Background: There is much debate about the optimal management of pregnancies with a large-for-gestational age baby (LGA, birthweight >90th population percentile). A recent French randomised controlled trial reported that early term induction of labour reduced caesarean delivery rates and infant morbidity. However, long term child outcomes have not been assessed.
Objective: To assess maternal, neonatal and child health and education outcomes for LGA infants induced at 37-38 weeks.
Methods: Record-linkage study of term (37+ weeks), cephalic-presenting singleton pregnancies with an LGA baby in New South Wales, 2002- 2006. Linked birth, hospital, mortality and education data were used; with at least nine years follow-up. Exposure was induction of labour at 37-38 weeks, compared to expectant management (spontaneous birth at ≥37 weeks and planned births at ≥39 weeks). Relative risks and 95% confidence intervals were estimated.
Results: Among 11,774 pregnancies, 423 (3.6%) had an induction at 37-38 weeks. Women in the induction group were less likely to have a caesarean delivery (RR 0.44, 95% CI 0.35-0.56). Infants in the induction group were born earlier and weighed less, had higher rates of low Apgar scores, birth trauma, neonatal jaundice and phototherapy use than their expectantly managed counterparts. As children, they had higher rates of hospital admission and special needs. However, there was no difference in literacy and numeracy achievement by Year 3.
Conclusion: While the lack of long term harm is encouraging, the increased risk of neonatal morbidities and additional healthcare utilisation suggests the need for caution in early induction of LGA infants.