Effects of maternal anesthesia exposure during pregnancy on pregnancy outcome and neurodevelopment of offspring

PENG Rui, YUAN Hongmei

Chinese Journal of Child Health Care ›› 2023, Vol. 31 ›› Issue (11) : 1225-1229.

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Chinese Journal of Child Health Care ›› 2023, Vol. 31 ›› Issue (11) : 1225-1229. DOI: 10.11852/zgetbjzz2023-0109
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Effects of maternal anesthesia exposure during pregnancy on pregnancy outcome and neurodevelopment of offspring

  • PENG Rui, YUAN Hongmei
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Abstract

With the improvement of medical technology, an increasing number of women need to receive anesthesia during pregnancy because of surgery, and medical workers gradually pay attention to the impact of anesthesia exposure during pregnancy on the neurodevelopment of offspring. Much of exploration of the neurotoxicity of anesthetics comes from preclinical studies in rodents and nonhuman primates, which are different from the data of these animal studies and previous retrospective cohort studies in humans. Human studies in this field are limited and currently inconclusive. In 2016, the United States Food and Drug Administration issued a warning regarding impaired brain development after exposure to certain anesthetic agents used for general anesthesia in the third trimester of pregnancy. Furthermore, it is also recommended that healthcare professionals balance the benefits and potential risks of anesthesia in infants and pregnant women. However, women may be exposed to narcotic drugs at any stage of pregnancy. Therefore, this paper summarizes the effects of maternal exposure to general anesthesia during early (<14 weeks), mid(14 - 27 weeks), and late pregnancy(≥28 weeks) on the neurodevelopment and cognitive function of their offspring.

Key words

pregnancy / anesthesia exposure / offspring / neurodevelopment

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PENG Rui, YUAN Hongmei. Effects of maternal anesthesia exposure during pregnancy on pregnancy outcome and neurodevelopment of offspring[J]. Chinese Journal of Child Health Care. 2023, 31(11): 1225-1229 https://doi.org/10.11852/zgetbjzz2023-0109

References

[1] Colón-Ramos DA. Synapse formation in developing neural circuits[J]. Curr To Dev Biol, 2009, 87:53-79.
[2] Jevtovic-Todorovic V, Hartman RE, Izumi Y, et al. Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits[J]. J Neurosci, 2003, 23(3):876-882.
[3] Fisher SC, Siag K, Howley MM, et al. Maternal surgery and anesthesia during pregnancy and risk of birth defects in the National Birth Defects Prevention Study, 1997-2011[J]. Birth Defects Res, 2020, 112(2):162-174.
[4] Lin J, Wang S, Feng Y, et al. Propofol exposure during early gestation impairs learning and memory in rat offspring by inhibiting the acetylation of histone[J]. J Cell Mol Med, 2018, 22(5):2600-2611.
[5] Yu X, Ma F, Cao X, et al. Effects of the application of general anesthesia with propofol during the early stage of pregnancy on brain development and function of SD rat offspring and the intervention of DHA[J]. Neurol Res, 2019, 41(11):1008-1014.
[6] Cui FH, Li J, Li KZ, et al. Effects of sevoflurane exposure during different stages of pregnancy on the brain development of rat offspring[J]. J Anesth, 2021, 35(5):654-662.
[7] Slater BL. Multiple anaesthetics during pregnancy. A case report[J]. Br J Anaesth, 1970, 42(12):1131-1134.
[8] Brodsky JB, Cohen EN, Brown BW Jr, et al. Surgery during pregnancy and fetal outcome[J]. Am J Obstet Gynecol, 1980, 138(8):1165-1167.
[9] Konieczko KM, Chapple JC, Nunn JF. Fetotoxic potential of general anaesthesia in relation to pregnancy[J]. Br J Anaesth, 1987, 59(4):449-454.
[10] Czeizel AE, Pataki T, Rockenbauer M. Reproductive outcome after exposure to surgery under anesthesia during pregnancy[J]. Arch Gynecol Obstet, 1998, 261(4):193-199.
[11] Cohen-Kerem R, Railton C, Oren D, et al. Pregnancy outcome following non-obstetric surgical intervention[J]. Am J Surg, 2005, 190(3):467-473.
[12] Spence AA. Environmental pollution by inhalation anaesthetics[J]. Br J Anaesth, 1987, 59(1):96-103.
[13] Lawson CC, Rocheleau CM, Whelan EA, et al. Occupational exposures among nurses and risk of spontaneous abortion[J]. Am J Obstet Gynecol, 2012, 206(4):327.e1-327.e3278.
[14] Committee Opinion No. 696: Nonobstetric surgery during pregnancy[J]. Obstet Gynecol, 2017, 129(4):777-778.
[15] Franze K. The mechanical control of nervous system development[J]. Development, 2013, 140(15):3069-3077.
[16] Zou S, Wei ZZ, Yue Y, et al. Desflurane and surgery exposure during pregnancy decrease synaptic integrity and induce functional deficits in juvenile offspring mice[J]. Neurochem Res, 2020, 45(2):418-427.
[17] Zhang Y, Wu Z, Li X, et al. Maternal sevoflurane exposure affects differentiation of hippocampal neural stem cells by regulating miR-410-3p and ATN1[J]. Stem Cell Res Ther, 2020, 11(1):423.
[18] Chen D, Qi X, Zhuang R, et al. Prenatal propofol exposure downregulates NMDA receptor expression and causes cognitive and emotional disorders in rats[J]. Eur J Pharmacol, 2019, 843:268-276.
[19] Olutoye OA, Sheikh F, Zamora IJ, et al. Repeated isoflurane exposure and neuroapoptosis in the midgestation fetal sheep brain[J]. Am J Obstet Gynecol, 2016, 214(4):542.e1-542.e8.
[20] Olutoye OA, Baker BW, Belfort MA, et al. Food and Drug Administration warning on anesthesia and brain development: Implications for obstetric and fetal surgery[J]. Am J Obstet Gynecol, 2018, 218(1):98-102.
[21] Wang Y, Yin S, Xue H, et al. Mid-gestational sevoflurane exposure inhibits fetal neural stem cell proliferation and impairs postnatal learning and memory function in a dose-dependent manner[J]. Dev Biol, 2018, 435(2):185-197.
[22] Wu Z, Li X, Zhang Y, et al. Effects of sevoflurane exposure during mid-pregnancy on learning and memory in offspring rats: Beneficial effects of maternal exercise[J]. Front Cell Neurosci, 2018, 12:122.
[23] Devroe S, Bleeser T, Van de Velde M, et al. Anesthesia for non-obstetric surgery during pregnancy in a tertiary referral center: A 16-year retrospective, matched case-control, cohort study[J]. Int J Obstet Anesth, 2019, 39:74-81.
[24] Fu PH, Yu CH, Chen YC, et al. Risk of adverse fetal outcomes following nonobstetric surgery during gestation:A nationwide population-based analysis[J]. BMC Pregnancy Childbirth, 2022, 22(1):406.
[25] Zhong L, Luo F, Zhao W, et al. Propofol exposure during late stages of pregnancy impairs learning and memory in rat offspring via the BDNF-TrkB signalling pathway[J]. J Cell Mol Med, 2016, 20(10):1920-1931.
[26] Devroe S, Van der Veeken L, Bleeser T, et al. The effect of xenon on fetal neurodevelopment following maternal sevoflurane anesthesia and laparotomy in rabbits[J]. Neurotoxicol Teratol, 2021, 87:106994.
[27] Hirotsu A, Iwata Y, Tatsumi K, et al. Maternal exposure to volatile anesthetics induces IL-6 in fetal brains and affects neuronal development[J]. Eur J Pharmacol, 2019, 863:172682.
[28] Zhao Y, Ai Y. Overexpression of lncRNA Gm15621 alleviates apoptosis and inflammation response resulting from sevoflurane treatment through inhibiting miR-133a/Sox4[J]. J Cell Physiol, 2020, 235(2):957-965.
[29] Van der Veeken L, Emam D, Bleeser T, et al. Fetal surgery has no additional effect to general anesthesia on brain development in neonatal rabbits[J]. Am J Obstet Gynecol MFM, 2022, 4(1):100513.
[30] Huang W, Dong Y, Zhao G, et al. Influence of isoflurane exposure in pregnant rats on the learning and memory of offsprings[J]. BMC Anesthesiol, 2018, 18(1):5.
[31] Suehara T, Morishita J, Ueki M, et al. Effects of sevoflurane exposure during late pregnancy on brain development of offspring mice[J]. Paediatr Anaesth, 2016, 26(1):52-59.
[32] Gluncic V, Moric M, Chu Y, et al. In utero exposure to anesthetics alters neuronal migration pattern in developing cerebral cortex and causes postnatal behavioral deficits in rats[J]. Cereb Cortex, 2019, 29(12):5285-5301.
[33] McClaine RJ, Uemura K, de la Fuente SG, et al. General anesthesia improves fetal cerebral oxygenation without evidence of subsequent neuronal injury[J]. J Cereb Blood Flow Metab, 2005, 25(8):1060-1069.
[34] Hashemi SJ, Jabalameli M, Mokhtary F. Effects of different anesthetic techniques on neurologic and adaptation capacity in newborn with elective cesarean section[J]. Adv Biomed Res, 2015, 4:249.
[35] Dick WF. Anaesthesia for caesarean section (epidural and general):Effects on the neonate[J]. Eur J Obstet Gynecol Reprod Biol, 1995, 59(Suppl):61-67.
[36] Sprung J, Flick RP, Wilder RT, et al. Anesthesia for cesarean delivery and learning disabilities in a population-based birth cohort[J]. Anesthesiology, 2009, 111(2):302-310.
[37] 张瑾,陈亮,姚淑萍,等.《中国产科麻醉专家共识(2017)》解读[J].河北医科大学学报,2019,40(2):128-132.
Zhang J, Chen L, Yao S, et al. Interpretation of the expert consensus on obstetric Anesthesia in China (2017)[J]. Hebei Med Univ,2019,40(2):128-132.(in Chinese)
[38] 沈晓凤, 姚尚龙.分娩镇痛专家共识(2016版)[J].临床麻醉学杂志,2016,32(8):816-818.
Shen X, Yao S. Expert Consensus on labor analgesia (2016)[J]. J Clin Anesthesiol,2016,32(8):816-818.(in Chinese)
[39] 刘梅,侯玉萍.镇痛分娩临床应用的研究进展[J].医学综述,2019,25(24):4960-4964.
Liu M, Hou Y. Research progress in clinical application of labor analgesia[J]. Med Recapitulate,2019,25(24):4960-4964.(in Chinese)
[40] Weiner E, Mizrachi Y, Keidar R, et al. Laparoscopic surgery performed in advanced pregnancy compared to early pregnancy[J]. Arch Gynecol Obstet, 2015, 292(5):1063-1068.
[41] Kwon H, Lee M, Park HS, et al. Laparoscopic management is feasible for nonobstetric surgical disease in all trimesters of pregnancy[J]. Surg Endosc, 2018, 32(6):2643-2649.
[42] Floyd TF, Khmara K, Lamm R, et al. Hypoxia, hypercarbia, and mortality reporting in studies of anaesthesia-related neonatal neurodevelopmental delay in rodent models: A systematic review[J]. Eur J Anaesthesiol, 2020, 37(2):70-84.
[43] Bleeser T, Van Der Veeken L, Fieuws S, et al. Effects of general anaesthesia during pregnancy on neurocognitive development of the fetus: A systematic review and meta-analysis[J]. Br J Anaesth, 2021, 126(6):1128-1140.
[44] Anand KJ, Soriano SG. Anesthetic agents and the immature brain: Are these toxic or therapeutic?[J]. Anesthesiology, 2004, 101(2):527-530.
[45] 黄星辉,李师阳,姚伟瑜.产科全身麻醉的新进展[J].医学综述,2014, 20(18):3383-3384,3396.
Huang XH, Li SY, Yao WY. Recent progress in obstetric general anesthesia[J]. Med Recapitulate,2014,20(18):3383-3384,3396.(in Chinese)
[46] Horvath B, Kloesel B, Todd MM, et al. The evolution, current value, and future of the American Society of Anesthesiologists Physical Status Classification System[J]. Anesthesiology, 2021, 135(5):904-919.
[47] Okeagu CN, Anandi P, Gennuso S, et al. Clinical management of the pregnant patient undergoing non-obstetric surgery: Review of guidelines[J]. Best Pract Res Clin Anaesthesiol, 2020, 34(2):269-281.
[48] 陈彬,严雨霖,杜海雯,等.人工智能在产科超声中的应用进展[J].医学综述,2022,28(14):2903-2907.
Chen B, Yan Y, Du H, et al. Application progress of artifical intelligence in obstetric ultrasonography[J]. Med Recapitulate,2022,28(14):2903-2907.(in Chinese)
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