Children born after induced labour may score lower in school tests at age 12, research suggests. Although the impact on individual attainment is small, researchers said it should prompt medical teams to “think twice” before artificially kickstarting labour in otherwise healthy pregnancies.
Most pregnancies come to a natural end after 37 to 42 weeks with the spontaneous onset of labour, but approximately one in five births in the UK are artificially induced. Sometimes there are strong medical grounds for doing so, such as the mother or baby’s health being at risk, but in other cases women may be offered an induction because their baby is apparently healthy but overdue.
Although previous studies have suggested that inducing labour at 41 weeks may slightly reduce the risk of the baby dying or experiencing serious problems shortly before or after birth, they did not look at the longer-term effects on the child, such as whether induction affects their brain development, said Wessel Ganzevoort, a gynaecologist and associate professor at Amsterdam University medical centre in the Netherlands.
To investigate, he and his colleagues combined pregnancy data with the results of standard tests taken when 226,684 Dutch children reached the end of primary school, at around 12 years old.
All of the children were born healthy, at between 37 and 42 weeks of gestation, after uncomplicated pregnancies, but in some cases, the mother’s labour was induced while in others it occurred naturally.
The study, published in Acta Obstetricia et Gynecologica Scandinavica, found that at every gestational age up to and including 41 weeks, children born after an induced labour received roughly 1 point lower school test scores, compared with those children born after a wait-and-see policy.
“For the individual, these findings are not life-changing, but they were very consistent throughout these last few weeks of pregnancy. They suggest that these interventions are not without any bearing on the future,” Ganzevoort said.
In the Netherlands, for instance, school tests are used to help decide which of three types of secondary school children will attend, and the study found that 10% fewer induced children received school advice that would set them on track for university.
His suspicion is that inducing labour results in a proportion of babies being born before they are fully developed, resulting in a very mild form of prematurity. “Some foetuses will be ‘finished’ at 36 weeks, whereas some won’t be done until 42 weeks. If you were programmed to be mature enough to start your own delivery at 42 weeks and you are heaved out 39 weeks, actually you are three weeks premature.”
Ganzevoort stressed that the decision to induce labour was always a balance of risks and benefits for child and mother. He said: “If there are other bigger risks that are approaching you, then this very mild form of prematurity may be acceptable, but if there are no other strong reasons [to induce delivery], maybe we should think twice.”
