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

Abstract

Introduction:There is debate about optimal management of pregnancies with a large-for-gestational age baby. A recent randomized controlled trial reported that early term induction of labor reduced cesarean section rates and infant morbidity. However, long term childhood outcomes have not been assessed. The aim of this study was to assess maternal, neonatal and child health and education outcomes for large-for-gestational age babies induced at 37-38 weeks' gestation. Material and methods:Population-based record linkage study of term (37+ weeks), cephalic-presenting singleton pregnancies with a large-for-gestational age baby in New South Wales, Australia, 2002Australia, -2006. Linked birth, hospital, mortality and education data were used with at least 9 years follow up from birth. Exposure was induction of labor at 37-38 weeks, compared to expectant management (spontaneous birth at ≥37 weeks and planned births at ≥39 weeks). Relative risks and 95% confidence intervals were estimated using Modified Poisson regression with robust variance.Results: Among 10 174 eligible pregnancies, 412 (4.0%) had an induction at 37-38 weeks. Women in the induction group were less likely to have a cesarean section (RR: 0.65, 95% CI: 0.51-0.82). Infants had higher rates of: low Apgar scores, birth trauma, neonatal jaundice and phototherapy use, and admission to special care nursery or neonatal intensive care than their expectantly managed counterparts. As children, they had higher rates of hospital admission (RR: 1.16, 95% CI: 1.04-1.30) and special needs (RR: 1.98, 95% CI: 1.12-3.50). However, by age 8 there was no difference in overall literacy and numeracy achievement. Conclusions:Although women who had an early term labor induction with large-forgestational age were less likely to have a cesarean section, the increased risk of neonatal morbidities and additional healthcare utilization suggests the need for caution in early induction of large-for-gestational age babies before 39 weeks' gestation. K E Y W O R D Sbirth injuries, dystocia, fetal macrosomia, gestational age, hospitalization, induction of labor, large-for-gestational age, literacy

Fetal monitoring from 39 weeks’ gestation to identify South Asian-born women at risk of perinatal compromise: a retrospective cohort study

“…There is also concern about the short- and long-term adverse effects of iatrogenic early term births. Being born at 37–39 weeks’ gestation, as opposed to > 40 weeks, is associated with a higher rate of immediate perinatal morbidity, hospitalisation in the first five years of life, childhood diabetes, and impaired primary school performance 28 , 29 . Whether earlier birth in SA-born women reduces adverse outcomes without causing harm is unknown.…”

Trends in induction of labour and associated co-morbidities and demographics in Queensland, Australia from 2001 – 2021: A population-based study

“…[30,31] Other longitudinal studies of IOL for LGA also demonstrated signi cantly reduced birthweight in the IOL cohorts compared to expectant management associated with increased hospitalisations and special needs to age 8 years. [32] Across the 20 year study period the rate of intrapartum CS remained relatively stable in both nulliparous and multiparous women. This suggests that the increase in CS reported in both Queensland and national perinatal data are related predominantly to non-labour CS.…”

Induction of labor in case of suspected macrosomia

“…This gestational age has been chosen to minimize iatrogenic prematurity, and a later gestational age would not reduce the neonatal morbidity that is intended to be reduced. A population-based study [28] reported on infant health and educational outcomes in 412 children born after labor induction between 37 and 38 weeks for LGA (birth weight >95th percentile) compared to 9762 children managed with expectant management, with a follow-up period of 9 years. The study revealed that children in the first group subjected to labor induction had a higher number of low Apgar scores, birth trauma, neonatal jaundice, phototherapy use, and neonatal intensive care unit admission, and as children, they had higher hospitalization and admission rates (RR 1.16; 95% CI: 1.04-1.30) and special needs (RR 1.98; 95% CI: 1.12-3.50).…”