Skip to main content

No association of labor epidural analgesia with cerebral palsy in children



Some pregnant women avoid labor epidural analgesia because of their concerns about risk of cerebral palsy in children. Although it is believed that labor epidural does not contribute to cerebral palsy, to our knowledge no study has been published to specifically address this concern. We carried out a retrospective case–control study to investigate whether labor epidural analgesia is associated with cerebral palsy in children.


This study used data that were collected and entered into the Geisinger electronic health records between January 2004 and January 2013. During this period, 20,929 children were born at Geisinger hospitals. Among them, 50 children were diagnosed with cerebral palsy, and 20 of those were born vaginally. Each of these 20 cerebral palsy children was matched with up to 5 non-cerebral palsy children born at the same hospitals in the same timeframe using propensity scoring methods. Analgesia was classified as epidural (including epidural or combined spinal and epidural) or non-epidural. Conditional logistic regression was used to compare the percentages of deliveries with each analgesia type between the cerebral palsy and non-cerebral palsy groups.


In the non-cerebral palsy group, the percentage of patients receiving labor epidural analgesia was 72 %, and in the cerebral palsy group the percentage was 45 %. There was no significant difference between non-cerebral palsy and cerebral palsy groups (odds ratio, 0.57; 95 % confidence interval, 0.14–2.24; p = 0.42).


We found no association between the use of labor epidural analgesia and the occurrence of cerebral palsy in children.

This is a preview of subscription content, access via your institution.


  1. Osterman MJ, Martin JA. Epidural and spinal anesthesia use during labor: 27-state reporting area, 2008. Natl Vital Stat Rep. 2011;59(5):1–13.

    Google Scholar 

  2. Toledo P, Sun J, Peralta F, Grobman WA, Wong CA, Hasnain-Wynia R. A qualitative analysis of parturients’ perspectives on neuraxial labor analgesia. Int J Obstet Anesth. 2013;22(2):119–23.

    Article  CAS  PubMed  Google Scholar 

  3. Pakula AT, Braun NK, Yeargin-Allsopp M. Cerebral palsy: classification and epidemiology. Phys Med Rehabil Clin N Am. 2009;20(3):425–52.

    Article  PubMed  Google Scholar 

  4. Oskoui M, Coutinho F, Dykeman J, Jette N, Pringsheim T. An update on the prevalence of cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol. 2013;55(6):509–19.

    Article  PubMed  Google Scholar 

  5. Kirby RS, Wingate MS, Van Naarden Braun K, Doernberg NS, Arneson CL, Benedict RE, Mulvihill B, Durkin MS, Fitzgerald RT, Maenner MJ, Patz JA, Yeargin-Allsopp M. Prevalence and functioning of children with cerebral palsy in four areas of the United States in 2006: a report from the Autism and Developmental Disabilities Monitoring Network. Res Dev Disabil. 2011;32(2):462–9.

    Article  PubMed  Google Scholar 

  6. Dunn PM. Dr. William Little (1810–1894) of London and cerebral palsy. Arch Dis Child Fetal Neonatal Ed. 1995;72(3):F209–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Tronnes H, Wilcox AJ, Lie RT, Markestad T, Moster D. Risk of cerebral palsy in relation to pregnancy disorders and preterm birth: a national cohort study. Dev Med Child Neurol. 2014;56(8):779–85.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Janik MD, Newman TB, Cheng YW, Xing G, Gilbert WM, Wu YW. Maternal diagnosis of obesity and risk of cerebral palsy in the child. J Pediatr. 2013;163(5):1307–12.

    Article  Google Scholar 

  9. Strand KM, Heimstad R, Iversen AC, Austgulen R, Lydersen S, Andersen GL, Irgens LM, Vik T. Mediators of the association between pre-eclampsia and cerebral palsy: population based cohort study. BMJ. 2013;9(347):f4089.

    Article  Google Scholar 

  10. Wu YW, Croen LA, Torres AR, Van De Water J, Grether JK, Hsu NN. Interleukin-6 genotype and risk for cerebral palsy in term and near-term infants. Ann Neurol. 2009;66(5):663–70.

    Article  CAS  PubMed  Google Scholar 

  11. Moreno-De-Luca A, Ledbetter DH, Martin CL. Genetic [corrected] insights into the causes and classification of [corrected] cerebral palsies. Lancet Neurol. 2012;11(3):283–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B. Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol. 2005;47(8):571–6.

    Article  PubMed  Google Scholar 

  13. Hudson AE, Hemmings HC Jr. Are anaesthetics toxic to the brain? Br J Anaesth. 2011;107(1):30–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Ing C, DiMaggio C, Whitehouse A, Hegarty MK, Brady J, von Ungern-Sternberg BS, Davidson A, Wood AJ, Li G, Sun LS. Long-term differences in language and cognitive function after childhood exposure to anesthesia. Pediatrics. 2012;130(3):e476–85.

    Article  PubMed  Google Scholar 

  15. Wilder RT, Flick RP, Sprung J, Katusic SK, Barbaresi WJ, Mickelson C, Gleich SJ, Schroeder DR, Weaver AL, Warner DO. Early exposure to anesthesia and learning disabilities in a population-based birth cohort. Anesthesiology. 2009;110(4):796–804.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Block RI, Thomas JJ, Bayman EO, Choi JY, Kimble KK, Todd MM. Are anesthesia and surgery during infancy associated with altered academic performance during childhood? Anesthesiology. 2012;117(3):494–503.

    Article  PubMed  Google Scholar 

  17. Greenwell EA, Wyshak G, Ringer SA, Johnson LC, Rivkin MJ, Lieberman E. Intrapartum temperature elevation, epidural use, and adverse outcome in term infants. Pediatrics. 2012;129(2):e447–54.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Flick RP, Lee K, Hofer RE, Beinborn CW, Hambel EM, Klein MK, Gunn PW, Wilder RT, Katusic SK, Schroeder DR, Warner DO, Sprung J. Neuraxial labor analgesia for vaginal delivery and its effects on childhood learning disabilities. Anesth Analg. 2011;112(6):1424–31.

    Article  PubMed  Google Scholar 

  19. Thorngren-Jerneck K, Herbst A. Perinatal factors associated with cerebral palsy in children born in Sweden. Obstet Gynecol. 2006;108(6):1499–505.

    Article  PubMed  Google Scholar 

  20. Volpe JJ. Brain injury in premature infants: a complex amalgam of destructive and developmental disturbances. Lancet Neurol. 2009;8(1):110–24.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Dammann O, Leviton A. Brain damage in preterm newborns: might enhancement of developmentally regulated endogenous protection open a door for prevention? Pediatrics. 1999;104(3 pt 1):541–50.

    Article  CAS  PubMed  Google Scholar 

  22. Nelson KB, Willoughby RE. Overview: infection during pregnancy and neurologic outcome in the child. Ment Retard Dev Disabil Res Rev. 2002;8(1):1–2.

    Article  PubMed  Google Scholar 

  23. Ahlin K, Himmelmann K, Hagberg G, Kacerovsky M, Cobo T, Wennerholm UB. Cerebral palsy and perinatal infection in children born at term. Obstet Gynecol. 2013;122(1):41–9.

    Article  PubMed  Google Scholar 

  24. Berry SA, Laam LA, Wary AA, Mateer HO, Cassagnol HP, McKinley KE, Nolan RA. ProvenCare perinatal: a model for delivering evidence/guideline-based care for perinatal populations. Jt Comm J Qual Patient Saf. 2011;37(5):229–39.

    PubMed  Google Scholar 

  25. Pappas A, Kendrick DE, Shankaran S, Stoll BJ, Bell EF, Laptook AR, Walsh MC, Das A, Hale EC, Newman NS, Higgins RD, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Chorioamnionitis and early childhood outcomes among extremely low-gestational-age neonates. JAMA Pediatr. 2014;168(2):137–47.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding authors

Correspondence to Li Zhang or Jove H. Graham.

Ethics declarations

Conflict of interest

This study received no external funding, and the authors have no conflicts of interest to declare.

About this article

Verify currency and authenticity via CrossMark

Cite this article

Zhang, L., Graham, J.H., Feng, W. et al. No association of labor epidural analgesia with cerebral palsy in children. J Anesth 30, 1008–1013 (2016).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Labor and delivery
  • Epidural analgesia
  • Cerebral palsy
  • Neurological disorder