Association between cesarean anesthesia type and long-term neurodevelopmental outcomes in offspring: a nationwide...

We aimed to investigate whether the mode of anesthesia- neuraxial versus general-used during cesarean delivery is associated with the risk of long-term neurodevelopmental disorders (LNDDs) in offspring.

We conducted a nationwide, population-based cohort study using data from the South Korean National Health Insurance Service. The study included 735 280 children born via cesarean delivery between January 1, 2010 and December 31, 2014. After applying 1:1 propensity score matching based on maternal receipt of neuraxial anesthesia (NA) versus general anesthesia (GA), 273 266 births were included in the matched cohort. The primary outcome was the diagnosis of LNDDs, including intellectual disabilities and psychological development disorders, through December 31, 2023. Incidence rates per 1000 person-years (PYs) and HRs with 95% CIs were estimated using Cox proportional-hazards models. Sensitivity analyses included multivariable Cox models in the full cohort and a within-family (discordant sibling) design.

In the matched cohort, the incidence rate of LNDDs was 3.53 (95% CI, 3.45 to 3.62) per 1000 PYs in the NA group and 3.99 (95% CI, 3.90 to 4.09) per 1000 PYs in the GA group. NA was associated with a lower hazard of LNDDs (HR 0.87, 95% CI 0.84 to 0.90; p<0.001). This association was consistent for intellectual disabilities (HR 0.83, 95% CI 0.78 to 0.88; p<0.001) and for psychological development disorders (HR 0.88, 95% CI 0.85 to 0.91; p<0.001). These associations remained consistent in both the full cohort analyses and the sibling comparison.

In this nationwide cohort, NA for cesarean delivery was associated with a modestly lower incidence and hazard of LNDDs compared with GA. These findings should be interpreted as exploratory and hypothesis-generating, rather than causal, and highlight the need for further research integrating detailed perinatal and anesthetic data.