The association between prenatal exposure to general anaesthesia for maternal surgery during pregnancy and subsequent risk of disruptive or internalising behavioural disorder diagnosis in the child has not been well-defined.
Columbia researchers, led by Caleb Ing, MD, undertook the task to better define the association by linking a nationwide sample of pregnant women to their liveborn infants using the Medicaid Analytic eXtract (MAX, 1999e2013). Multivariate matching was used to match each child prenatally exposed to general anaesthesia owing to maternal appendectomy or cholecystectomy during pregnancy with five unexposed children. The primary outcome was diagnosis of a disruptive or internalising behavioural disorder in children. Secondary outcomes included diagnoses for a range of other neuropsychiatric disorders.
34,271 prenatally exposed children were matched with 171,355 unexposed children in the database. Prenatally exposed children were more likely than unexposed children to receive a diagnosis of a disruptive or internalizing behavioural disorder (hazard ratio [HR], 1.31; 95% confidence interval [CI], 1.23e1.40). For secondary outcomes, increased hazards of disruptive (HR, 1.32; 95% CI, 1.24e1.41) and internalising (HR, 1.36; 95% CI, 1.20e1.53) behavioural disorders were identified, and also increased hazards of attention-deficit/hyperactivity disorder (HR, 1.32; 95% CI, 1.22e1.43), behavioural disorders (HR, 1.28; 95% CI, 1.14e1.42), developmental speech or language disorders (HR, 1.16; 95% CI, 1.05e1.28), and autism (HR, 1.31; 95% CI, 1.05e1.64).
Researchers found that prenatal exposure to general anaesthesia is associated with a 31% increased risk for a subsequent diagnosis of a disruptive or internalising behavioural disorder in children. However, caution is advised when making any clinical decisions regarding care of pregnant women, as avoidance of necessary surgery during pregnancy can have detrimental effects on mothers and their children.