Highlights
- •Few data on neurologic outcomes after in utero exposure to general anesthesia (GA).
- •Secondary analysis of randomized trial of maternal magnesium and cerebral palsy.
- •Exposure to GA was not associated with impaired neurodevelopment overall.
- •Only severe motor delay was significantly more common among infants exposed to GA.
- •Findings are reassuring regarding a single, short in utero exposure to GA.
Abstract
Background
In 2016, the U.S. Food and Drug Administration expressed concern that neurodevelopment
may be negatively affected by anesthesia or sedation exposure in pregnancy or before
three years of age. We examined the association between general anesthesia at the
time of cesarean delivery and early childhood neurodevelopment.
Methods
A secondary analysis of a multicenter randomized controlled trial assessing magnesium
for prevention of cerebral palsy in infants at risk for preterm delivery. Exposure
was general compared to neuraxial anesthesia. The primary outcome was motor or mental
delay at two years of age, assessed by Bayley Scales of Infant Development II (BSIDII).
Secondary outcomes included BSIDII subdomains and perinatal outcomes. Multivariable
logistic regression models were performed to control for confounders.
Results
Of 557 women undergoing cesarean delivery, 119 (21%) received general anesthesia.
There were no differences in the primary composite outcome of developmental delay
(aOR 0.93, 95% CI 0.61 to 1.43) or the BSIDII subdomains of mild, moderate, or severe
mental delay, or mild or moderate motor delay. Severe motor delay was more common
among infants exposed to general anesthesia (aOR 1.98, 95% CI 1.06 to 3.69). Infants
exposed to general anesthesia had longer neonatal intensive care stays (51 vs 37 days,
P=0.010).
Conclusions
General anesthesia for cesarean delivery was not associated with overall neurodevelopmental
delay at two years of age, except for greater odds of severe motor delay. Future studies
should evaluate this finding, as well as the impact on neurodevelopment of longer
or multiple anesthetic exposures across all gestational ages.
Keywords
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Article info
Publication history
Published online: August 25, 2020
Accepted:
August 17,
2020
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
