Association of Term Labor Induction vs Expectant Management With Child Academic Outcomes

Abstract

IMPORTANCE Although labor induction at 39 weeks of gestation has been shown to reduce the number of cesarean deliveries, compared with expectant management, without increasing neonatal morbidity in nulliparous, low-risk women, the association between induction at 39 weeks and longer-term childhood cognitive outcomes is not certain. OBJECTIVE To evaluate educational outcomes of children born by induction at 39 or 40 weeks compared with those whose mothers were expectantly managed beyond those weeks. DESIGN, SETTING, AND PARTICIPANTS This statewide cohort study was conducted in Rhode Island. The participants included children of nulliparous women who were born at 39 weeks of gestation or later and then completed third-grade math and reading tests during the 2014 to 2017 academic year. Data analysis was performed from July 2019 to October 2019. EXPOSURES Induction of labor compared with expectant management. MAIN OUTCOMES AND MEASURES Third-grade math and reading test scores and proficiency (based on achievement level) among children born after induction in the 39th or 40th week were compared with scores for those who remained in utero beyond that same gestational week. The hypothesis was that induction in the 39th or 40th week would not be associated with differences in math or reading scores or proficiency compared with expectant management past the 39th or 40th week of gestation. RESULTS Of the 6393 children meeting the inclusion criteria (mean [SD] age, 8.00 [0.22] years; 3208 boys [50.2%]; 376 [5.8%] black; 1280 [22.0%] Hispanic), 455 were delivered by induction in the 39th week and 610 were delivered by induction in the 40th week. There were no differences in mean math or reading test scores or in the frequency of math or reading proficiency between children delivered by induction at 39 or 40 weeks compared with those whose mothers were expectantly managed (overall mean [SD] math score, 744 [33]; overall mean [SD] reading score, 743 [38]; 2945 children [46%] achieved proficiency in math and 2833 [44%] achieved proficiency in reading). After adjusting for plausible confounders (race/ethnicity, maternal education, hypertension, diabetes, and socioeconomic status), induction continued to be associated with similar proficiency in math and reading compared with expectant management. For children born by induction at 39 weeks, the adjusted relative risks were 1.07 (95% CI, 0.97-1.18) for math proficiency and 0.98 (95% CI, 0.88-1.08) for reading proficiency. For children born by induction at 40 weeks, the adjusted relative risks were 0.97 (95% CI, 0.88-1.08) for math proficiency and 0.98 (95% CI, 0.89-1.08) for reading proficiency. CONCLUSIONS AND RELEVANCE These findings suggest that the offspring of nulliparous women for whom labor is induced at 39 or 40 weeks have similar third-grade educational outcomes (continued) Key Points Question Does academic achievement differ in children delivered by induction at term compared with those whose mothers were managed expectantly? Findings In this cohort study, there were no ...

Elective labor induction vs expectant management of pregnant women at term and children's educational outcomes at 8 years of age

“…Despite the large amount of evidence regarding the short-term outcome of elective induction of labor at 39 weeks, there is limited evidence regarding the longer-term neurodevelopmental effects. A 2020 study conducted by Werner et al 18 in Rhode Island, USA, compared educational outcomes between children born following induction of labor at 39 or 40 weeks and those born following expectant management, and found that induction of labor at term is not associated with poorer third-grade reading-and math-test scores. However, the study did not establish whether induction of labor was elective or not.…”

“…Several studies have found that elective induction of labor at 39 weeks reduces the rate of adverse perinatal outcome, including Cesarean delivery [11][12][13][14][15][16][17] . However, there has been limited research reported on the link between labor induction at 39 weeks and children's educational outcomes 18 . We speculate on two potential mechanisms linking elective induction of labor at 39 weeks and children's educational outcomes.…”

Preventing harm: A balance measure for improving the detection of fetal growth restriction

“…Accordingly, in the setting of a performance measure designed to drive improved detection of FGR, we decided to develop balance measures to monitor and mitigate unwarranted early delivery of healthy babies. We limited the measures to babies delivered for suspected FGR before 39 weeks gestation with the aim of identifying those babies that are most exposed to iatrogenic harm 12,13 . Although not perfectly gestation‐aligned with the existing PSPI measure in Victoria – which reports the proportion of severe FGR babies born ≥ 40 weeks – we believe that a gestation cut‐off of < 39 weeks for the balance measure has better face validity for clinicians.…”

“…We chose a fixed gestation cut‐off of less than 39 +0 weeks because delivery at or after 39 weeks has a low chance of being harmful 12,13 . We decided to evaluate both the ≥10th centile and ≥25th centile to determine whether one birthweight centile cut‐off best captured those babies in which clinical suspicion of FGR was not likely to be accurate.…”

Proportion and Outcome of Induction of Labor Among Mothers Who Delivered in Teaching Hospital, Southwest Ethiopia

“…Hence, the IOL after 41 completed weeks of pregnancy should be done to prevent fetal or neonatal death ( 11 , 19 , 20 ). Besides, when properly indicated, the procedure should also reduce the need for a cesarean section ( 21 – 23 ). It has been suggested that regions with high rates of induced labor tend to have lower rates of cesarean section ( 19 ).…”