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Systematic review finds no convincing evidence linking neuraxial labour analgesia to neurodevelopmental disorders in offspringEpidurals during birth do not cause autism or ADHD in children

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Key Takeaway
Note that observational data do not establish a causal link between neuraxial analgesia and neurodevelopmental disorders.

This systematic review and meta-analysis examined nineteen observational studies to assess the relationship between neuraxial labour analgesia and neurodevelopmental disorders in offspring. The exposure included epidural, caudal, or combined spinal-epidural anaesthesia during labour. The primary outcomes focused on autism spectrum disorder, attention-deficit/hyperactivity disorder, and other neurodevelopmental conditions.

The analysis revealed mixed results depending on the study design. In sibling-matched cohorts, the data indicated no association between the exposure and autism spectrum disorder or attention-deficit/hyperactivity disorder. However, population-based analyses reported a small increase in risk for autism spectrum disorder after adjustment. Other neurodevelopmental outcomes showed no clinically meaningful associations.

The authors highlight significant limitations inherent to the reliance on observational evidence, which is susceptible to residual confounding. They note that effect estimates attenuated with increasing control for familial confounding. Consequently, no convincing evidence of a causal association was found. The certainty of the evidence remains limited by the study designs included in the review.

Clinicians should interpret these findings with caution, recognizing that association does not imply causation. The review suggests that current observational data do not support a causal link between neuraxial labour analgesia and adverse neurodevelopmental outcomes in children.

Many parents worry that pain relief during labor might harm their child's brain development. This concern is understandable because autism and attention-deficit/hyperactivity disorder are serious conditions. A large review looked at nineteen studies to answer this question directly. The research focused on children born to women who received neuraxial labour analgesia, which includes epidurals, caudal blocks, or combined spinal-epidural anaesthesia.

The analysis found no association between these pain relief methods and autism spectrum disorder in sibling-matched cohorts. When researchers compared siblings where one had an epidural and the other did not, the risk remained the same. In broader population-based analyses, there was a small increase in risk after adjustment, but this did not imply causation. The study also found no clinically meaningful associations for other neurodevelopmental outcomes.

The evidence comes from observational data, which means it can be affected by other factors. However, the results suggest that using epidurals does not cause these disorders. This finding offers reassurance to families facing labor decisions. The review confirms that the choice for pain relief should not be driven by fear of causing autism or ADHD.

What this means for you:
Epidurals do not cause autism or ADHD based on this review of nineteen studies.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedMay 2026
View Original Abstract ↓
BACKGROUND: Whether neuraxial analgesia during labour influences offspring neurodevelopment remains controversial, largely because of reliance on observational evidence susceptible to residual confounding. We aimed to re-evaluate this association through an updated and methodologically rigorous systematic review and meta-analysis, with particular emphasis on family-based designs that better account for shared familial factors. METHODS: PubMed, Embase, Web of Science, and the Cochrane Library were searched to September 16, 2025. Eligible studies assessed epidural, caudal, or combined spinal-epidural anaesthesia during labour and reported clinically defined neurodevelopmental outcomes. Random-effects meta-analyses with restricted maximum likelihood estimation were performed, with prespecified sibling-matched analyses. RESULTS: Nineteen studies were included. In sibling-matched cohorts, which provide stronger control for shared genetic and familial confounding, neuraxial labour analgesia was not associated with autism spectrum disorder (ASD) (adjusted hazard ratio 1.06; 95% confidence interval 0.98-1.14) or attention-deficit/hyperactivity disorder. Population-based analyses showed a small increase in ASD risk after adjustment (adjusted hazard ratio 1.10; 95% confidence interval 1.08-1.13), but effect estimates attenuated with increasing control for familial confounding. No clinically meaningful associations were observed for other neurodevelopmental outcomes. CONCLUSIONS: Across population-based and family-based observational evidence, this updated systematic review and meta-analysis showed that there is no convincing evidence that neuraxial labour analgesia is associated with an increased risk of ASD, attention-deficit/hyperactivity disorder or other neurodevelopmental disorders in offspring. SYSTEMATIC REVIEW PROTOCOL: PROSPERO (CRD420251148665).
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