Association of epidural labor analgesia with clinician‐diagnosed early neonatal infection and maternal morbidity in routine care: A propensity score–matched cohort study

BACKGROUND: Epidural labor analgesia is increasingly integrated into patient centered maternity care, yet its real-world associations with maternal morbidity and early neonatal infection remain incompletely defined. We assessed whether epidural analgesia is associated with clinician-diagnosed early neonatal infection and selected maternal complications among term singleton vaginal births in routine care. METHODS: We conducted a retrospective cohort study at Kunshan First People's Hospital, China, including term singleton cephalic vaginal deliveries between October 2022 and August 2023. Epidural analgesia was initiated at a cervical dilation of at least 2 cm on maternal request. The primary outcome was clinician-diagnosed neonatal infection within 3 days, defined by chart-recorded diagnoses of neonatal sepsis, infection specific to the perinatal period, or neonatal pneumonia, rather than uniformly culture-confirmed infection. Secondary outcomes included maternal intrapartum temperature elevation, urinary retention, postpartum hemorrhage, labor course measures, and Apgar scores. Propensity score matching used 1 to 1 nearest neighbor matching without replacement (caliper 0.05). Odds ratios were estimated by logistic regression with additional adjustment for total labor duration. RESULTS: Among 3342 screened deliveries, 2902 met eligibility criteria (epidural 1170; control 1732). In the unmatched cohort, clinician-diagnosed neonatal infection occurred in 5.6% versus 2.6% (odds ratio [OR] 2.21, 95% confidence interval [CI] 1.50 to 3.25). Matching yielded 723 pairs. In the matched cohort, clinician-diagnosed neonatal infection occurred in 4.7% versus 2.4% and remained associated with epidural analgesia after labor duration adjustment (adjusted OR 1.82, 95% CI 1.02 to 3.37). Epidural analgesia was associated with maternal intrapartum temperature elevation (18.4% vs. 7.6%; adjusted OR 2.05, 95% CI 1.45 to 2.94) and urinary retention (2.5% vs. 0.6%; adjusted OR 2.88, 95% CI 1.18 to 8.55). Postpartum hemorrhage was similar (2.5% vs. 2.4%; adjusted OR 1.03, 95% CI 0.51 to 2.08). Five-minute Apgar impairment was uncommon and did not differ materially. CONCLUSION: Epidural labor analgesia in routine term vaginal births was associated with higher odds of maternal intrapartum temperature elevation and urinary retention, as well as a higher likelihood of clinician-diagnosed early neonatal infection within a surveillance-sensitive institutional care pathway. These findings should not be interpreted as evidence of a direct increase in culture-confirmed neonatal infectious morbidity.