Abstract
OBJECTIVE: Induction of labour (IOL) from 37 weeks for various indications is associated with a reduction in perinatal deaths compared to expectant management, though absolute rates are small. The incidence of IOL has been rising. The effects of IOL from 37 weeks on childhood neurodevelopment however are not well studied. We aimed to study the influence of IOL for each week of 12 years.
STUDY DESIGN: We performed a population-based study among
liveborn singletons from 37+0-42+6 weeks of gestation in cephalic
presentation born in 2003-2008 from uncomplicated pregnancies (no hypertensive disorders, diabetes or birthweight < p5). Children with congenital anomalies, of non-Western ethnicity and born after
planned cesarean section were excluded. Birth records were linked with national data on standardized school achievement at age 11-12
(rates 501-550).
We compared, using a fetus-at-risk approach and per week of
gestation, school performance in those born after IOL to those born after expectant management, i.e. spontaneous onset of labour in the
same week plus all those born at later gestations. Education scores
were standardized to a mean of 0 and a S.D. of 1 and adjusted in the
regression analyses.
RESULTS: We included 226,684 children. At each week of gestation,
IOL was associated with a decreased mean education score compared
with expectant management (at 37 weeks -0.96, 95%CI -1.43 to
-0.50; at 42 weeks -0.52, 95%CI -1.00 to -0.04; Table 1). Adjusted mean education z-score was -0.10 (-0.15 to -0.05) lower after IOL
compared to expectant management at 37 weeks (Figure 1). At each gestational week between 38 and 42 weeks we found comparable differences in mean education z-score, favoring expectant
management.
CONCLUSION: Consistently, at every week of gestation from 37-42 weeks, IOL at term in uncomplicated pregnancies significantly reduces
offspring school performance at age 12 compared to expectant management. Residual confounding may remain. These long-term effects should be incorporated in decisions around IOL.
STUDY DESIGN: We performed a population-based study among
liveborn singletons from 37+0-42+6 weeks of gestation in cephalic
presentation born in 2003-2008 from uncomplicated pregnancies (no hypertensive disorders, diabetes or birthweight < p5). Children with congenital anomalies, of non-Western ethnicity and born after
planned cesarean section were excluded. Birth records were linked with national data on standardized school achievement at age 11-12
(rates 501-550).
We compared, using a fetus-at-risk approach and per week of
gestation, school performance in those born after IOL to those born after expectant management, i.e. spontaneous onset of labour in the
same week plus all those born at later gestations. Education scores
were standardized to a mean of 0 and a S.D. of 1 and adjusted in the
regression analyses.
RESULTS: We included 226,684 children. At each week of gestation,
IOL was associated with a decreased mean education score compared
with expectant management (at 37 weeks -0.96, 95%CI -1.43 to
-0.50; at 42 weeks -0.52, 95%CI -1.00 to -0.04; Table 1). Adjusted mean education z-score was -0.10 (-0.15 to -0.05) lower after IOL
compared to expectant management at 37 weeks (Figure 1). At each gestational week between 38 and 42 weeks we found comparable differences in mean education z-score, favoring expectant
management.
CONCLUSION: Consistently, at every week of gestation from 37-42 weeks, IOL at term in uncomplicated pregnancies significantly reduces
offspring school performance at age 12 compared to expectant management. Residual confounding may remain. These long-term effects should be incorporated in decisions around IOL.
| Original language | English |
|---|---|
| Article number | 1152 |
| Pages (from-to) | S728-S729 |
| Journal | American Journal of Obstetrics and Gynecology |
| Volume | 226 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 1 Jan 2022 |
Keywords
- Obstertics