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Does electively induced labor in pregnancy affect a child’s future school performance?
New research published in Acta Obstetricia et Gynecologica Scandinavica found that in women with uncomplicated pregnancies, elective induction of labor at any point between 37 and 41 weeks was consistently associated with lower school performance in children at age 12.
The analysis included 266,684 children born between 37 and 42 weeks from uncomplicated pregnancies in white women in the Netherlands. School performance scores at age 12 years were lower in those from pregnancies with induced labor at 37–41 weeks compared with those with uninduced labor. At 42 weeks, there was no significant difference in school performance between these groups.
“Of course, if there is an indication to induce delivery before 41 weeks, there is little doubt we should do this. But if the reason is purely elective, it is reasonable to be cautious of these subtle adverse effects,” said Wessel Ganzevoort, MD, PhD, senior investigator and maternal fetal medicine specialist at Amsterdam UMC.
Expert Reaction
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Associate Professor Alex Polyakov is a Clinical Associate Professor in the Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne and is a Medical Director at Genea Fertility Melbourne
The study results indicate that for each gestational age up to 41 weeks, labour induction was associated with lower school performance scores, and fewer children reached higher secondary school level compared with non-intervention.
Specifically, for children born after induction of labour, fewer children reached higher secondary school level, and school performance scores were 0.05-0.08 standard deviations lower, adjusted for confounding factors, at each week of gestation between 37 and 41 weeks.
The study is the first to use a fetus-at-risk approach to compare school performance after labour induction and non-intervention in low-risk term pregnancies, simulating the dilemma often faced in clinical practice. It is important to note that the effect of labour induction on the individual child is likely extremely small but given a large number of early term labour inductions, the impact on the population level should be considered.
The study suggests that the advantages of labour induction at term in perinatal mortality and caesarean section rate might come at a price of possible reduced long-term intellectual development in the offspring. Clinicians should, therefore, balance the advantages and disadvantages of induction of labour and incorporate long-term outcomes in counselling and decision-making around induction of labour.
The study’s limitations include that it is observational and thus cannot establish causation. Additionally, residual confounding may be present because the study did not have information on potential confounders that could influence the association of labour induction and long-term educational outcomes, such as marital status, paternal education level, maternal smoking, or body mass index.
Nonetheless, the study highlights the need for future research to incorporate long-term measurements in their outcome sets and conclusions to fully appreciate the issue studied. Future studies should focus on different aspects of school performance and other performance domains later in life, including income and professional choices.
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