CC BY-NC-ND 4.0 · AJP Rep 2023; 13(04): e65-e70
DOI: 10.1055/s-0043-1776147
Original Article

Association between Maternal Neuraxial Analgesia and Neonatal Outcomes in Very Preterm Infants

Lilly Y. Liu
1   Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, New York, New York
Elizabeth M. S. Lange
2   Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Lynn M. Yee
3   Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
› Institutsangaben
Funding Dr. Yee was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, under the ID: NICHD K12 HD050121-11 at the time of the study.


Background Although the use of neuraxial analgesia has been shown to improve uteroplacental blood flow and maternal and fetal hemodynamics related to labor pain, possibly improving immediate outcomes in term neonates, the association between neuraxial analgesia use and outcomes in preterm neonates remains unclear.

Objective The aim of this article was to evaluate the association between maternal use of neuraxial analgesia and neonatal outcomes in very preterm infants.

Methods This is a retrospective cohort study of women delivering singleton neonates between 23 and 32 weeks' gestation at a large academic center between 2012 and 2016. Outcomes of neonates born to women who used neuraxial analgesia for labor and/or delivery were compared to those whose mothers did not. Multivariable logistic regression was utilized to assess the independent associations of neuraxial analgesia use with neonatal outcomes after controlling for potential confounders, including gestational age, mode of delivery, and existing interventions to improve neonatal outcomes of prematurity.

Results Of 478 eligible women who delivered singleton very preterm neonates in this study period, 352 (73.6%) used neuraxial analgesia. Women who used neuraxial analgesia were more likely to have delivered at a later preterm gestational age, to have a higher birthweight, to have preeclampsia and/or hemolysis, elevated liver enzymes, low platelet count (HELLP), to have undergone labor induction, to have delivered by cesarean delivery, and to have received obstetric interventions such as magnesium prophylaxis for fetal neuroprotection, antenatal corticosteroids for fetal lung maturity, and antibiotics prior to delivery; they were less likely to have been diagnosed with a clinical abruption. Neuraxial analgesia was associated with decreased incidence of cord umbilical artery pH less than 7.0 (24.7 vs. 34.9%, p = 0.03), as well as decreased incidence of neonatal intensive care unit length of stay over 60 days (35.5 vs. 48.4%, p = 0.01), although these associations did not persist on multivariable analysis. On multivariable analyses, neuraxial analgesia remained independently associated with decreased odds of necrotizing enterocolitis (adjusted odds ratio [aOR]: 0.28, 95% confidence interval [CI]: 0.12–0.62) and grade III/IV intraventricular hemorrhage (aOR: 0.33, 95% CI: 0.13–0.87). These associations remained significant on sensitivity analyses, which were performed between 10 and 90% of the overall cohort in order to control for outliers, as well as between the subgroup of patients who received obstetric interventions.

Conclusions Maternal neuraxial analgesia use may be associated with lower odds of adverse outcomes in very preterm infants, even after controlling for existing interventions for prematurity. Prior work has suggested such effects may be due to improved neonatal acid–base status from changes in placental perfusion and maternal pain management, but further work is required to prospectively investigate such associations.


This abstract was presented as a poster presentation at the Society for Reproductive Investigation 65th Annual Scientific Meeting, in San Diego, California, on March 9, 2018.


Eingereicht: 28. März 2020

Angenommen: 08. Oktober 2021

Artikel online veröffentlicht:
06. November 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

  • References

  • 1 Traynor AJ, Aragon M, Ghosh D. et al. Obstetric anesthesia workforce survey: a 30-year update. Anesth Analg 2016; 122 (06) 1939-1946
  • 2 Halpern SH, Leighton BL, Ohlsson A, Barrett JF, Rice A. Effect of epidural vs parenteral opioid analgesia on the progress of labor: a meta-analysis. JAMA 1998; 280 (24) 2105-2110
  • 3 Martínez AH, Almagro JJR, García-Suelto MM, Barrajon MU, Alarcón MM, Gómez-Salgado J. Epidural analgesia and neonatal morbidity: a retrospective cohort study. Int J Environ Res Public Health 2018; 15 (10) 2092
  • 4 Srebnik N, Barkan O, Rottenstreich M. et al. The impact of epidural analgesia on the mode of delivery in nulliparous women that attain the second stage of labor. J Matern Fetal Neonatal Med 2020; 33 (14) 2451-2458
  • 5 Poma S, Scudeller L, Verga C. et al. Effects of combined spinal-epidural analgesia on first stage of labor: a cohort study. J Matern Fetal Neonatal Med 2019; 32 (21) 3559-3565
  • 6 Heesen M, Böhmer J, Klöhr S, Hofmann T, Rossaint R, Straube S. The effect of adding a background infusion to patient-controlled epidural labor analgesia on labor, maternal, and neonatal outcomes: a systematic review and meta-analysis. Anesth Analg 2015; 121 (01) 149-158
  • 7 Bodner-Adler B, Bodner K, Kimberger O. et al. The effect of epidural analgesia on the occurrence of obstetric lacerations and on the neonatal outcome during spontaneous vaginal delivery. Arch Gynecol Obstet 2002; 267 (02) 81-84
  • 8 Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev 2018; 5 (05) CD000331
  • 9 Capogna G, Camorcia M. Epidural analgesia for childbirth: effects of newer techniques on neonatal outcome. Paediatr Drugs 2004; 6 (06) 375-386
  • 10 Deshmukh VL, Ghosh SS, Yelikar KA, Gadappa SN. Effects of epidural labour analgesia in mother and foetus. J Obstet Gynecol India 2018; 68 (02) 111-116
  • 11 Han B, Xu M. A comprehensive analysis of continuous epidural analgesia's effect on labor and neonates in maternal hypertensive disorder patients. Pregnancy Hypertens 2017; 7: 33-38
  • 12 Leighton BL, Halpern SH. Epidural analgesia: effects on labor progress and maternal and neonatal outcome. Semin Perinatol 2002; 26 (02) 122-135
  • 13 Sharma SK, Alexander JM, Messick G. et al. Cesarean delivery: a randomized trial of epidural analgesia versus intravenous meperidine analgesia during labor in nulliparous women. Anesthesiology 2002; 96 (03) 546-551
  • 14 Brownridge P. The nature and consequences of childbirth pain. Eur J Obstet Gynecol Reprod Biol 1995; 59 (Suppl): S9-S15
  • 15 Ralston DH, Shnider SM, DeLorimier AA. Uterine blood flow and fetal acid-base changes after bicarbonate administration to the pregnant ewe. Anesthesiology 1974; 40 (04) 348-353
  • 16 Reynolds F, Sharma SK, Seed PT. Analgesia in labour and fetal acid-base balance: a meta-analysis comparing epidural with systemic opioid analgesia. BJOG 2002; 109 (12) 1344-1353
  • 17 Bergmans MG, van Geijn HP, Hasaart TH, Weber T, Nickelsen C. Fetal and maternal transcutaneous PCO2 levels during labour and the influence of epidural analgesia. Eur J Obstet Gynecol Reprod Biol 1996; 67 (02) 127-132
  • 18 Hägerdal M, Morgan CW, Sumner AE, Gutsche BB. Minute ventilation and oxygen consumption during labor with epidural analgesia. Anesthesiology 1983; 59 (05) 425-427
  • 19 Lederman RP, Lederman E, Work Jr B, McCann DS. Anxiety and epinephrine in multiparous women in labor: relationship to duration of labor and fetal heart rate pattern. Am J Obstet Gynecol 1985; 153 (08) 870-877
  • 20 Shnider SM, Abboud TK, Artal R, Henriksen EH, Stefani SJ, Levinson G. Maternal catecholamines decrease during labor after lumbar epidural anesthesia. Am J Obstet Gynecol 1983; 147 (01) 13-15
  • 21 Morishima HO, Pedersen H, Finster M. The influence of maternal psychological stress on the fetus. Am J Obstet Gynecol 1978; 131 (03) 286-290
  • 22 Stoll BJ, Hansen NI, Bell EF. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010; 126 (03) 443-456
  • 23 Munnur U, de Boisblanc B, Suresh MS. Airway problems in pregnancy. Crit Care Med 2005; 33 (10) S259-S268