Receiving anesthesia during pregnancy does not interfere with the development of the child

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A study by Belgian researchers and published in the scientific journal Anaesthesia found no link between a woman’s prenatal exposure to anesthesia and the child’s neurodevelopmental outcomes. This is the most extensive work to date to study the subject, with more than 500 children evaluated. The suspicion was that if a woman received general anesthesia during pregnancy it could interfere with the long-term development of the child.

To arrive at the results, researchers analyzed the neurodevelopment of 129 children between 2 and 18 years old, born between 2001 and 2018, whose mothers received anesthesia during the prenatal period. They were compared with 453 other children who were not exposed to any surgical procedures while in the mother’s womb. Those who were exposed to obstetric anesthesia (cesarean delivery) or intrauterine fetal surgeries were excluded from the survey.

Although the need for anesthesia during pregnancy is rare, researchers point out that about 1% of women need to undergo the procedure as a result of non-obstetric surgery (problems not related to pregnancy), such as an emergency operation to treat appendicitis or to remove a tumor.

To compare the children’s development, the scientists applied a series of standardized tools that included parent questionnaires and assessments of the children’s executive function, psychosocial problems, behavioral variations, diagnosis of any psychiatric problems (such as autism, bipolar disorder, schizophrenia, anxiety, dyslexia) and learning disorders.

Adjustments were made for demographic and social variables. According to the survey, 90% of children exposed to anesthesia during prenatal care received it only once, with mothers’ abdominal surgery being the most frequent. No developmental differences and no significant impairment were found between groups exposed and unexposed to anesthesia.

The researchers highlighted the importance of this work by pointing out that a previous study carried out in rats indicated that general anesthesia during pregnancy could induce neuronal damage in the fetus and impair learning and memory. However, there was not enough evidence to bring this scenario to clinical practice.

The authors also said that the FDA published a warning in 2016 saying that the repeated or prolonged use of general anesthesia in pregnant women during the third trimester could harm the children’s neurological development. They point out, however, that despite the results of this new study, the recommendations to avoid anesthesia and to postpone the procedure whenever possible remain the same.

Surgery always has risks.

According to pediatrician Linus Pauling Fascina, medical manager of the Maternal and Child Department at Hospital Israelita Albert Einstein, usually pregnant women who undergo anesthesia during prenatal care need to treat urgent problems that cannot be postponed, such as cases involving risk of life for the mother.

“Whenever possible, we try to postpone the surgery so as not to subject this woman and the baby to the risks of the anesthetic and the entire surgical procedure itself”, he says.

Fascina points out that the risks are not limited to anesthesia and listed a series of factors that need to be evaluated: the first of them, he explains, is that, every time a person undergoes a surgical procedure, he “breaks” the natural protection of organs.

“From the moment that an incision is made with a scalpel, that we enter deeper into a cavity, this can trigger an inflammatory process that the pregnant woman’s body interprets as a sign to start an early labor”, he said.

Another factor pointed out by Linus is that even though there is asepsis, cleaning and hygiene in the surgical environment, there is always the risk of the woman suffering a hospital infection, which can also affect the fetus. In addition, the infection process can trigger a thrombotic phenomenon, which happens when thrombi break loose and obstruct the placenta, impairing the baby’s nutrition. There is also a risk of a clotting disorder, with increased bleeding. “All of these risk factors can lead the pregnant woman’s body to start early labor,” she said.

According to Fascina, anesthetics are increasingly safe and modern and the results of this study are important to reinforce the safety of mothers and professionals, in case the pregnant woman needs to undergo anesthesia.

“Due to these many other risk factors, it is still recommended to postpone surgery in pregnant women whenever possible. But, if this is not possible, [do ponto de vista anestésico] women can have the surgery safely because it won’t impact the baby’s development”, concluded the doctor.

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