The Relationship Between Use of Maternal Anesthesia during Delivery and Child Development at 12 Months in the Enriched Risk EARLI Pregnancy Cohort

Friday, May 13, 2016: 5:30 PM-7:00 PM
Hall A (Baltimore Convention Center)
S. C. Brown1, M. D. Fallin2, C. J. Newschaffer3, L. A. Croen4, M. Stacy5, M. Landrum6, C. Walker7, M. L. Massolo4, R. Landa8, J. Feinberg9, K. M. Bakulski6, I. Hertz-Picciotto10, D. M. Caruso11, X. Hong12 and X. Wang13, (1)Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, (2)Wendy Klag Center for Autism and Developmental Disabilities, JHBSPH, Baltimore, MD, (3)A.J. Drexel Autism Institute, Philadelphia, PA, (4)Division of Research, Kaiser Permanente, Oakland, CA, (5)Southern Illinois University- Carbondale, Carbondale, IL, (6)Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (7)MIND Institute, University of California, Davis, Sacramento, CA, (8)The Kennedy Krieger Institute, Baltimore, MD, (9)Johns Hopkins University, Baltimore, MD, (10)Dept of Public Health Sciences, School of Medicine, UC Davis MIND Institute, Davis, CA, (11)Center on the Early Life Origins of Disease, Department of Population, Family, Reproductive Health, JHBSPH, Baltimore, MD, (12)Johns Hopkins University School of Public Health, Baltimore, MD, (13)Center on Early Life Origins of Disease, Department of Population, Family, Reproductive Health, JHBSPH, Baltimore, MD
Background: Many pre- and perinatal risk factors have been reported to increase the risk of ASD, including obstetric complications, antidepressant and anti-seizure medications, maternal infection, and pre-pregnancy BMI.  The rate of maternal anesthesia use has tripled over the past 35 years and it is estimated that approximately 60% of US women receive some form of anesthesia during labor.  Many of the anesthetics have been shown to move rapidly through the placenta, but research on the effects has focused mainly on short term outcomes.  

Objectives: To evaluate the relationship between maternal anesthesia use during delivery and child development at 12 months based on the AOSI (Autism Observation Scale for Infants), in an ASD high-risk pregnancy cohort.  To also evaluate the relationship between the specific types and doses of anesthetics used during delivery and child development and ASD diagnosis in an urban medical system. 

Methods: Data are from the Early Autism Risk Longitudinal Investigation (EARLI) study and the Boston Birth Cohort (BBC).  EARLI is an ASD high-risk pregnancy cohort that follows mothers of children with ASD from the start of a subsequent pregnancy through age 3 of the child.  Available data include self-reported maternal medical, dietary, and health behaviors histories; labor and delivery; biological samples; and autism and other behavioral assessments.  The AOSI is a play-based observational evaluation for children aged 6-18 months that has been correlated with later diagnosis of ASD.  Of 259 live births in the EARLI cohort, 176 had both maternal labor and delivery records and AOSI scores available.  The association between maternal use of anesthesia (all, epidural, spinal) and AOSI score parameterized as continuous and dichotomous (total AOSI>7) outcomes was estimated using multiple linear and logistic regression, respectively, while adjusting for potential confounders.  The BBC is a prospective birth cohort of approximately 8,500 mother infant pairs.  Available data include labor and delivery records, hospital and medical records.  At this time there are approximately 107 children in the BBC with an ICD9 code indicating ASD.  As a replication, BBC data will be analyzed to evaluate the relationship between specific anesthetics and the doses used during delivery and an ASD diagnosis.

Results: Twelve month AOSI score was significantly associated with the use of epidural (β = 2.3., p =0.005) and spinal (β = 2.6., p =0.002) anesthesia in the EARLI cohort with adjustment for gender, gestational age and father’s ethnicity.  After adjusting for cesarean delivery only epidural anesthesia (β = 2.5., p =0.002) was significantly associated with AOSI score.  Similar results were seen whether AOSI was parameterized as dichotomous (top quartile) or continuous.  No significant associations were found with AOSI score and other labor and delivery or maternal medical history risk factors examined.  Replication analyses in the BBC sample are underway.

Conclusions: The use of maternal epidural anesthesia during delivery was associated with an increase in the 12 month AOSI score in 176 children in the EARLI cohort.  BBC data will be analyzed to assess the drug and dose specific relationships between maternal anesthesia and a diagnosis of ASD.

See more of: Epidemiology
See more of: Epidemiology