III. Medical Hazards: Research Warnings

Epidural Anesthesia During Labor: Effects on Newborn Habituation and Novelty Preference.

By Gail A. Brumitt, Poster, International Conference on Infant Studies, Paris (June), 1994.

This study will add fuel to a long-lasting debate on the negative effects of obstetric anesthesias on newborn babies. This is the first study to demonstrate that maternal epidural anesthesia via continuous infusion of bupivacaine and fentanyl"by far the most popular form of anesthesia in childbirth today--adversely affects newborn visual habituation as well as immediate novelty preference, two important aspects of cognitive processing. Faster habituation is an indication of more efficient information processing. These results are consistent with auditory habituation studies done earlier by Brackbill, Conway and Brackbill, and Van der Maelen. The epidural-exposed infants showed a lower rate of habituation and required more trials to habituate. Newborns who did not have the epidural exposure preferred the novel stimulus, which is the characteristically normal, curious, and perceptive response. The epidural babies did not react to the novel item when it was presented. While any evidence of cognitive impairment from anesthetics is an ominous sign, this research informs us only about the newborn period close to birth.

Effects of Frequent Ultrasound During Pregnancy: A Randomized Controlled Trial.

By J.P. Newnham, S.F. Evans, C.A. Michael, F.J. Stanley, and L.I. Landau (1993). The Lancet, 342 (Oct.9), 887-891.

A study of over 1400 women in Perth, Western Australia compared pregnant mothers who had ultrasound only once during gestation with mothers who had five monthly ultrasounds from 18 weeks to 38 weeks. They found significantly higher intrauterine growth restriction in the intensive ultrasound group. These mothers gave birth to lower weight babies. The researchers concluded that prenatal ultrasound imaging and Doppler flow exams should be restricted to clinically necessary situations. This recommendation comes at a time when ultrasound during prenatal visits has become increasingly popular and serves as a kind of entertainment feature of office check-up visits.

Case-Controlled Study of Prenatal Ultrasound Exposure in Children with Delayed Speech.

By J.D. Campbell, R.W. Elford and R.F. Brant (1993). Canadian Medical Association Journal, 149(10), 1435-1440.

Delayed speech is not a pathological or organic syndrome but a developmentally defined symptom complex. Clinicians have noted an increased incidence of delayed speech in pediatric patients. This is a matched-case control study of 72 children 2 to 8 years old presenting with delayed speech of unknown cause. The children were measured for articulation, language comprehension, language production, meta-linguistic skills, and verbal memory. When checked for ultrasound exposure, the speech-delayed children were about twice as likely to have been exposed to ultrasound than the matched controls. The authors believe that delayed speech is a sensitive measure reflecting sub-optimal conditions for development. If ultrasound can cause developmental delays, the authors are concerned about the routine use of ultrasound and they warn against it.

Obstetric Pain Medication and Eventual Adult Amphetamine Addiction in Offspring.

By By Bertil Jacobson, K. Nyberg, G. Eklund, M. Bygdeman, and U. Rydberg (1990). Acta Obstetrica and Gynecol. Scandinavica, 67, 677-682.

The purpose of this study was to investigate whether general anesthetic, especially nitrous oxide, creates a risk that the infant might develop amphetamine addiction in later life. They did confirm this in a group of 200 addicts born from 1945-1966 in Stockholm in the hospital where pain medications were administered in large doses. In a blind matched-comparison of 73 addicts with 109 non-addicted siblings, they showed the risk for amphetamine addiction increased with the duration of intermittant administration of pure nitrous oxide. The risk of addiction was 5.6 times greater when nitrous oxide had been given for about 4.5 hours. They think these estimated risks are underestimates.

Opiate Addiction in Adult Offspring Through Possible Imprinting After Obstetric Treatment.

By Bertil Jacobson, K. Nyberg, L. Gronbladh, G. Eklund, M. Bygdeman, and U. Rydberg (1990). British Medical Journal, 301, 1067-1070.

Using data on 200 opiate addicts born in Stockholm during 1945-1966 and 230 siblings, this team found that a significant proportion of mothers of addicts had received opiates or barbiturates, and nitrous oxide during delivery, compared with siblings. The relative risk for offspring to become addicts increased with the number of administrations of any of these three drugs. When addicts were matched with their own siblings, the estimated relative risk was 4.7 for three administrations compared to no drugs given. Drug effects increased when administered from 10 hours to birth. Such results followed the same pattern as their previously published data on amphetamine addiction, suggesting a dose-related effect"more anesthetics leads to more addicts. They believe the evidence supports the theory of imprinting during the hours surrounding birth, probably mediated by the peak flow of catecholamines at that time. The predominence of male addicts may trace to their higher concentrations of circulating testosterone at birth, which facilitates imprinting. These researchers link the first use of heavy analgesia and sedation in the 1940,s with the phenomenal increase in drug misuse in the 1960,s.