Earlier Inductions Lead to Better Outcomes

Inducing pregnant women once they reach 37 weeks' gestation appears to lower the chance of neonatal death, asphyxia, and cerebral palsy, a Danish study suggests.

This new research found that proactive labor induction was associated with improved outcomes for babies in Denmark.

Key Points:

- Inducing pregnant women after they reach 37 weeks appeared to improve birth outcomes in Denmark.

- ACOG recommends against elective inductions before
39 weeks' gestation.

- More study is needed before proactive labor induction is implemented elsewhere.

The study analyzed 770,926 babies born in Denmark over a 13-year period and found a decrease in neonatal death correlated with the implementation of a proactive labor induction practice from 2009. The risk of neonatal death went down from 1.9 to 1.0 per 1,000 births from 2000 to 2012, according to the study results.

Currently, about a quarter of Danish women who are pregnant beyond 37 weeks are induced. (Note: This practice isn't currently supported by ACOG, which advises against elective inductions before 39 weeks' gestation.)

In addition to nearly halving the risk of infant death, the researchers found the risk of asphyxia decreased by 23% from 2003 to 2012. This corresponded with a decrease in the incidence rate of cerebral palsy by 26% from 2002 to 2010, the study reported.

Finally, the researchers noticed that the risk of macrosomia decreased by one third and peripheral nerve injury decreased by 43%.

The findings differ from current guidelines on late-term induction, which recommend uncomplicated pregnancies be induced between weeks 41 and 42. In Denmark, the practice of inducing women from 37 weeks' gestation increased from 9.1% in 2000 to 26% in 2012. At the same time, the percentage of pregnancies in the country that continued beyond 42 weeks decreased from 8% in 2000 to 1.5% in 2012.

While the findings, published in BJOG: An International Journal of Obstetrics and Gynaecology, seemed to suggest a benefit to inducing women earlier at just after 37 weeks' gestation, John Thorp, MD, a BJOG Deputy Editor-in-Chief, urged caution.

“Labour induction is a simple intervention but demands a closer surveillance during labour, and hospital settings must be able to support such changes,” he said in a news release. “These findings require further education and scrutiny before being implemented in other nations."