Abstract：
BACKGROUND: Recent studies report conflicting results regarding the relationship between labour epidural analgesia (LEA) in mothers and neurodevelopmental disorders in their offspring. We evaluated behavioural and neuropsychological test scores in children of mothers who used LEA.
METHODS: Children enrolled in the Raine Study from Western Australia and delivered vaginally from a singleton pregnancy between 1989 and 1992 were evaluated. Children exposed to LEA were compared with unexposed children. The primary outcome was the parent-reported Child Behaviour Checklist (CBCL) reporting total, internalising, and externalising behavioural problem scores at age 10 yr. Score differences, an increased risk of clinical deficit, and a dose-response based on the duration of LEA exposure were assessed. Secondary outcomes included language, motor function, cognition, and autistic traits.
RESULTS: Of 2180 children, 850 (39.0%) were exposed to LEA. After adjustment for covariates, exposed children had minimally increased CBCL total scores (+1.41 points; 95% confidence interval [CI] 0.09 to 2.73; P=0.037), but not internalising (+1.13 points; 95% CI -0.08 to 2.34; P=0.066) or externalising (+1.08 points; 95% CI -0.08 to 2.24; P=0.068) subscale subscores. Increased risk of clinical deficit was not observed for any CBCL score. For secondary outcomes, score differences were inconsistently observed in motor function and cognition. Increased exposure duration was not associated with worse scores in any outcomes.
CONCLUSIONS: Although LEA exposure was associated with slightly higher total behavioural scores, there was no difference in subscores, increased risk of clinical deficits, or dose-response relationship. These results argue against LEA exposure being associated with consistent, clinically significant neurodevelopmental deficits in children.
METHODS: Children enrolled in the Raine Study from Western Australia and delivered vaginally from a singleton pregnancy between 1989 and 1992 were evaluated. Children exposed to LEA were compared with unexposed children. The primary outcome was the parent-reported Child Behaviour Checklist (CBCL) reporting total, internalising, and externalising behavioural problem scores at age 10 yr. Score differences, an increased risk of clinical deficit, and a dose-response based on the duration of LEA exposure were assessed. Secondary outcomes included language, motor function, cognition, and autistic traits.
RESULTS: Of 2180 children, 850 (39.0%) were exposed to LEA. After adjustment for covariates, exposed children had minimally increased CBCL total scores (+1.41 points; 95% confidence interval [CI] 0.09 to 2.73; P=0.037), but not internalising (+1.13 points; 95% CI -0.08 to 2.34; P=0.066) or externalising (+1.08 points; 95% CI -0.08 to 2.24; P=0.068) subscale subscores. Increased risk of clinical deficit was not observed for any CBCL score. For secondary outcomes, score differences were inconsistently observed in motor function and cognition. Increased exposure duration was not associated with worse scores in any outcomes.
CONCLUSIONS: Although LEA exposure was associated with slightly higher total behavioural scores, there was no difference in subscores, increased risk of clinical deficits, or dose-response relationship. These results argue against LEA exposure being associated with consistent, clinically significant neurodevelopmental deficits in children.
摘要：
背景：最近的研究报告了关于母亲分娩硬膜外镇痛（LEA）与后代神经发育障碍之间关系的相互矛盾的结果。我们评估了使用LEA的母亲的孩子的行为和神经心理学测试得分。
方法：评估了1989年至1992年来自西澳大利亚州的Raine研究中从单胎妊娠阴道分娩的儿童。将暴露于LEA的儿童与未暴露的儿童进行比较。主要结果是父母报告的儿童行为清单（CBCL）报告总数，内化，并在10岁时将行为问题分数外化。分数差异,临床缺陷的风险增加，并评估了基于LEA暴露持续时间的剂量反应.次要结果包括语言，运动功能,认知，和自闭症特征。
结果：在2180名儿童中，850例(39.0%)暴露于LEA。在调整协变量后，暴露儿童CBCL总分最低限度增加(+1.41分;95%置信区间[CI]0.09至2.73;P=0.037),但不内化(+1.13分;95%CI-0.08至2.34;P=0.066)或外化(+1.08分;95%CI-0.08至2.24;P=0.068)子量表子评分。任何CBCL评分均未观察到临床缺陷风险增加。对于次要结果，在运动功能和认知方面的评分差异不一致。在任何结果中，暴露持续时间的增加与较差的评分无关。
结论：尽管LEA暴露与总行为得分略高相关，子分数没有差异，增加临床缺陷的风险，或剂量-反应关系。这些结果反对LEA暴露与一致，儿童临床上显着的神经发育缺陷。
方法：评估了1989年至1992年来自西澳大利亚州的Raine研究中从单胎妊娠阴道分娩的儿童。将暴露于LEA的儿童与未暴露的儿童进行比较。主要结果是父母报告的儿童行为清单（CBCL）报告总数，内化，并在10岁时将行为问题分数外化。分数差异,临床缺陷的风险增加，并评估了基于LEA暴露持续时间的剂量反应.次要结果包括语言，运动功能,认知，和自闭症特征。
结果：在2180名儿童中，850例(39.0%)暴露于LEA。在调整协变量后，暴露儿童CBCL总分最低限度增加(+1.41分;95%置信区间[CI]0.09至2.73;P=0.037),但不内化(+1.13分;95%CI-0.08至2.34;P=0.066)或外化(+1.08分;95%CI-0.08至2.24;P=0.068)子量表子评分。任何CBCL评分均未观察到临床缺陷风险增加。对于次要结果，在运动功能和认知方面的评分差异不一致。在任何结果中，暴露持续时间的增加与较差的评分无关。
结论：尽管LEA暴露与总行为得分略高相关，子分数没有差异，增加临床缺陷的风险，或剂量-反应关系。这些结果反对LEA暴露与一致，儿童临床上显着的神经发育缺陷。
