Neuraxial Anesthesia May Reduce the Risk for Childhood Asthma

The early placement of neuraxial anesthesia may be associated with a lower risk for childhood asthma, particularly in boys, according to study results published in the journal Current Medical Research and Opinion.

In this retrospective cohort analysis, the data of 196 mother/child pairs (boys, 53.06%; Blacks, 50.51%) from the Newborn Epigenetics Study (NEST) were examined. Data on the type of maternal anesthesia used, duration of exposure to the anesthesia, and medications that were administered to the women in the peripartum period were extracted, and prenatal risk factors were determined based on questionnaires. In addition, asthma diagnoses in children from these pairs were determined using questionnaires.

Of the mothers in this cohort, 14.29% had asthma, 28.57% were smokers, 31.63% were obese prior to pregnancy, and 37.24% had a cesarean section. These 4 factors were reported more often by women who had children with asthma.

A longer duration of epidural anesthesia was found to be associated with a lower risk of developing asthma in boys (odds ratio [OR], 0.80; 95% CI, 0.66-0.95) for each hour of epidural exposure. Each additional unit in the composite dose of local anesthesia and opioid analgesics administered intrathecally was associated with a lower risk for asthma in boys and girls (boys: OR, 0.59; 95% CI, 0.36-0.96; girls:  OR, 0.26; 95% CI, 0.09-0.82). The use of antiemetics was associated with a lower risk for asthma in girls (OR, 0.26; 95% CI, 0.06-0.63). An increasing dose of phenylephrine was marginally associated with an increased risk for asthma in boys, but not girls (OR, 1.15; 95% CI, 1.00-1.33).

“This study present early evidence for associations between neuraxial anesthesia and a lower risk of asthma — these associations may be stronger in males. Clinically, early placement of neuraxial anesthesia in women in labor who experience elevated levels of peripartum psychosocial stress could be a useful intervention for reducing the risk of childhood asthma. If replicated in larger studies with longer follow-up, investigating mechanisms could inform intervention strategies,” concluded the study authors.

Reference

Huang Y, Tzeng JY, Maguire R, Hoyo C, Allen T. The association between neuraxial anesthesia and the development of childhood asthma – a secondary analysis of the Newborn Epigenetics Study Cohort [published online March 26, 2020]. Curr Med Res Opin. doi: 10.1080/03007995.2020.1747417