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Abstract
Background The fetus is vulnerable to maternal drug exposure. We determined associations of exposure to spinal, epidural, or general anesthesia on neonatal and childhood development outcomes during the first 1000 days of life.
Methods Population-based study of all singleton, cesarean livebirths of 24+0 to 43+6 weeks gestation between January 2007 and December 2016 in Scotland, stratified by urgency with follow-up to age 2 years. Models were adjusted for: maternal age, weight, ethnicity, socioeconomic status, smoking, drug-use, induction, parity, previous cesarean or abortion, pre-eclampsia, gestation, birth weight, and sex.
Results 140 866 mothers underwent cesarean section (41.2% (57,971/140,866) elective, 58.8% (82,895/140,866) emergency) with general anesthesia used in 3.2% (1877/57,971) elective and 9.8% (8158/82,895) of emergency cases. In elective cases, general anesthesia versus spinal was associated with: neonatal resuscitation (crude event rate 16.2% vs 1.9% (adjusted RR 8.20, 95% CI 7.20 to 9.33), Apgar <7 at 5 min (4.6% vs 0.4% (adjRR 11.44, 95% CI 8.88 to 14.75)), and neonatal admission (8.6% vs 4.9% (adjRR 1.65, 95% CI 1.40 to 1.94)). Associations were similar in emergencies; resuscitation (32.2% vs 12.3% (adjRR 2.40, 95% CI 2.30 to 2.50)), Apgar <7 (12.6% vs 2.8% (adjRR 3.87, 95% CI 3.56 to 4.20), and admission (31.6% vs 19.9% (adjRR 1.20, 95% CI 1.15 to 1.25). There was a weak association between general anesthesia in emergency cases and having ≥1 concern noted in developmental assessment at 2 years (21.0% vs 16.5% (adjRR 1.08, 95% CI 1.01 to 1.16)).
Conclusions General anesthesia for cesarean section, irrespective of urgency, is associated with neonatal resuscitation, low Apgar, and neonatal unit admission. Associations were strongest in non-urgent cases and at term. Further evaluation of long-term outcomes is warranted.
- obstetrics
- regional anesthesia
- outcome assessment
- health care
Data availability statement
Data may be obtained from a third party and are not publicly available. The data analyzed during this work are not permitted to be made publicly available and will be archived and destroyed in line with eDRIS protocols. We can make available the code used in cleaning the data and deriving the variables on request to ensure reproducibility of the research. As we are not data custodians, we are not permitted to pass the data to third parties under the terms of the access agreement. Any applications to access the data would have to be submitted directly to the data custodian.
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Data availability statement
Data may be obtained from a third party and are not publicly available. The data analyzed during this work are not permitted to be made publicly available and will be archived and destroyed in line with eDRIS protocols. We can make available the code used in cleaning the data and deriving the variables on request to ensure reproducibility of the research. As we are not data custodians, we are not permitted to pass the data to third parties under the terms of the access agreement. Any applications to access the data would have to be submitted directly to the data custodian.
Footnotes
RJK and MS are joint first authors.
DAL and SMN are joint senior authors.
Twitter @rjharrison79
Contributors RJK, MS, SI and SNMN designed the study. RJK, PSG, MS, and SNMN wrote the analysis plan. SI facilitated data access. PSG, MS and RJK analyzed the data. RJK, SNMN and DL drafted the initial manuscript. All authors contributed to data interpretation, critical revision, and final approval of the submitted manuscript.
Funding The study was supported by the Obstetric Anaesthetists Association, Scottish Society of Anaesthetists and Chief Scientist’s Office (RK) and the Bristol NIHR Biomedical Research Centre (DAL & SMN). DAL works in an MRC Unit that is supported by the University of Bristol and Medical Research Council (MC_UU_00011/6) and she is a NIHR Senior Investigator (NF-0616-10102).
Disclaimer We plan to disseminate the results to patient organisations such as the James Lind Alliance to disseminate emerging findings with relevant couples and health care professionals. None of the funders influenced the study design, analyses or interpretation of results. Views expressed in this paper are those of the authors and not necessarily those of any funders.
Competing interests SNMN has participated in Advisory Boards and received consultancy or speakers’ fees from Access Fertility, Beckman Coulter, Ferring, Finox, Merck, MSD, Roche Diagnostics, and The Fertility Partnership. DL has received grant funding for other studies, not related to this one, from government, charity and industry funders, including Roche Diagnostics and Medtronic.
Provenance and peer review Not commissioned; externally peer reviewed.