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I keep seeing references to a study suggesting a link between epidurals during labor and autism risk, and it’s made me anxious about the pain management choices I made (and might make again). Is there good evidence that epidurals increase the risk of autism, or is this one of those findings that doesn’t really hold up?
—Second-Guessing Mom
This claim has come up at various times, but most notably in research that got a lot of media attention back in 2020. This study, which was published in JAMA Pediatrics, included almost 150,000 children born in California between 2008 and 2015. The analysis in the paper was fairly simple: the authors correlated the use of an epidural during labor with a later autism diagnosis.
The top-line conclusion of the study was a 37% increase in risk of autism diagnosis with epidural usage. The increase was small in absolute terms: the share of children in the non-epidural group with autism was 1.3%, versus 1.9% in the epidural group.
The main issue with this study is that it is not a randomized trial. The approach the authors take is to compare the children of women who have an epidural to those who do not. The problem, as usual, is that other things differ a lot. There are very large differences in, among other things, race, ethnicity, and income between women who get an epidural and those who do not.
These differences are likely important because we know that they relate to differences in access to diagnosis. The story may simply be that women with access to better medical care are both more likely to get an epidural and more likely to have access to the medical system for autism diagnosis.
From this study alone, it is difficult to know what is driving the results and if any part of this relationship is causal. However, subsequent research largely does not support this link. A 2021 paper, published in the same journal, used a similar approach with Canadian data and showed no relationship between epidural usage and autism diagnosis. Given the more consistent health care system in Canada, this suggests differences in health access could drive the original results.
A meta-analysis from 2024 put the data together and concluded that, once appropriate adjustment for confounding was done, there was no relationship between epidural usage and autism in the data. In the end, although the first study cited caused a lot of waves when it came out, the data pretty clearly rejects this link.
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