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Is neuraxial labor analgesia associated with lower risk of neonatal morbidity among normotensive women of pregnancy with term singleton pregnancies?
Abstract Number: F5A-2
Abstract Type: Original Research
Introduction: Neuraxial analgesia (NA) is commonly used by women in labor in the United States.(1) However, there is a dearth of population-level data examining whether NA influences neonatal outcomes. In this observational population-based study, we sought to examine whether NA during labor is associated with adverse neonatal outcomes among normotensive women.
Methods: Using United States natality data, our study cohort comprised 15,081,816 women with term singleton pregnancies who underwent labor between 2009 and 2015. We excluded women with fetal malpresentations, those who delivered babies weighing less than 2500 g or with congenital anomalies, and women with any hypertensive disorder. Our primary outcome was neonatal morbidity, classified by the presence of at least one of the following: 5-min Apgar score ≤3, neonatal ICU admission, assisted ventilation at delivery or for > 6 h after delivery, and neonatal seizure or serious neurologic dysfunction. In our secondary analyses, we examined the associations between NA with each neonatal morbidity. We calculated the crude and adjusted relative risk (RR) of neonatal morbidity for women receiving NA compared to women not receiving NA. In our multivariable analyses, we adjusted for maternal, obstetric, and intrapartum confounders, year of delivery and the US state where the delivery occurred (Table).
Results: Among our study cohort, 10,684,094 (70.8%) received NA and 4,392,209 (29.1%) did not receive NA. The overall rate of neonatal morbidity was higher among women receiving NA vs. not receiving NA (5.19% vs. 3.41%, respectively; P<0.001). The results of our crude and adjusted analyses are presented in the Table. After adjusting for potential confounders, women who received NA had a slightly increased risk of neonatal morbidity compared with those not receiving NA (adjusted RR=1.39; 95% CI=1.38-1.4).
Conclusion: Our findings suggest that the risk of neonatal morbidity is modestly increased among women with term singleton pregnancies receiving NA compared to women not receiving NA. Confounding is a distinct concern in this observational study (e.g., confounding by indication whereby women with high-risk pregnancies or more complicated labors receive epidural analgesia); therefore, further studies with alternative confounder-control strategies are needed to examine whether NA is associated with neonatal morbidity among normotensive women.
References: (1) NVSS Reports 2011; 59: no.5