By combining pregnancy data from the Dutch perinatal registration with data on school performance from Statistics Netherlands, researchers from Amsterdam UMC were able to study the potential effects of induced labour on school performance in low-risk pregnancies.
"We saw a small yet significant reduction in test scores for children born after induced labour from 37 to 41 weeks, compared to children in whom labour was not induced at that same week, among low-risk pregnancies. And while the impact on the individual child may be small this could lead to a potentially large impact on society, given the increasing number of elective inductions," says Renee Burger, researcher at Department of Obstetrics at Amsterdam UMC.
School Advice
In the Netherlands, testing at age 12 is used to help determine which of the three types of secondary school children will attend. This research, which only collected data from pregnancies without complications, shows that at every gestational age up to and including 41 weeks, the group of children born after an induced labour scored lower than the children born after a wait-and-see policy. Resulting, on average, in 10% fewer children receiving a school advice that sets them on track for university. In the group after induction at 37 weeks, 49.8% received this advice whereas 54.4% of those who weren't received the same advice.
If the pregnancy goes without any problems, it is customary in the Netherlands to discuss with women whether they wish to be induced or wait until 42 weeks. This policy is partially based on two studies from the Netherlands and Sweden, both published in 2019, which show that inducing labour at 41 weeks produces a small reduction in the risk of the baby dying before or shortly after delivery and a small reduction in serious problems in the child after birth, without any other short-term medical risks. Induction beyond 41 weeks therefore seems reasonable based on these studies.
Increasing rate of Induction
Another study in an American context, the ARRIVE trial found that elective induction in low-risk women, giving birth for the first time, at 39 weeks of gestation did not have an effect on perinatal outcomes. The fact that it led to a significantly lower frequency of caesarean delivery means that that study has had a worldwide impact on increasing rates of induced labour.
In the Netherlands, in 2021, 28% (47,068) of births were induced, in the US, this is around 30% and in Australia, more than 40% of first-time mothers are induced. Although there are often medical reasons that provide an indication for inducing labour, for example high blood pressure or growth problems, , the number of elective inductions – i.e., not medically indicated – is rising in all three countries. Mainly driven by a rise in induction that is not medically required.
"The tricky part is that the previous studies all looked at short-term outcomes: infant death and serious problems shortly after birth. None of the studies look at the long-term effects of induction on the child, such as cognitive development," says Wessel Ganzevoort, gynaecologist and Associate Professor at Amsterdam UMC's Department of Obstetrics.
Balance of Risks
Both Burger and Ganzevoort emphasise that the decision to induce labour is always a balance of risks and consequences for child and mother. If there are complications in the pregnancy, and thus an increased risk for mother or child if the pregnancy continues, these risks outweigh a modest adverse effect in the long term, such as school performance. However, in an uncomplicated pregnancy before 41 weeks, when there are no proven benefits of inducing labour, the researchers believe that induction should be used with caution.