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April 19, 2021

Epidural Analgesia and Autism Spectrum Disorder Risk—The Challenges Inherent in Complex Observational Research

Author Affiliations
  • 1Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
  • 2Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
  • 3School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
JAMA Pediatr. Published online April 19, 2021. doi:10.1001/jamapediatrics.2021.0382

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by a cluster of social and communication impairments and repetitive and restrictive behaviors across a spectrum of severity that appears to arise from disordered brain development early in gestation.1 With an increase in prevalence in ASD from 1 in 150 in 2000 to 1 in 54 children in 2016, considerable2 attention has focused on a search for modifiable exposure-related risk factors. A recent population-based study by Qiu et al3 reported a 37% increased risk for a diagnosis of ASD in children of mothers receiving epidural labor analgesia (ELA) for labor and delivery. Given that ELA is widely accepted as a standard for labor analgesia, these findings led to widespread public4 and scientific5concern. It thus comes with some relief that Wall-Wieler et al6 found no association when controlling for key maternal sociodemographic and perinatal factors. But does the finding of the absence of evidence put this issue to rest?

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