize the potential for this article to create anxiety among pregnant women who face a decision of whether or not to receive an epidural for childbirth. While this concern is certainly understandable, these five medical societies that represent more than 100,000 physicians want to assure the public 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. In the scientific literature, the finding of an association between a treatment and an outcome does not prove the treatment caused the outcome.
"Neuraxial analgesia is the gold standard for labor pain relief,” said Ruth Landau, Virginia Apgar Professor of Anesthesiology and president of SOAP, “We should not stop providing labor epidurals, and if anything, epidurals improve maternal and neonatal outcomes."
Millions of women worldwide benefit from epidural pain relief every year and give birth without any complications to mother or baby. There are many medical indications for analgesia and anesthesia during labor and delivery. In the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor. Importantly, in this study many of the details about the course of these deliveries are not available. There are multiple other possible causes of autism that the study does not address.
Additionally, while the authors speculate about mechanisms (like maternal fever) that could explain a link between epidural pain relief and autism, none of these are plausible or confirmed in the analysis. Epidural analgesia involves administering small amounts of dilute local anesthetics and opioids into the mother’s epidural space. 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.
We urge women to continue to choose safe ways to relieve pain, including epidurals, for a positive childbirth experience. Our organizations will continue to foster research and education in all aspects of childbirth care, including the safety of labor analgesia for mother and child.