Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Anesth Analg. 2011 Jun;112(6):1424-31. doi: 10.1213/ANE.0b013e3181f2ecdd. Epub 2010 Aug 24.
In prior work, children born to mothers who received neuraxial anesthesia for cesarean delivery had a lower incidence of subsequent learning disabilities compared with vaginal delivery. The authors speculated that neuraxial anesthesia may reduce stress responses to delivery, which could affect subsequent neurodevelopmental outcomes. To further explore this possibility, we examined the association between the use of neuraxial labor analgesia and development of childhood learning disabilities in a population-based birth cohort of children delivered vaginally.
The educational and medical records of all children born to mothers residing in the area of 5 townships of Olmsted County, Minnesota from 1976 to 1982 and remaining in the community at age 5 years were reviewed to identify those with learning disabilities. Cox proportional hazards regression was used to compare the incidence of learning disabilities between children delivered vaginally with and without neuraxial labor analgesia, including analyses adjusted for factors of either potential clinical relevance or that differed between the 2 groups in univariate analysis.
Of the study cohort, 4684 mothers delivered children vaginally, with 1495 receiving neuraxial labor analgesia. The presence of childhood learning disabilities in the cohort was not associated with use of labor neuraxial analgesia (adjusted hazard ratio, 1.05; 95%confidence interval, 0.85-1.31; P = 0.63).
The use of neuraxial analgesia during labor and vaginal delivery was not independently associated with learning disabilities diagnosed before age 19 years. Future studies are needed to evaluate potential mechanisms of the previous finding indicating that the incidence of learning disabilities is lower in children born to mothers via cesarean delivery under neuraxial anesthesia compared with vaginal delivery.
在之前的研究中，与阴道分娩相比，接受椎管内麻醉行剖宫产分娩的产妇所生的儿童，随后发生学习障碍的几率较低。作者推测，椎管内麻醉可能会降低分娩时的应激反应，这可能会影响随后的神经发育结局。为了进一步探讨这种可能性，我们在一个基于人群的阴道分娩的儿童队列中，研究了椎管内分娩镇痛的使用与儿童期学习障碍的发生之间的关系。
回顾了明尼苏达州奥姆斯特德县 5 个镇的所有母亲在 1976 年至 1982 年期间分娩的并在 5 岁时仍留在社区的儿童的教育和医疗记录，以确定那些有学习障碍的儿童。使用 Cox 比例风险回归比较了接受和未接受椎管内分娩镇痛的阴道分娩儿童的学习障碍发生率，包括根据潜在临床相关因素或单因素分析中两组之间存在差异的因素进行调整的分析。
在研究队列中，有 4684 名母亲经阴道分娩，其中 1495 名接受了椎管内分娩镇痛。在队列中，儿童学习障碍的存在与使用分娩时的神经轴镇痛无关（调整后的危险比为 1.05；95%置信区间，0.85-1.31；P=0.63）。
分娩时使用椎管内镇痛与阴道分娩时发生学习障碍无关。未来需要研究来评估之前的发现表明，与阴道分娩相比，接受椎管内麻醉行剖宫产分娩的产妇所生的儿童，发生学习障碍的几率较低的潜在机制。
