Prenatal Exposure to General Anesthesia Increases Risk of Subsequent ADHD, Behavioral Disorder Diagnosis

Prenatal exposure to anesthesia can increase the risk of that child developing attention deficit hyperactivity disorder (ADHD) and other behavioral disorders, according to investigators at the Columbia University Mailman School of Public Health and Columbia University Irving Medical Center (CUIMC) who published their findings in the British Journal of Anesthesia.¹

The investigators observed that risk of ADHD diagnosis increased by 32% and risk of a disruptive or internalizing behavioral disorder (DIBD) diagnosis increased by 31% if the child was prenatally exposed to anesthesia for maternal surgery during pregnancy.

“For several years there have been concerns about the long-term neurodevelopmental effects of anesthetic exposure in children, with the FDA in 2016 releasing a Drug Safety Communication warning against repeated or lengthy use of anesthesia in young children and pregnant women,” said first author Caleb Ing, MD, MS, associate professor of Anesthesiology and Epidemiology at Columbia Public Health and CUIMC, in the press release.

When a woman who is pregnant receives general anesthesia, that drug can actually cross the placenta, according to the study authors. While the FDA cautions this exposure, children may have other underlying health problems that can also increase their risk of getting a neurodevelopmental disorder, Ing explained.

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Investigators conducted this study because there had previously been limited data on the association between prenatal exposure to anesthesia for maternal surgery during pregnancy and risk of children developing a behavioral disorder.

During this study, investigators matched 34,271 children prenatally exposed to anesthesia with 171,355 children who were not exposed. Patient data was collected from the Medicaid Analytic eXtract, and the team defined the primary end point as DIBD diagnosis in children, and secondary outcomes as diagnoses for other neuropsychiatric disorders, including ADHD, behavioral disorders, developmental speech or language disorders, and autism.²

Investigators observed an increased hazard ratio for disruptive (HR, 1.32; 95% CI, 1.24–1.41) and internalizing (HR, 1.36; 95% CI, 1.20–1.53) behavioral disorders.They observed that prenatal anesthesia exposure also increased increased risk of ADHD by 32% (HR, 1.32; 95% CI, 1.22–1.43) and behavioral disorders by 28% (HR, 1.28; 95% CI, 1.14–1.42).

Further, the risk of a developmental speech or language disorder diagnosis increased by 16% (HR, 1.16; 95% CI, 1.05–1.28) while risk of autism diagnosis increased by 31% (HR, 1.31; 95% CI, 1.05–1.64).

However, Ing noted that it is sometimes necessary for expecting mothers to have surgery during pregnancy, so not having surgery because of anesthesia exposure could actually be riskier for the mother and child.¹

“Our findings could help inform preoperative risk assessment in pregnant women, especially when the surgical procedure is elective or when viable treatment is available,” said senior author Guohua Li, MD, DrPH, professor of Epidemiology and Anesthesiology at Columbia Mailman School and Vagelos College of Physicians and Surgeons, in the press release.

REFERENCES

1. Uptick in behavioral disorders reported in children following prenatal exposure to anesthesia. Mailman School Of Public Health at Columbia University. News Release. February 28, 2024. Accessed on March 4, 2024. https://www.eurekalert.org/news-releases/1036115
2. Ing C, Silber JH, Lackraj D, et al. Behavioral disorders after prenatal exposure to anesthesia for maternal surgery. BJA. 2024. doi:10.1016/j.bja.2024.01.025