Epidural Anesthesia, Intrapartum Use of Synthetic Oxytocin and the Odds of Autistic Disorder

BACKGROUND: Epidural anesthesia (LEA) can block the Ferguson reflex, which stimulates the release of maternal oxytocin during labor. LEA may increase the need for synthetic oxytocin (sOT) to augment labor. Recent research has demonstrated an association between a elevated odds of autism spectrum disorder (ASD) and higher doses and durations of sOT. AIMS: To examine the associations between the duration of LEA, sOT dosing, the duration of sOT exposure, and a diagnosis of ASD. METHODS: Delivery data from 115 adolescents with ASD were compared to a reference population of 114 adolescents without ASD. The key variables examined were epidural duration (h), the cumulative dose of sOT (milliUnits), and sOT exposure duration (h). RESULTS: The mothers of children with ASD had significantly longer exposure to sOT and LEA with significantly higher cumulative sOT dosage than those in the non-ASD group. Mothers in the ASD group received sOT for a longer time period prior to LEA administration than those in the non-ASD group. This suggests that factors other than LEA impacted sOT usage. Mothers in the ASD group had significantly higher body mass indices, which are associated with the need for higher intrapartum sOT dosing. CONCLUSIONS: Any association between LEA and ASD could be due to other variables affecting sOT use, leading to longer durations of both sOT and LEA use, rather than a direct impact of LEA on SOT use. Future studies examining the association between anesthesia or sOT dosing and ASD must include quantitative data on sOT and LEA dosing and exposure duration.