Influence of smoking and socioeconomic status on labor analgesia: a nationwide register-based study in Finland.

PURPOSE: Labor pain can be treated by medical and non-medical analgesia. Smoking during pregnancy has been shown to increase the incidence of several complications and may influence analgesic effectiveness. Previous studies have linked socioeconomic status to the use of epidurals for labor analgesia. We aimed to determine whether smoking and socioeconomic status influence the use of labor analgesia in Finland. METHODS: From January 1, 2004 to December 31, 2018, we collected data from the national Finnish Medical Birth Register on smoking status, labor analgesia, and socioeconomic status during pregnancy. These categorized variables were presented as absolute numbers and percentages. We included data on singleton pregnancies and excluded any data on pregnancies that missed smoking or socioeconomic status. RESULTS: 71,603 women smoked during the first trimester, 42,079 women continued to smoke after the first trimester, and 641,449 were non-smokers. The four most used labor analgesia were nitrous oxide, epidural, other medical analgesia, and non-medical analgesia. The most frequently used analgesia was nitrous oxide, which was used by 60.8% of the group of smokers after the first trimester, 58.8% of smokers during the first trimester, and 54.5% of non-smokers. There were no substantial differences between socioeconomic status classes and labor analgesia used. CONCLUSION: Women who continued smoking after the first trimester used labor analgesia more often than non-smokers. There were no clear differences between socioeconomic status classes and labor analgesia used. These findings highlight the need to reduce maternal smoking during pregnancy, and universal social healthcare systems should promote equality in labor analgesia.

The association between epidural labor analgesia and the fetal outcome and mode of delivery of the second twin: a nationwide register-based cohort study in Finland.

BACKGROUND: The aim of this study was to assess the association between epidural labor analgesia and the mode of delivery for the second twin and to analyze the health outcomes of the second twin. METHODS: In this nationwide, retrospective, register-based cohort study, data from the National Medical Birth Register (MBR) of Finland (2004-2018) were used to analyze the association between epidural analgesia and delivery mode (emergency and urgent cesarean section, and assisted vaginal delivery) and fetal outcomes (neonatal mortality and need for intensive care unit admission) for the second twin. Multivariable logistic regression was used to assess the delivery mode and fetal outcomes of the second twin. RESULTS: A total of 3242 twin pregnancies with epidural analgesia were compared with a control group consisting of 2780 twin pregnancies without epidural analgesia. Epidural analgesia was associated with lower odds for all cesarean delivery (aOR 0.64, 95% CI 0.44 to 0.92) for the second twin and for emergency cesarean delivery (aOR 0.52, 95% CI 0.33 to 0.79) when compared with the odds for the second twin in the control group. Epidural analgesia was associated with lower odds of neonatal mortality for the second twin (aOR 0.61, 95% CI 0.73 to 0.90). CONCLUSION: This study found epidural labor analgesia was associated with a lower rate of emergency cesarean delivery and neonatal mortality for the second twin. These results should be acknowledged by obstetricians and anesthesiologists when planning optimal peripartum management for mothers with twin pregnancies.