Elective labor induction vs expectant management in women and children's educational outcomes at 8 years of age

Abstract

OBJECTIVE: To estimate the effect of elective induction of labour at 39 weeks of gestation on children's educational outcomes as measured by the Australian National Assessment Program-Literacy and Numeracy (NAPLAN) tests at year 3 (~8 years of age), compared with expectant management. METHODS: We merged perinatal data, including information regarding all infants in South Australia from 1999 to 2008, with children's school assessment data (i.e., NAPLAN data). The study population included all singleton births born without malformations at 39-42 weeks of gestation in vertex presentation. Children had to have undertaken year-3 NAPLAN (~8 years of age). We excluded births from women who had a contraindication to vaginal delivery and with conditions possibly justifying elective delivery before 39 weeks of gestation. Our outcome of interest was children's educational outcomes as measured by NAPLAN. The NAPLAN included five learning domains (reading, writing, spelling, grammar and numeracy). Each domain was categorised according to performing at or below versus above the National Minimum Standards (NMS). Average Treatment Effects (ATEs) of elective induction of labour at 39 weeks for children performing at/below the NMS for each domain were estimated using Augmented Inverse Probability Weighted (AIPW) estimator accounting for potential confounders. RESULTS: Among 53,843 children born at 39-42 weeks with vertex presentation from 1999-2008 and those who were expected to participate in year 3 NAPLAN from 2008-2015, a total of 31,120 children had at least one year 3 NAPLAN domain. Of these (i.e., 31,120 children), 1,353 children were delivered after elective induction of labour at 39 weeks while 29,767 children were born following expectant management. The ATEs (mean differences) comparing elective induction of labour at 39 weeks with expectant management for children scoring at/below the NMS on each domain were: reading (0.01 (95% CI -0.02 to 0.03)), writing (0.02 (95% CI 0.00 to 0.04)), spelling (0.01 (95% CI -0.01 to 0.04)), grammar (0.02 (95% CI -0.01 to 0.04)) and numeracy (0.03 (95% CI -0.00 to 0.05)). CONCLUSION: Elective induction of labour at 39 weeks of gestation did not affect children's standardised literacy and numeracy testing outcomes at eight years of age when compared with expectant management. This article is protected by copyright. All rights reserved.