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Is neuraxial labor analgesia associated with lower risk of neonatal morbidity among hypertensive women with term singleton pregnancies?
Abstract Number: F5A-6
Abstract Type: Original Research
Introduction: The risk of neonatal morbidity is increased among women with hypertensive disorders of pregnancy (HTN).(1) However, among women with HTN, limited population-level data exist to determine whether neuraxial labor analgesia (NA) reduces the risk of neonatal morbidity compared with non-receipt of NA.
Methods: Using United States natality data, our study cohort comprised 616,208 women with term singleton pregnancies with HTN who underwent labor between 2009 and 2015. We excluded women with fetal malpresentations, and those who delivered babies weighing less than 2500 g or with congenital anomalies. Patients with gestational hypertension, preeclampsia or eclampsia were classified as having HTN. Our primary outcome was neonatal morbidity, classified by the presence of at least one of the following: 5-min Apgar scores ≤ 3, neonatal ICU admission, assisted ventilation at delivery or for > 6 h post-delivery, neonatal seizure or serious neurologic dysfunction. In our secondary analyses, we examined the associations between NA with each neonatal morbidity. Using logistic regression analyses, we calculated the crude and adjusted relative risk (RR) of neonatal morbidity for women receiving NA vs. those not receiving NA. We accounted for maternal, obstetric, and intrapartum confounders in our multivariable analyses, as well as the year of delivery and the US state where the delivery occurred (see Table).
Results: Among our study cohort, 503,927 (81.8%) received NA and 112,159 (18.2%) did not receive NA. The overall rate of neonatal morbidity was higher among women receiving NA vs not receiving NA (8.3% vs. 6.5%; P<0.001). The results of our crude and unadjusted analyses are presented in the Table. After adjusting for potential confounders, women who received NA had a modestly increased risk of neonatal morbidity compared with those not receiving NA (adjusted RR=1.23; 95% CI=1.2-1.27).
Conclusion: Our findings suggest that, among term women with singleton pregnancies and hypertensive disease, labor NA is associated with a slightly increased risk of neonatal morbidity. Because confounding by indication or severity are major concerns, it is critical that future studies use robust confounder-control strategies to clarify whether NA is associated with neonatal morbidity among HTN women and account for HTN severity.
References: (1) Ear Hum Dev 2011; 87: 445-9.