Maternal, fetal and long-term neurodevelopmental outcomes after labor epidural analgesia: a narrative review

Abstract

Labor pain is among the most intense pain a woman may endure in her lifetime. Without analgesia, labor pain could result in intense maternal emotional distress, postpartum depression and fetal distress. In the European countries and United States of America, up to 83% of pregnant women receive labor epidural analgesia (LEA) for delivery, which is considered effective and safe for both mother and fetus. The aim of this narrative review is to summarize maternal outcomes, pregnancy outcomes, neonatal outcomes and long-term neurodevelopmental outcomes after labor epidural analgesia. LEA reduces the risk for severe maternal morbidity (e.g. heart failure) in women with a medical indication (e.g., cardiovascular disease) for LEA and in preterm delivery. Modern LEA using low concentrations of local anesthetics does not result in a clinically relevant prolongation of labor, it does not increase the risk for instrumental vaginal delivery or cesarean sections. LEA does neither affect APGAR scores, nor acid-base status. There is ongoing debate whether LEA impacts neurodevelopmental outcomes such as autism spectrum disorder (ASD), but this association may be explained by unmeasured confounders. No significant association was found between LEA and other long-term neurodevelopmental outcomes (e.g., Attention-Deficit Hyperactivity Disorder), but this has been investigated by only a limited number of studies. There is need for high quality studies investigating long-term neurodevelopmental outcomes after LEA.