BACKGROUND AND PURPOSE:

• Yisma et al. (Ultrasound in Obstetrics & Gynecology, 2021) examined the effect of elective induction of labor at 39 weeks on children’s educational outcomes vs expectant management

METHODS:

• Retrospective cohort study
  • South Australia between 1999 to 2008
• Population
  • All infants born at 39 to 42 weeks | Vertex presentation
  • Children who had school assessment data from the National Assessment Program—Literacy and Numeracy (NAPLAN) test in school year 3 (approximately 8 years of age)
  • Exclusion: Births with medical indications for delivery <39 weeks
• Exposures
  • Elective induction of labor >39 weeks
  • Expectant management: Spontaneous labor, elective induction of labor or medically indicated induction and cesarean deliveries from 40 to 42 weeks
• Study design
  • Propensity scoring was used to determine treatment effects, with adjustment for potential confounders
• Primary outcome
  • Children’s educational outcome as measured using NAPLAN
    • Includes five learning domains: Reading | Writing | Spelling | Grammar | Numeracy
    • Each domain was categorized against the national minimum standard (NMS)

RESULTS:

• 31,120 children born during study period with at least one year-3 NAPLAN domain
  • Elective induction: 1,353 children
  • Expectant management: 29,767 children
• Average treatment effects (mean differences) of elective induction at 39 weeks vs expectant management (proportion of children scoring at/below the NMS)
  • Reading: 0.01 (95% CI, -0.02 to 0.03)
  • Writing: 0.02 (95% CI, 0.00 to 0.04)
  • Spelling: 0.01 (95% CI, -0.01 to 0.04)
  • Grammar: 0.02 (95% CI, -0.01 to 0.04)
  • Numeracy: 0.03 (95% CI, 0.00 to 0.05)

CONCLUSION:

• Elective induction at 39 weeks vs expectant management had no significant effect on children’s educational performance at 8 years of age
• The authors state

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

These findings provide the first contribution on the effect of elective induction of labor at 39 weeks to the ongoing scientific discourse on longer-term neurodevelopmental outcomes

Learn More – Primary Sources:

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

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