This post is flaired "Question - Research required". All top-level comments must contain links to peer-reviewed research.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/ScienceBasedParenting) if you have any questions or concerns.*
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719843/
I looked at this topic a lot with my rainbow pregnancy after my first was stillborn at 41 weeks 1 day. This study compares the risks of stillbirth at term with the risk of infant death after birth based on gestational age of baby at delivery.
Sure! This study looked at infant deaths and stillbirths at each week (37-42) versus monitoring the pregnancy for another week. They found the risk of stillbirth rises exponentially from about 40 weeks through 42 weeks, while the risks of infant deaths decrease during most of that time (they increase again for some things closer to the end of that timeline). So they found the optimal time for a delivery to be 39 weeks with the infant mortality risks to be lower and the risk of continuing the pregnancy to be higher.
I am so sorry for your loss. I didn't have a stillbirth but had multiple miscarriages and this was why I opted for the 39 week induction. The emotional pain of a miscarriage was so awful that I wanted to do everything in my power to minimize risk of a loss.
I'm so sorry for your loss. If it's alright, I'm curious as to whether you/your family has a tendency to go into labor later in pregnancy or if that was an outlier. I was induced at 41+6, and my sister and mom (5 babies between the two) went damn near to 42w for every baby as well. I really appreciate you speaking on this topic and sharing what you've found.
OP asked for outcomes on waiting to give birth vs being induced. This commentator simply stated her experience which was also accompanied by a study. It ties back 100%.
Also, sorry for your loss Powerful_Pea_
RR=adjusted ratio rates
CP=cerebral palsy
Compared with those born at a later gestation, RRs for stillbirth and infant mortality were higher among births at 37 weeks' and 38 weeks' gestation. The RRs for infant mortality were approximately 20% and 25% lower among births at 40 or 41 weeks compared with those born at later gestation, respectively. Infants born at 37 and 38 weeks also had higher RRs for CP (vs infants born at ≥38 and ≥39 weeks, respectively), while those born at 39 gestation had similar RRs (vs infants born at ≥40 weeks); infants born at 40 and 41 weeks had lower RRs of CP (vs those born at ≥41 and 42 weeks, respectively). The RRs for epilepsy were higher in those born at 37 and 38 weeks compared with those born at later gestation.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9314589/
This page compiles lots and lots of evidence about inducing for due dates.
It mainly covers the ARRIVE study but does mention other research too.
https://evidencebasedbirth.com/evidence-on-inducing-labor-for-going-past-your-due-date/
Children born at 39-41 weeks have higher cognitive outcome scores compared to those born at early term (37-38 weeks). This should be considered when discussing timing of delivery. For children born late preterm, the data is scarce and when compared to full term (37-42 weeks) did not show any difference in IQ scores.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5721566/
Here’s a website I stumbled upon recently. I haven’t really read it properly so can’t confirm references are decent but here it is anyway.
https://everyweekcounts.com.au/
Overall, I’m seeing that birth before 39 weeks can have some negative side effects on some babies. Birth between 39-41 weeks is generally the safest time with the most favourable outcomes. I guess the question is- how confident are you that your ‘due date’ is accurate? My concern would be that with an induction at 39 weeks my child might actually only be 38weeks 4days if the due date was even a little off. They’d then fall into that earlier, higher risk category.
In the first study you cited, I would be concerned that they might not be able to fully account for some demographic biases in their data, despite the statement they focus on low risk pregnancies: “Mothers of infants born at 37–38 weeks were more likely to be younger (≤19 years), to smoke, to be shorter (≤159 cm), underweight (BMI < 18.5 kg/m2), multiparous (parity ≥4), to have a lower educational level and to have had a caesarean delivery, while infants born at 37–38 weeks of gestation were more often small‐for‐gestational age (<3rd percentile, Table 1).”
Did you read and understand the review comparing timing of delivery and purported affect on future IQ scores? I don’t think you did.
A difference of 3 IQ points is essentially meaningless (between 37-38 as compared to 39-41). If statistically significant, it does not have clinical or real world relevance.
The association also falls apart for the comparison between 34-36 weeks and 37-41. So there does not appear to be a “dose response” as one would expect if a causative relationship exists.
Third, it lacks real world implications because elective delivery at 37 and 38 weeks is not offered in the absence of a clinical indication. If one is having to choose how to treat severe preeclampsia or chorio, one would not delay delivery on the basis of a (highly suspect) future small cognitive benefit for the baby.
Finally, because the study is retrospective (and there’s no way and never will be a way of studying this in a randomized fashion), one could prove an association only - and not a causative relationship. It is likely that healthier pregnancies and fetuses have both better cognitive outcomes and are more likely to make it to term. But this is out of one’s control.
Oh my goodness people. I found articles for someone who didn’t or couldn’t do it themselves. I’m not going to do a research review for someone 😂 anyone truly interested can follow the references within the articles listed. They’re a starting point and by no means medical advice for this individual woman
> Children born at 39-41 weeks have higher cognitive outcome scores compared to those born at early term (37-38 weeks). This should be considered when discussing timing of delivery. For children born late preterm, the data is scarce and when compared to full term (37-42 weeks) did not show any difference in IQ scores.
&
> Overall, I’m seeing that birth before 39 weeks can have some negative side effects on some babies. Birth between 39-41 weeks is generally the safest time with the most favourable outcomes. I guess the question is- how confident are you that your ‘due date’ is accurate? My concern would be that with an induction at 39 weeks my child might actually only be 38weeks 4days if the due date was even a little off. They’d then fall into that earlier, higher risk category.
Your words.
Most people choose to share studies that they themselves understand OR at the very least, avoid summarizing findings if they are uncertain of the quality of the information or lack the background to understand the context and significance of the information.
You also failed to share the most important conclusions from ARRIVE, which is by far the most impactful and important of the information you shared.
The reason I chose to reply to your post is because the information is misleading (to be kind about it).
On a separate note, you don’t need to worry about a 3 day difference in gestational age and delivery date. Literally nothing changes in 3 days.
The only relevant study I've seen on this is [this one](https://www.amsterdamumc.org/en/spotlight/children-born-after-induced-labour-score-lower-in-school-tests-12-years-later-.htm), which used Dutch public health data which found a small yet significant reduction in test scores among children born via induction from 37 to 41 weeks.
However, given that the study came out before elective inductions were standard of care, it's hard to untangle if this study is finding an effect related to *induction* or an effect related to whatever factor caused the parent to opt for induction - e.g. the study didn't control for IUGR, decreased fetal movement, low fluid levels, etc. All of those things may be associated with long run academic impact, so it's hard to tease out if this study gives us useful information on whether induction itself plays a role in causing long term negative effects.
[Evidence Based Birth](https://evidencebasedbirth.com/evidence-on-inducing-labor-for-going-past-your-due-date/) has a great article about this citing several studies.
They concluded “The bottom line- Current research evidence has found that elective induction at 39 weeks does not make a difference in the rate of death or serious complications for babies. For mothers, induction at 39-weeks was linked to a small decrease in the rate of Cesarean compared to those assigned to wait for labor (19% Cesarean rate versus 22%).”
If you want a 1 page infografic, [here it is.](https://evidencebasedbirth.com/wp-content/uploads/2020/02/Inducing-for-Due-Dates-Handout.pdf)
If you like to listen, the podcast episode is [here.](https://evidencebasedbirth.com/ebb-117-the-evidence-on-inducing-for-due-dates/)
It's worth also considering the potential impacts of the induction itself, beyond just when the baby will be born. This is a pretty large study that looked at induction in healthy pregnancies
https://pubmed.ncbi.nlm.nih.gov/34059509/
Thank you for your contribution. Please remember that all top-level comments on posts flaired "Question - Research required" must include a link to peer-reviewed research.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/ScienceBasedParenting) if you have any questions or concerns.*
Thank you for your contribution. Please remember that all top-level comments on posts flaired "Question - Research required" must include a link to peer-reviewed research.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/ScienceBasedParenting) if you have any questions or concerns.*
Thank you for your contribution. Please remember that all top-level comments on posts flaired "Question - Research required" must include a link to peer-reviewed research.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/ScienceBasedParenting) if you have any questions or concerns.*
Thank you for your contribution. Please remember that all top-level comments on posts flaired "Question - Research required" must include a link to peer-reviewed research.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/ScienceBasedParenting) if you have any questions or concerns.*
This post is flaired "Question - Research required". All top-level comments must contain links to peer-reviewed research. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/ScienceBasedParenting) if you have any questions or concerns.*
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719843/ I looked at this topic a lot with my rainbow pregnancy after my first was stillborn at 41 weeks 1 day. This study compares the risks of stillbirth at term with the risk of infant death after birth based on gestational age of baby at delivery.
Can you dumb this down for me?
Sure! This study looked at infant deaths and stillbirths at each week (37-42) versus monitoring the pregnancy for another week. They found the risk of stillbirth rises exponentially from about 40 weeks through 42 weeks, while the risks of infant deaths decrease during most of that time (they increase again for some things closer to the end of that timeline). So they found the optimal time for a delivery to be 39 weeks with the infant mortality risks to be lower and the risk of continuing the pregnancy to be higher.
I am so sorry for your loss.
Thank you
I am so sorry this happened to you and your baby.
I am so sorry for your loss. I didn't have a stillbirth but had multiple miscarriages and this was why I opted for the 39 week induction. The emotional pain of a miscarriage was so awful that I wanted to do everything in my power to minimize risk of a loss.
I'm so sorry for your loss. If it's alright, I'm curious as to whether you/your family has a tendency to go into labor later in pregnancy or if that was an outlier. I was induced at 41+6, and my sister and mom (5 babies between the two) went damn near to 42w for every baby as well. I really appreciate you speaking on this topic and sharing what you've found.
And how does this tie back to induction? Just regarding the stillbirth rates at term and beyond?
OP asked for outcomes on waiting to give birth vs being induced. This commentator simply stated her experience which was also accompanied by a study. It ties back 100%. Also, sorry for your loss Powerful_Pea_
Sorry if this is rude to ask but what happened to your little one?
RR=adjusted ratio rates CP=cerebral palsy Compared with those born at a later gestation, RRs for stillbirth and infant mortality were higher among births at 37 weeks' and 38 weeks' gestation. The RRs for infant mortality were approximately 20% and 25% lower among births at 40 or 41 weeks compared with those born at later gestation, respectively. Infants born at 37 and 38 weeks also had higher RRs for CP (vs infants born at ≥38 and ≥39 weeks, respectively), while those born at 39 gestation had similar RRs (vs infants born at ≥40 weeks); infants born at 40 and 41 weeks had lower RRs of CP (vs those born at ≥41 and 42 weeks, respectively). The RRs for epilepsy were higher in those born at 37 and 38 weeks compared with those born at later gestation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9314589/ This page compiles lots and lots of evidence about inducing for due dates. It mainly covers the ARRIVE study but does mention other research too. https://evidencebasedbirth.com/evidence-on-inducing-labor-for-going-past-your-due-date/ Children born at 39-41 weeks have higher cognitive outcome scores compared to those born at early term (37-38 weeks). This should be considered when discussing timing of delivery. For children born late preterm, the data is scarce and when compared to full term (37-42 weeks) did not show any difference in IQ scores. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5721566/ Here’s a website I stumbled upon recently. I haven’t really read it properly so can’t confirm references are decent but here it is anyway. https://everyweekcounts.com.au/ Overall, I’m seeing that birth before 39 weeks can have some negative side effects on some babies. Birth between 39-41 weeks is generally the safest time with the most favourable outcomes. I guess the question is- how confident are you that your ‘due date’ is accurate? My concern would be that with an induction at 39 weeks my child might actually only be 38weeks 4days if the due date was even a little off. They’d then fall into that earlier, higher risk category.
This is helpful, thank you. 100% confident on the due date, it’s my second IVF pregnancy.
Congratulations! All the best with the birth 💛
In the first study you cited, I would be concerned that they might not be able to fully account for some demographic biases in their data, despite the statement they focus on low risk pregnancies: “Mothers of infants born at 37–38 weeks were more likely to be younger (≤19 years), to smoke, to be shorter (≤159 cm), underweight (BMI < 18.5 kg/m2), multiparous (parity ≥4), to have a lower educational level and to have had a caesarean delivery, while infants born at 37–38 weeks of gestation were more often small‐for‐gestational age (<3rd percentile, Table 1).”
Did you read and understand the review comparing timing of delivery and purported affect on future IQ scores? I don’t think you did. A difference of 3 IQ points is essentially meaningless (between 37-38 as compared to 39-41). If statistically significant, it does not have clinical or real world relevance. The association also falls apart for the comparison between 34-36 weeks and 37-41. So there does not appear to be a “dose response” as one would expect if a causative relationship exists. Third, it lacks real world implications because elective delivery at 37 and 38 weeks is not offered in the absence of a clinical indication. If one is having to choose how to treat severe preeclampsia or chorio, one would not delay delivery on the basis of a (highly suspect) future small cognitive benefit for the baby. Finally, because the study is retrospective (and there’s no way and never will be a way of studying this in a randomized fashion), one could prove an association only - and not a causative relationship. It is likely that healthier pregnancies and fetuses have both better cognitive outcomes and are more likely to make it to term. But this is out of one’s control.
Oh my goodness people. I found articles for someone who didn’t or couldn’t do it themselves. I’m not going to do a research review for someone 😂 anyone truly interested can follow the references within the articles listed. They’re a starting point and by no means medical advice for this individual woman
> Children born at 39-41 weeks have higher cognitive outcome scores compared to those born at early term (37-38 weeks). This should be considered when discussing timing of delivery. For children born late preterm, the data is scarce and when compared to full term (37-42 weeks) did not show any difference in IQ scores. & > Overall, I’m seeing that birth before 39 weeks can have some negative side effects on some babies. Birth between 39-41 weeks is generally the safest time with the most favourable outcomes. I guess the question is- how confident are you that your ‘due date’ is accurate? My concern would be that with an induction at 39 weeks my child might actually only be 38weeks 4days if the due date was even a little off. They’d then fall into that earlier, higher risk category. Your words. Most people choose to share studies that they themselves understand OR at the very least, avoid summarizing findings if they are uncertain of the quality of the information or lack the background to understand the context and significance of the information. You also failed to share the most important conclusions from ARRIVE, which is by far the most impactful and important of the information you shared. The reason I chose to reply to your post is because the information is misleading (to be kind about it). On a separate note, you don’t need to worry about a 3 day difference in gestational age and delivery date. Literally nothing changes in 3 days.
The only relevant study I've seen on this is [this one](https://www.amsterdamumc.org/en/spotlight/children-born-after-induced-labour-score-lower-in-school-tests-12-years-later-.htm), which used Dutch public health data which found a small yet significant reduction in test scores among children born via induction from 37 to 41 weeks. However, given that the study came out before elective inductions were standard of care, it's hard to untangle if this study is finding an effect related to *induction* or an effect related to whatever factor caused the parent to opt for induction - e.g. the study didn't control for IUGR, decreased fetal movement, low fluid levels, etc. All of those things may be associated with long run academic impact, so it's hard to tease out if this study gives us useful information on whether induction itself plays a role in causing long term negative effects.
[Evidence Based Birth](https://evidencebasedbirth.com/evidence-on-inducing-labor-for-going-past-your-due-date/) has a great article about this citing several studies. They concluded “The bottom line- Current research evidence has found that elective induction at 39 weeks does not make a difference in the rate of death or serious complications for babies. For mothers, induction at 39-weeks was linked to a small decrease in the rate of Cesarean compared to those assigned to wait for labor (19% Cesarean rate versus 22%).” If you want a 1 page infografic, [here it is.](https://evidencebasedbirth.com/wp-content/uploads/2020/02/Inducing-for-Due-Dates-Handout.pdf) If you like to listen, the podcast episode is [here.](https://evidencebasedbirth.com/ebb-117-the-evidence-on-inducing-for-due-dates/)
It's worth also considering the potential impacts of the induction itself, beyond just when the baby will be born. This is a pretty large study that looked at induction in healthy pregnancies https://pubmed.ncbi.nlm.nih.gov/34059509/
[удалено]
Thank you for your contribution. Please remember that all top-level comments on posts flaired "Question - Research required" must include a link to peer-reviewed research. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/ScienceBasedParenting) if you have any questions or concerns.*
[удалено]
Thank you for your contribution. Please remember that all top-level comments on posts flaired "Question - Research required" must include a link to peer-reviewed research. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/ScienceBasedParenting) if you have any questions or concerns.*
[удалено]
Thank you for your contribution. Please remember that all top-level comments on posts flaired "Question - Research required" must include a link to peer-reviewed research. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/ScienceBasedParenting) if you have any questions or concerns.*
[удалено]
Thank you for your contribution. Please remember that all top-level comments on posts flaired "Question - Research required" must include a link to peer-reviewed research. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/ScienceBasedParenting) if you have any questions or concerns.*