Labor Induction Linked to Lower School Performance in Children

Scientists found that induction of labor from 37 to 42 weeks gestation was associated with lower school performance scores at age 12.

According to the American Academy of Family Physicians (AAFP), the labor induction rate has more than doubled since 1990 in the United States. Moreover, the organization does not believe this is the result of a rise in medical conditions that warrant labor intervention.

The AAFP says that because of the risks associated with induction, including increased risks of excessive bleeding, higher risk of cesarean, and higher risk of fetal distress, they urge healthcare providers to refrain from promoting labor induction without a medical reason.

Despite these increasing rates and concerns among medical professionals, few studies have investigated the long-term effects of labor induction on children.

However, a new study published in Acta Obstetricia et Gynecologica Scandinavica took a closer look at the possible long-term impacts of labor induction. Specifically, how inducing labor might affect school performance when the children reached age 12.

To conduct the study, Dutch researchers analyzed data from 226,684 children born between 2003 to 2008 at 37 to 42 weeks gestation. The team chose Dutch mothers and mothers of other European descent to ensure uniformity in the data. They also linked birth records with national data on school achievement.

Using a fetus-at-risk approach and examining each week of gestation separately, the team compared school performance scores and secondary school level at age 12 in children born after labor induction to those born without labor intervention.

After analyzing the data, the team found that for each gestational age up to 41 weeks, labor induction was associated with lower school performance scores compared with non-intervention. Specifically, at each week of gestation from 37 to 41 weeks, labor induction was associated with 0.05 to 0.08 SD lower school performance scores.

Moreover, children born after labor induction were 8% to 14% less likely to reach higher secondary school levels.

The study authors note that although residual confounding may remain and the effects of labor induction on individual children are subtle — the societal impact due to the increases in early-term labor inductions could be extensive.

"Induction of labor by definition shortens duration of pregnancy. As duration of pregnancy is strongly associated with brain development and school performance, it is likely that duration of pregnancy and associated brain maturation is the factor driving the difference in school performance between the induction and non-intervention group," the authors wrote.

Still, the findings have some limitations. For example, the associations found in the study do not prove labor induction causes decreased school performance. The scientists also say they did not have information on potential factors that could influence the findings, such as long-term education outcome, marital status, paternal education level, maternal smoking, or body mass index.

In addition, because schools use different performance tests and the team did not account for children with special education needs, the impacts of labor induction could be underestimated.

Still, the researchers suggest that healthcare providers should be mindful of these potential educational effects when talking with expectant parents and deciding whether to induce labor.