On average, children born following induced labor perform worse at school at age 12 years than their peers who were born after spontaneous onset of labor. This is the outcome of a report by Anita Ravelli, PhD, and her team of Dutch researchers in the department of obstetrics and gynecology of the Amsterdam University Medical Center, published in Acta Obstetricia et Gynecologica Scandinavica.
For the retrospective cohort study, the team analyzed data from almost 230,000 patients. According to these data, the likelihood of children reaching higher secondary school level is around 10% lower after elective induction of labor.
Labor induction frequent
These days in Germany, more than 20% of all births are induced. Sometimes this decision is made because of medical reasons, such as the woman’s having gestational diabetes, the presence of gestational toxicity, or the occurrence of a premature rupture of membranes. However, contractions are most often artificially triggered because the expected delivery date has passed.
Guidelines from the German Society of Gynecology and Obstetrics recommend inducing labor if there is a medical indication and if more than 10 days have passed since the expected delivery date. After 14 days, induction is strongly advised. This recommendation is based on studies that indicate that the child is at increased risk of disease and death once the expected delivery date is far exceeded.
Causal relationship unproven
It is still unclear whether and to what extent inducing labor affects a child’s neurologic development. Since the frequency of induced labor has increased greatly worldwide, Dr. Ravelli and her colleagues investigated this matter.
The study may have limited validity, however. “The outcome of the study only determines an association between spontaneous labor in mature children versus induced labor and a school performance test at 12 years of age,” said Maria Delius, MD, MPH, head of the Perinatal Center at the Clinic and Polyclinic for Obstetrics and Gynecology of the Ludwig Maximilian University of Munich. “The study is unable to prove any causality, even if it sounds that way in the abstract.”
This publication may in no way instigate a change in current practices, Dr. Delius emphasized. “There is a lot of potential for the wrong conclusions to be drawn from this study, and as a result – if it is presented and perceived in a subjective manner in public – to also cause harm to mothers and children,” she warned. The study also must not be associated with the drug misoprostol, since the various mechanical and medicinal methods of induction were not the topic of the Dutch investigation.
Gestational-week differences
The primary author of the study, Renee J. Burger, MD, PhD, of Dr. Ravelli’s UMC team, and her colleagues assessed the school performance of 226,684 children at age 12 years who were born in the 37th to 42nd week of gestation (WOG) between 2003 and 2008 in the Netherlands following an uncomplicated single pregnancy. They compared school performance, divided for each of the six WOG analyzed, between children whose birth was mechanically or medicinally induced and those who were born without intervention.