Elective Birth Before 40 Weeks Not Linked With Impaired Developmental Outcomes

By Patricia A. Sheiner MD

May 14, 2022

NEW YORK (Reuters Health) - Elective birth at 39 weeks' gestation when compared with expectant management was not associated with adverse childhood developmental outcomes in a retrospective study from Australia.

Linking perinatal data of births from 2005 through 2013 with developmental outcomes collected in 2012, 2015, and 2018 from the triennial Australian Early Development Census (AEDC), researchers found that the mode of delivery and the timing of delivery did not impact early childhood development as assessed in the first year of school (ages 4-6 years).

Dr. Anthea Lindquist from the University of Melbourne and colleagues sought to examine long-term outcomes of elective birth at 39 weeks' gestation (39 weeks 0 days to 39 weeks 6 days) vs expectant deliveries at 40-43 weeks. The researchers studied singleton births and excluded infants born with congenital anomalies, those with missing data for labor onset, mode of birth or gestational age at birth, and implausible birth weights. Also excluded were those born between 39 weeks 0 days and 39 weeks 6 days after spontaneous or augmented labor.

Overall, 15,927 infants were born electively between 39 weeks 0 days and 39 weeks 6 days; another 72,238 were born between 40 weeks 0 days and 43 weeks 6 days, following expectant management. There was no difference between the elective group and the expectant group in the primary outcome: the risk of developmental vulnerabilities at school entry, defined as scoring below the 10th percentile in at least 2 of 5 developmental domains (adjusted relative risk, 1.03; 95% CI, 0.96-1.12).

Of the 15,927 infants born electively at 39 weeks, 7,999 were planned cesarean births and 7,928 were delivered after induction of labor. Induction of labor compared with planned cesarean delivery was not associated with the risk of developmental vulnerability (aRR, 0.96; 95% CI, 0.82 to 1.12; aRD, -0.34; 95% CI, -1.71 to 1.03).

Furthermore, there were no differences among any of the groups in five individual developmental domains: physical health and well-being, social competence, emotional maturity, language and cognitive skills (school-based), and communication skills and general knowledge.

All of the groups were comparable in terms of demographics, maternal body mass index, Socioeconomic data, education, mode of birth, location and year of AEDC testing.

The authors say the results of their study "offer reassurance about the long-term impact of elective birth at 39 weeks' gestation and provide information that may assist in shared decision-making with patients when planning birth."

SOURCE: https://bit.ly/3L6lndw JAMA Pediatrics, online May 9, 2022.

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