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