Peer-reviewed article
Induction of labour in singleton pregnancy and subsequent risk of childhood special educational need: Scottish population cohort study
Murray S, Clark E, Decrue F, Reynolds R, Stock S ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This Scottish study examined whether inducing labour early in pregnancy affects children's educational outcomes. Researchers followed over 720,000 children born between 1988 and 2015 and found that babies born through labour induction at 37-40 weeks had a higher risk of requiring special educational support at school compared to babies born after waiting (expectant management). However, induction at 41 weeks showed no increased risk. The findings suggest that routine early induction may have long-term developmental consequences.
Key points
- Elective induction of labour at 37-40 weeks gestation was associated with increased risk of special educational need in children (odds ratio 1.18 at 39 weeks)
- At 41 weeks gestation, there was no difference in special educational need risk between induction and expectant management groups
- 21.9% of the study population (158,217 of 721,177 women) underwent elective induction of labour without recognised medical indication
- The association persisted after adjustment for multiple factors in logistic regression analysis
- Findings suggest counselling women about risks of induction before 41 weeks' gestation is warranted
Limitations
The study is observational and cannot establish causation; unmeasured confounding factors related to why induction was chosen may explain the association. The mechanism linking induction timing to later special educational need is not explored in this report.
Abstract
Abstract Background Induction of labour occurs in approximately 1 in 3 pregnancies in high income countries. Induction of labour is recommended from 41 weeks to reduce the risks of stillbirth, neonatal death and neonatal intensive care admission by the World Health Organisation and the National Institute for Health and Care Excellence (NICE) in the UK, however in recent years the gestational age at delivery has decreased. In this study we aimed to determine the childhood outcomes of Induction of labour at term compared to those expectantly managed. Methods and Findings: We conducted a population cohort study of all children born after 37 weeks between 1988–2015 using routinely collected Scottish maternity data linked to school census data. The exposure was induction of labour with no recognised medical indication at each week of term (37–41 weeks gestation). For each week we identified a comparison group of women who had been expectantly managed and delivered after the gestation at which the comparator induction of labour had been performed. The primary outcome was special educational need (a learning or physical difficulty) at school. Analyses were performed using multiple logistic regression. Of 721 177 women with singleton pregnancy, 158 217 underwent elective induction of labour (21.9%). At each week of gestation between 37 and 40 completed weeks, elective induction of labour was associated with an increased risk of special educational need compared with expectant management (adjusted odds ratio for induction of labour at 39 weeks compared to expectant management 1.18 [95% CI 1.12–1.24]; p < 0.001). However at 41 weeks gestation there was no difference in the risk of special educational need between the groups (adjusted OR 1.01, 95% CI [0.95–1.07]; p = 0.762). Conclusion Compared to expectant management, elective induction of labour at each week from 37–40 weeks’ gestation is associated with an increased risk of special educational need in children. This information should be used when counselling women especially regarding induction of labour before 41 weeks’ gestation.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
Problem
Childhood special educational need (learning or physical difficulty requiring school support)
- Intervention
- Elective induction of labour at term (37-41 weeks gestation) without recognised medical indication
- Population
- Children born after 37 weeks gestation in Scotland between 1988-2015 (721,177 singleton pregnancies; 158,217 underwent elective induction)
Key finding
Elective induction at 37 weeks associated with increased special educational need risk compared to expectant management