{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T14:21:02Z","timestamp":1783952462159,"version":"3.55.0"},"reference-count":27,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology & Obste"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Epidural labor analgesia is increasingly integrated into patient centered maternity care, yet its real\u2010world associations with maternal morbidity and early neonatal infection remain incompletely defined. We assessed whether epidural analgesia is associated with clinician\u2010diagnosed early neonatal infection and selected maternal complications among term singleton vaginal births in routine care.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 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\u2009cm on maternal request. The primary outcome was clinician\u2010diagnosed neonatal infection within 3\u2009days, defined by chart\u2010recorded diagnoses of neonatal sepsis, infection specific to the perinatal period, or neonatal pneumonia, rather than uniformly culture\u2010confirmed 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 3342 screened deliveries, 2902 met eligibility criteria (epidural 1170; control 1732). In the unmatched cohort, clinician\u2010diagnosed 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\u2010diagnosed 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\u2010minute Apgar impairment was uncommon and did not differ materially.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n 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\u2010diagnosed early neonatal infection within a surveillance\u2010sensitive institutional care pathway. These findings should not be interpreted as evidence of a direct increase in culture\u2010confirmed neonatal infectious morbidity.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ijgo.71208","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T13:36:53Z","timestamp":1783949813000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of epidural labor analgesia with clinician\u2010diagnosed early neonatal infection and maternal morbidity in routine care: A propensity score\u2013matched cohort study"],"prefix":"10.1002","author":[{"given":"Bin","family":"Xia","sequence":"first","affiliation":[{"name":"Department of Obstetrics The First People's Hospital of Kunshan Kunshan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"YaPing","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Obstetrics The First People's Hospital of Kunshan Kunshan China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"issue":"9","key":"e_1_2_12_2_1","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2024.33730","article-title":"Epidural analgesia during labor and neonatal hypoxic\u2010ischemic encephalopathy","volume":"7","author":"Cornet MC","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"1","key":"e_1_2_12_3_1","doi-asserted-by":"crossref","DOI":"10.1080\/14767058.2025.2509147","article-title":"Labor epidural analgesia and autism spectrum disorder in 3\u2010year\u2010old offspring based on data from the Japan environment and children's study: a prospective cohort study","volume":"38","author":"Fukuda T","year":"2025","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"12","key":"e_1_2_12_4_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2024-090208","article-title":"Impact of dexmedetomidine\u2010ropivacaine versus sufentanil\u2010ropivacaine combination for epidural labour analgesia on neonatal outcomes: a pilot randomised clinical trial","volume":"14","author":"Jin KX","year":"2024","journal-title":"BMJ Open"},{"issue":"2","key":"e_1_2_12_5_1","doi-asserted-by":"crossref","DOI":"10.1080\/14767058.2023.2278020","article-title":"Risk factors for failure of conversion from epidural labor analgesia to cesarean section anesthesia and general anesthesia incidence: an updated meta\u2010analysis","volume":"36","author":"Li P","year":"2023","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"3","key":"e_1_2_12_6_1","doi-asserted-by":"crossref","first-page":"e208","DOI":"10.1097\/AOG.0000000000003132","article-title":"ACOG Practice Bulletin No. 209: obstetric analgesia and anesthesia","volume":"133","author":"American College of Obstetricians and Gynecologists' Committee on Practice Bulletins\u2014Obstetrics","year":"2019","journal-title":"Obstet Gynecol"},{"key":"e_1_2_12_7_1","doi-asserted-by":"crossref","first-page":"5063","DOI":"10.2147\/DDDT.S488920","article-title":"Programmed intermittent epidural bolus vs manual epidural bolus for labor analgesia initiation: a randomized non\u2010inferiority trial","volume":"18","author":"Lu Y","year":"2024","journal-title":"Drug Des Devel Ther"},{"issue":"5","key":"e_1_2_12_8_1","doi-asserted-by":"crossref","first-page":"1240","DOI":"10.1016\/j.bja.2025.07.084","article-title":"Association of labour epidural analgesia exposure with infant neurodevelopment: secondary analysis of a prospective cohort study","volume":"135","author":"Tao S","year":"2025","journal-title":"Br J Anaesth"},{"issue":"1","key":"e_1_2_12_9_1","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-025-07155-5","article-title":"Association of epidural labor analgesia with maternal and neonatal outcomes in women with preeclampsia: a propensity score\u2010matched single\u2010center retrospective cohort study","volume":"25","author":"Wu XZ","year":"2025","journal-title":"BMC Pregnancy Childbirth"},{"issue":"3","key":"e_1_2_12_10_1","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1007\/s12630-022-02389-9","article-title":"Comparison of different delivery modalities of epidural analgesia and intravenous analgesia in labour: a systematic review and network meta\u2010analysis","volume":"70","author":"Wydall S","year":"2023","journal-title":"Can J Anaesth"},{"issue":"22","key":"e_1_2_12_11_1","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000038363","article-title":"Effect of different concentrations of sufentanil combined with ropivacaine on epidural fever during labor: a single\u2010center retrospective study","volume":"103","author":"Zhang S","year":"2024","journal-title":"Medicine (Baltimore)"},{"key":"e_1_2_12_12_1","doi-asserted-by":"crossref","first-page":"117","DOI":"10.2147\/LRA.S499370","article-title":"The maternal and neonatal glycemic stress response in normal vaginal delivery: a comparative study between epidural and parenteral opioids analgesia","volume":"17","author":"Alhowary AA","year":"2024","journal-title":"Local Reg Anesth"},{"issue":"1","key":"e_1_2_12_13_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.xagr.2024.100324","article-title":"Comparative effects of epidural analgesia and intramuscular morphine on maternal and neonatal outcomes: a retrospective cohort study","volume":"4","author":"Elsayed A","year":"2024","journal-title":"AJOG Glob Rep"},{"key":"e_1_2_12_14_1","doi-asserted-by":"crossref","first-page":"4373","DOI":"10.2147\/DDDT.S521681","article-title":"Comparison of the dural puncture epidural and conventional epidural analgesia maintained using programmed epidural boluses for labor analgesia","volume":"19","author":"Mo X","year":"2025","journal-title":"Drug Des Devel Ther"},{"key":"e_1_2_12_15_1","doi-asserted-by":"crossref","first-page":"11547","DOI":"10.2147\/DDDT.S565516","article-title":"Addition of lidocaine to ropivacaine and sufentanil for epidural labour analgesia: a randomised double\u2010blind study on the incidence of epidural\u2010related maternal fever","volume":"19","author":"Shen Y","year":"2025","journal-title":"Drug Des Devel Ther"},{"issue":"2","key":"e_1_2_12_16_1","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1002\/ijgo.70438","article-title":"Early versus late epidural analgesia in nulliparous women: impact on labor duration and maternal\u2010neonatal outcomes in central Vietnam","volume":"172","author":"Tran TD","year":"2026","journal-title":"Int J Gynaecol Obstet"},{"issue":"12","key":"e_1_2_12_17_1","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000037509","article-title":"Efficacy and safety of nalbuphine for epidural labor analgesia at high altitude: an observational study","volume":"103","author":"Wang P","year":"2024","journal-title":"Medicine (Baltimore)"},{"issue":"6","key":"e_1_2_12_18_1","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1136\/rapm-2024-105468","article-title":"Comparison of the dural puncture epidural and the standard epidural techniques in patients having labor analgesia maintained using programmed epidural boluses: a prospective double\u2010blinded randomized clinical trial","volume":"50","author":"Yao HQ","year":"2025","journal-title":"Reg Anesth Pain Med"},{"issue":"7","key":"e_1_2_12_19_1","doi-asserted-by":"crossref","first-page":"5679","DOI":"10.62347\/WQTE9989","article-title":"Effects of combined spinal\u2010epidural anesthesia and epidural analgesia on pain and blood pressure in preeclamptic women undergoing painless delivery","volume":"17","author":"Yin D","year":"2025","journal-title":"Am J Transl Res"},{"key":"e_1_2_12_20_1","doi-asserted-by":"crossref","DOI":"10.3389\/fmed.2025.1653301","article-title":"Effect of dural puncture epidural combined with programmed intermittent epidural bolus on labor analgesia in patients with gestational hypertension: a randomized controlled clinical trial","volume":"12","author":"Zhang B","year":"2025","journal-title":"Front Med (Lausanne)"},{"key":"e_1_2_12_21_1","doi-asserted-by":"crossref","first-page":"9737","DOI":"10.2147\/DDDT.S547255","article-title":"Efficacy of intravenous butorphanol for preventing epidural\u2010related maternal fever (ERMF) during epidural labor analgesia: a randomized, double\u2010blind, placebo\u2010controlled clinical trial","volume":"19","author":"Zhang Y","year":"2025","journal-title":"Drug Des Devel Ther"},{"issue":"5","key":"e_1_2_12_22_1","doi-asserted-by":"crossref","first-page":"1797","DOI":"10.4103\/jfmpc.jfmpc_1508_24","article-title":"Epidural analgesia and rate of cesarean section, maternal and neonatal outcomes: retrospective study","volume":"14","author":"Almansouri N","year":"2025","journal-title":"J Family Med Prim Care"},{"issue":"1","key":"e_1_2_12_23_1","first-page":"130","article-title":"Epidural analgesia for labor: effects on length of labor and maternal and neonatal outcomes","volume":"27","author":"He FY","year":"2023","journal-title":"Eur Rev Med Pharmacol Sci"},{"issue":"6","key":"e_1_2_12_24_1","doi-asserted-by":"crossref","first-page":"491","DOI":"10.23736\/S0375-9393.24.17921-7","article-title":"Epidural analgesia and neonatal short\u2010term outcomes during routine childbirth: a 10\u2010year retrospective analysis from the national birth registry of Austria","volume":"90","author":"Kraft F","year":"2024","journal-title":"Minerva Anestesiol"},{"issue":"4","key":"e_1_2_12_25_1","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1038\/s41372-024-01893-8","article-title":"Association of epidural analgesia in labor with neurodevelopmental outcomes in premature infants born at <29\u2009weeks of gestational age","volume":"44","author":"Lodha A","year":"2024","journal-title":"J Perinatol"},{"issue":"10","key":"e_1_2_12_26_1","doi-asserted-by":"crossref","first-page":"999","DOI":"10.4103\/ija.ija_802_25","article-title":"Application efficacy of dural puncture epidural versus traditional combined spinal epidural for labour analgesia: a systematic review and meta\u2010analysis with trial sequential analysis","volume":"69","author":"Qin J","year":"2025","journal-title":"Indian J Anaesth"},{"issue":"3","key":"e_1_2_12_27_1","article-title":"Neonatal outcomes in labor after intravenous remifentanil analgesia vs. epidural analgesia: a retrospective observational study","volume":"16","author":"Sobot Novakovic S","year":"2024","journal-title":"Cureus"},{"issue":"7","key":"e_1_2_12_28_1","doi-asserted-by":"crossref","DOI":"10.1002\/iid3.869","article-title":"Comparisons of nonpharmaceutical analgesia and pharmaceutical analgesia on the labor analgesia effect of parturient women","volume":"11","author":"Zhu R","year":"2023","journal-title":"Immun Inflamm Dis"}],"container-title":["International Journal of Gynecology & Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.71208","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ijgo.71208","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.71208","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T13:36:57Z","timestamp":1783949817000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/ijgo.71208"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,13]]},"references-count":27,"alternative-id":["10.1002\/ijgo.71208"],"URL":"https:\/\/doi.org\/10.1002\/ijgo.71208","archive":["Portico"],"relation":{},"ISSN":["0020-7292","1879-3479"],"issn-type":[{"value":"0020-7292","type":"print"},{"value":"1879-3479","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,13]]},"assertion":[{"value":"2026-02-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ijgo.71208"}}