• Posted February 22, 2023

Kids Born After Elective Induced Labor Performed Worse in School: Study

You're 38 weeks pregnant and so uncomfortable you can barely move, so you ask your doctor if labor can be induced early.

That's not necessarily a good idea, according to new research that found children born after elective induced labor may do worse in school.

Dutch researchers found that 12-year-olds who as newborns were delivered after elective induced labor scored lower on tests than children who were not. Typically, this is done between 37 and 41 weeks of pregnancy.

"Brain maturation and development doesn't stop at 37 weeks, it continues until the end of pregnancy," explained lead researcher Renee Burger, from the Department of Obstetrics and Gynecology at Amsterdam University Medical Centers (Amsterdam UMC).

"Spontaneous delivery actually is induced by signals from the fetus itself, indicating that some of these maturation factors are sort of finished, and probably there's some variation in for each fetus," added researcher Dr. Wessel Ganzevoort, also from Amsterdam UMC.

By inducing labor, the baby is born prematurely, the authors said.

"This is actually a relatively preterm birth even at that gestational age because the fetus had not indicated that it was matured enough. So, if you were designed to deliver at 41 weeks and instead you are being delivered at, say 39 weeks, you are actually two weeks premature," Ganzevoort said.

Burger and Ganzevoort added that parents whose babies are delivered after induced labor should not panic because the effects were small.

"They should not be worried when they have the offer of induction of delivery because the individual impact is probably not so very big," Ganzevoort said. "If there's a good reason for induced labor, obviously, then there are advantages and it's better to deliver."

Ganzevoort, however, pointed out that induced labor deliveries are increasing and that can't be due solely to medical reasons. "So, it must be that these are mostly elective," he said.

In many cases, women want an end to their pregnancy because they are having difficulty sleeping or other discomfort and ask their doctor to induce labor, he said.

"I see these women parade by every day, in my outpatient clinic and I feel sympathy for the fact that at the end of pregnancy, there are lots of these complaints," Ganzevoort said. "Their bodies have grown out of proportion so it's natural that they ask, and we have to offer it. So in some sense, it's a matter of convenience. But it's not the right solution."

For the study, researchers used pregnancy information and school performance records at age 12 to collect data on nearly 227,000 Dutch children.

The researchers saw reductions in test scores for children born after elective induced labor from 37 to 41 weeks, compared with children whose labor was not induced.

Although the effect on test scores for any one child is small, it might have a large effect on society, given that the number of elective inductions is increasing, Burger said.

"If there's a good reason for induction, don't be afraid of it," Ganzevoort said. "But if there's no medical reason to deliver, be a bit cautious and consider the pros and cons both on the short-term, but also on the long-term."

According to the March of Dimes, reasons for induced labor include:

• Pregnancy lasts longer than 41 to 42 weeks.
• Placenta is separating from the uterus.
• Water breaks before labor begins.
• Health problems, like diabetes, high blood pressure or preeclampsia, or problems with the heart, lungs or kidneys.
• The fetus has stopped growing.
• Rh disease is causing problems with the fetus's blood.

One U.S. pregnancy expert warned that association in this study does not necessarily mean causation.

The Dutch researchers found a statistically significant, but very small, decrease in school performance among the kids that experienced an induction of labor, said Dr. Eran Bornstein, vice chair of obstetrics and gynecology at Lenox Hill Hospital in New York City.

"Although these results are interesting and may generate hypotheses for the association between induction and slightly lower school performance, I would urge caution in interpretation as a cause-and-effect is not clear," he said.

It is very likely that the association is due to other high-risk fetal or maternal conditions that required induction of labor, Bornstein said.

"For example, in the U.S. induction of labor before 39 weeks is only permitted when a maternal or fetal condition requiring early delivery is present, making these patients high-risk," he explained.

And other studies have shown that induction of labor at term is associated with several benefits, including a decrease in both stillbirth and cesarean section, Bornstein said.

"Induction is a procedure that is important in many cases," he said. "Ultimately, the decision regarding induction of labor should be shared by the obstetrician and the patient based on the maternal and fetal factors and in consultation with a maternal-fetal medicine specialist when necessary."

More information

For more on induced deliveries see the American College of Obstetricians and Gynecologists.

SOURCES: Renee Burger, MSc, and Wessel Ganzevoort, MD, PhD, Department of Obstetrics and Gynecology, University Medical College, Amsterdam UMC, University of Amsterdam, the Netherlands; Eran Bornstein, MD, vice chair, obstetrics and gynecology, Lenox Hill Hospital, New York City; Acta Obstetricia et Gynecologica Scandinavica, Feb. 22, 2023