The impact of neuraxial labour analgesia on neurodevelopmental disorders in offspring: a systematic review and meta-analysis.

BACKGROUND: Whether neuraxial analgesia during labour influences offspring neurodevelopment remains controversial, largely because of reliance on observational evidence susceptible to residual confounding. We aimed to re-evaluate this association through an updated and methodologically rigorous systematic review and meta-analysis, with particular emphasis on family-based designs that better account for shared familial factors. METHODS: PubMed, Embase, Web of Science, and the Cochrane Library were searched to September 16, 2025. Eligible studies assessed epidural, caudal, or combined spinal-epidural anaesthesia during labour and reported clinically defined neurodevelopmental outcomes. Random-effects meta-analyses with restricted maximum likelihood estimation were performed, with prespecified sibling-matched analyses. RESULTS: Nineteen studies were included. In sibling-matched cohorts, which provide stronger control for shared genetic and familial confounding, neuraxial labour analgesia was not associated with autism spectrum disorder (ASD) (adjusted hazard ratio 1.06; 95% confidence interval 0.98-1.14) or attention-deficit/hyperactivity disorder. Population-based analyses showed a small increase in ASD risk after adjustment (adjusted hazard ratio 1.10; 95% confidence interval 1.08-1.13), but effect estimates attenuated with increasing control for familial confounding. No clinically meaningful associations were observed for other neurodevelopmental outcomes. CONCLUSIONS: Across population-based and family-based observational evidence, this updated systematic review and meta-analysis showed that there is no convincing evidence that neuraxial labour analgesia is associated with an increased risk of ASD, attention-deficit/hyperactivity disorder or other neurodevelopmental disorders in offspring. SYSTEMATIC REVIEW PROTOCOL: PROSPERO (CRD420251148665).