Planned Birth Before 39 Weeks and Child Development: A Population-Based Study

Abstract

To investigate the association of gestational age and mode of birth with early child development. METHODS:Population-based record linkage cohort study was conducted among 153 730 liveborn infants of ≥32 weeks' gestation with developmental assessments at school age, in New South Wales, Australia, 2002 to 2007. Children were assessed in 5 domains: physical health and well-being, language and cognition, social competence, emotional maturity, and general knowledge and communication. Children scoring in the bottom 10% of national domains were considered developmentally vulnerable, and children developmentally vulnerable for ≥2 domains were classified as developmentally high risk (DHR), the primary outcome. Robust multivariable Poisson models were used to obtain individual and combined adjusted relative risks (aRRs) of gestational age and mode of birth for DHR children.RESULTS: Overall, 9.6% of children were DHR. The aRR (95% confidence interval) of being DHR increased with decreasing gestational age (referent: 40 weeks); 32 to 33 weeks 1.25 (1.08-1.44), 34 to 36 weeks 1.26 (1.18-1.34), 37 weeks 1.17 (1.10-1.25), 38 weeks 1.06 (1.01-1.10), 39 weeks 0.98 (0.94-1.02), ≥41 weeks 0.99 (0.94-1.03), and for labor induction or prelabor cesarean delivery (planned birth; referent: vaginal birth after spontaneous labor), 1.07 (1.04-1.11). The combined aRR for planned birth was 1.26 (1.18-1.34) at 37 weeks and 1.13 (1.08-1.19) at 38 weeks.CONCLUSIONS: Early (at <39 weeks) planned birth is associated with an elevated risk of poor child development at school age. The timing of planned birth is modifiable, and strategies to inform more judicious decision-making are needed to ensure optimal child health and development.

Long‐term childhood outcomes of breech presentation by intended mode of delivery: a population record linkage study

“…One caveat is the timing of cesarean section. There is emerging evidence that planned birth at early term (37–38 weeks) independently increases the risk of developmental vulnerability and poor academic performance relative to birth at 39–40 weeks . Contrary to local guidelines, we found more than a third of infants born by Planned CS were born prior to 39 completed weeks .…”

Long‐term cognition and behavior in children born at early term gestation: A systematic review

“…Some studies assessed more than one outcome and are included in several tables. The studies were carried out in Europe, the USA, Australia, Canada, Hong Kong, Bangladesh and Japan . Thirty‐six studies were population‐based studies, three were national multicenter studies and three were single‐center studies .…”

“…The studies were carried out in Europe, the USA, Australia, Canada, Hong Kong, Bangladesh and Japan . Thirty‐six studies were population‐based studies, three were national multicenter studies and three were single‐center studies . All the included studies were observational: 41 studies were cohort studies and one was a case‐control study .…”

“…Thirty‐six studies were population‐based studies, three were national multicenter studies and three were single‐center studies . All the included studies were observational: 41 studies were cohort studies and one was a case‐control study . The studies were published between 2006 and 2018.…”

Childhood health and education outcomes following early term induction for large‐for‐gestational age: A population‐based record linkage study

“…25 It has been suggested that birth around 40 weeks is associated with the lowest risk of developmental vulnerability 26 and special needs. 27 Amid a backdrop of increasing early planned births, 28 the induction rate among term LGA pregnancies in this study was 31% and the proportion of LGA babies induced at 37-38 weeks was very small (4.0%). This is in contrast to another population study that reported an association between planned birth prior to 39 weeks and developmental vulnerability.…”