Labour epidural analgesia and early childhood behavioural outcomes: the moderating role of maternal mental health and pro‐inflammatory cytokines
Anaesthesia, 2026
Asif S., Tu H., White R., Birgisdottir B., Lipcsey M., Bjurström M., Skalkidou A.
| Disease area | Application area | Sample type | Products |
|---|---|---|---|
Obstetrics | Pathophysiology | Blood |  Olink Target 96 |
Abstract
Introduction
Labour epidural analgesia is the most effective method for intrapartum pain relief and is associated with improved maternal outcomes. However, concerns have been raised regarding potential associations between labour epidural analgesia and adverse psycho‐emotional outcomes in children. Evidence from large epidemiological studies is inconsistent and potential biological mechanisms remain unclear. Maternal immune activation during pregnancy may play a role. We aimed to investigate behavioural and psycho‐emotional outcomes in children of mothers who received epidural analgesia during labour, accounting for perinatal mental health, sociodemographic characteristics and cytokine profiles.
Methods
Singleton vaginal births from the Biology, Affect, Stress, Imaging and Cognition study were included. Child behavioural outcomes were assessed by Child Behavioural Checklist scores at 18 months, 6 years and 11 years postpartum in the U‐BIRTH follow‐up cohort, with higher scores indicating more behavioural difficulties. The main exposure was maternal use of labour epidural analgesia. Maternal data were collected from questionnaires and medical records.
Results
Among 1962 mother–child dyads, 726 (37%) received labour epidural analgesia. Younger maternal age; lower resilience; inflammatory diseases; primiparity; antenatal depression; fear of childbirth; and longer duration of labour were associated with higher Child Behavioural Checklist scores at 18 months postpartum. In crude analysis, labour epidural analgesia correlated with higher Child Behavioural Checklist scores at 18 months postpartum; however, this association was not significant after adjusting for confounders. Among those with lower expression of TNFSF14 and CXCL6 cytokines, labour epidural analgesia use was associated with higher Child Behavioural Checklist scores.
Discussion
Use of epidural analgesia during labour was not found to be independently associated with adverse child behavioural outcomes. Variations in maternal cytokine profiles among those choosing labour epidural analgesia or not may influence susceptibility to early behavioural differences. Replication in larger cohorts and further exploration of additional immune biomarker dynamics during pregnancy are warranted.