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- Title
Developmental Outcomes for Children After Elective Birth at 39 Weeks' Gestation.
- Authors
Lindquist, Anthea; Hastie, Roxanne; Kennedy, Amber; Gurrin, Lyle; Middleton, Anna; Quach, Jon; Cheong, Jeanie; Walker, Susan P.; Hiscock, Richard; Tong, Stephen
- Abstract
Key Points: Question: Is the clinical decision for an elective birth at 39 weeks' gestation associated with adverse childhood developmental outcomes, compared with expectant management? Findings: In this cohort study of 88 165 births, elective birth at 39 weeks' gestation, compared with expectant management, was not associated with developmental vulnerability. Additionally, for elective births at 39 weeks' gestation, induction of labor had a comparable risk of childhood developmental vulnerability as planned cesarean delivery. Meaning: Elective birth at 39 weeks' gestation when compared with expectant management was not associated with adverse childhood developmental outcomes. This cohort study examines the association of elective birth at 39 weeks' gestation, compared with expectant management, with the risk of adverse childhood developmental outcomes. Importance: Elective births at 39 weeks' gestation are increasing. While this option may improve maternal and perinatal outcomes compared with expectant management, longer-term childhood developmental outcomes are uncertain. Objective: To investigate the association between elective birth at 39 weeks' gestation and the risk of childhood developmental vulnerability. Design, Setting, and Participants: For this cohort study, 2 causal inference analyses were conducted using Australian statewide, population-based data. Perinatal data from births between January 1, 2005, and December 31, 2013, were linked to childhood developmental outcomes at age 4 to 6 years (assessed using multiple imputation via inverse probability-weighted regression adjustment). Data analyses were conducted between September 7 and November 9, 2021. Exposures: Two exposure groups were considered: (1) elective birth between 39 weeks and 0 days' and 39 weeks and 6 days' gestation vs expectant management and (2) birth via induction of labor vs planned cesarean delivery among those born electively at 39 weeks' gestation. Main Outcomes and Measures: Childhood developmental vulnerability at school entry, defined as scoring below the 10th percentile in at least 2 of 5 developmental domains (physical health and well-being, social competence, emotional maturity, school-based language and cognitive skills, and communication skills and general knowledge). Results: Of 176 236 births with linked outcome data, 88 165 met the inclusion criteria. Among these, 15 927 (18.1%) were elective births at 39 weeks' gestation (induction of labor or planned cesarean delivery), and 72 238 (81.9%) were expectantly managed with subsequent birth between 40 and 43 weeks' gestation. Compared with expectant management, elective birth at 39 weeks' gestation was not associated with an altered risk of childhood global developmental vulnerability (adjusted relative risk [aRR], 1.03; 95% CI, 0.96-1.12) or with developmental vulnerability in any of the individual domains. In an analysis restricted to elective births at 39 weeks' gestation, induction of labor (n = 7928) compared with planned cesarean delivery (n = 7999) was not associated with childhood developmental vulnerability (aRR, 0.96; 95% CI, 0.82-1.12) or with vulnerability in any individual domains. Conclusions and Relevance: In this cohort study, elective birth at 39 weeks' gestation was not associated with childhood developmental vulnerability. For those born electively at 39 weeks' gestation, birth after induction of labor or by elective cesarean delivery had similar developmental outcomes.
- Subjects
AUSTRALIA; WELL-being; INDUCED labor (Obstetrics); CONFIDENCE intervals; CHILD development; PSYCHOLOGICAL vulnerability; COMMUNICATIVE competence; HEALTH status indicators; COGNITION; PREGNANCY outcomes; RISK assessment; DESCRIPTIVE statistics; CESAREAN section; SECONDARY analysis
- Publication
JAMA Pediatrics, 2022, Vol 176, Issue 7, p654
- ISSN
2168-6203
- Publication type
Article
- DOI
10.1001/jamapediatrics.2022.1165