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A retrospective cohort assessment of the association between the use of nitrous oxide during labor and delivery and neonatal outcomes
Abstract Number: F1B-3
Abstract Type: Original Research
Background: Nitrous oxide (N2O) as an option for analgesia in labor is perceived to have lower immediate risks and higher maternal satisfaction compared with the use of parenteral opioids1, but its association with adverse neonatal outcomes has been infrequently studied.
Objective: To determine the association between the use of inhaled N2O during labor and delivery and adverse neonatal outcomes.
Methods: After receiving ethics approval a population-based retrospective cohort study was conducted using the Perinatal Database from 1995 to 2016. The population included all term, singleton deliveries, excluding those complicated by use of alcohol, illicit drug or methadone and with planned cesarean delivery. Three exposure groups during labor and delivery were defined 1) N2O only, 2) epidural only, 3) both N2O and epidural. Infant outcomes included 5 minute Apgar score, umbilical cord gases and pH, need for resuscitation or respiratory depression, prolonged neonatal length of stay and admission to NICU. Multiple logistic regression allowed adjustment for maternal age, weight, smoking, diabetes, hypertension, pre-eclampsia, opioid use in labor, neighborhood-level income, and infant birth weight.
Results: Included were 69,222 births to primiparous women and 76,792 births to multiparous women. Among primiparous women, the use of epidural with N2O reduced the odds of a neonatal 5-minute Apgar score below 7 (OR 0.51, CI 0.35 to 0.76). Among primiparous women, the use of N2O alone was associated with lower odds for neonatal resuscitation (OR 0.74, CI 0.65 to 0.83). In multiparous women, the use of epidural with N2O was associated with increased odds of the neonate requiring significant resuscitation (OR 1.85, CI 1.29 to 2.64). Epidural with N2O was associated with reduced odds of low cord artery pH among primiparous women (OR 0.60, CI 0.48 to 0.78) but with increased odds among multiparous women (OR 1.54, CI 1.10 to 2.16). N2O alone was associated with reduced odds of length of neonatal stay longer than three days among both primiparous and multiparous women (OR 0.69, CI 0.64 to 0.74 and 0.64, CI 0.59 to 0.70 respectively).
Conclusion: Associations between N2O and many neonatal outcomes were heterogeneous between primiparous and multiparous women. More research in the form of randomized control trials is needed to confirm these associations.
1. Ryan, A. Clinical guidelines for obstetrical practice: Labour analgesia. Reproductive Care Program.