The association between neuraxial anesthesia and the development of childhood asthma – a secondary analysis of the newborn epigenetics study cohort

Abstract

Objectives

Childhood asthma is a common chronic illness that has been associated with mode of delivery. However, the effect of cesarean delivery alone does not fully account for the increased prevalence of childhood asthma. We tested the hypothesis that neuraxial anesthesia used for labor analgesia and cesarean delivery alters the risk of developing childhood asthma.

Methods

Within the Newborn Epigenetics Study birth cohort, 196 mother and child pairs with entries in the electronic anesthesia records were included. From these records, data on maternal anesthesia type, duration of exposure, and drugs administered peripartum were abstracted and combined with questionnaire-derived prenatal risk factors and medical records and questionnaire-derived asthma diagnosis data in children. Logistic regression models were used to evaluate associations between type of anesthesia, duration of anesthesia, and the development of asthma in males and females.

Results

We found that longer duration of epidural anesthesia was associated with a lower risk of asthma in male children (OR = 0.80; 95% CI = 0.66–0.95) for each hour of epidural exposure. Additionally, a unit increase in the composite dose of local anesthetics and opioid analgesics administered via the spinal route was associated with a lower risk of asthma in both male (OR = 0.59, 95% CI = 0.36–0.96) and female children (OR 0.26, 95% CI 0.09–0.82).

Conclusion

Our data suggest that peripartum exposure to neuraxial anesthesia may reduce the risk of childhood asthma primarily in males. Larger human studies and model systems with longer follow-up are required to elucidate these findings.

Keywords:

• Anesthesia
• opioid analgesics
• asthma
• children
• sex-specific

Transparency

Declaration of funding

This work was supported by departmental resources from the Department of Anesthesiology, Duke University School of Medicine. Data collection and statistical analysis were also supported by the National Institute of Environmental Health Sciences [R21ES014947, R01ES016772, and P30ES025128] the National Institute of Diabetes and Digestive and Kidney Diseases [R01DK085173], and The Duke cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.

Declaration of financial/other relationships

The authors declare no financial relationships. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

YH and JYT were involved in the analysis and interpretation of data, drafting the manuscript, and revising it critically for intellectual content. RLM was involved in drafting the manuscript and revising it critically for intellectual content. CH and TA were involved in the conception and design, interpretation of data, drafting the manuscript, and revising it critically for intellectual content. All authors approved the final version manuscript and agree to be accountable for all aspects of the work.

Acknowledgements

No assistance in the preparation of this article is to be declared.