ABSTRACT (250 words)
Background: Early induction of labour
(38+0-38+4 weeks) in
large-for-gestational-age (LGA) babies may reduce risks such as shoulder
dystocia but may increase another risk of reduced cognitive abilities in
offspring.
Objectives : To evaluate the cognitive and academic outcomes of
LGA children born at early-term (combined exposures or independently) in
the light of existing research.
Search Strategy: 5 databases were searched from inception to
March 2023 without language restrictions.
Selection Criteria: Studies reporting on cognitive or academic
outcomes either focusing on children born at early-term or LGA.Data Collection and Analysis: Besides narrative synthesis, we
conducted meta-analyses where possible.Main Results: Out of 1592 identified articles, no study
investigated the effect of early-term delivery in LGA babies on
cognitive or academic outcomes. 68 articles investigated the cognitive
effects of early-term delivery and LGA independently. Children born at
37 weeks (SMD, -0.13; 95% CI, -0.21 – -0.05) but not at 38 weeks (SMD,
-0.04; 95% CI, -0.08 – 0.002) have lower cognitive scores than at 40
weeks. LGA children had slightly higher cognitive scores than AGA
children (SMD, 0.06; 95% CI, 0.01 – 0.11). Syntheses results using
cognitive impairment or academic performance as outcomes were similar.Conclusions: There is no existing study that investigated
early-term delivery in LGA babies and their cognitive scores. Early-term
delivery has a small detrimental effect on cognitive scores, whereas LGA
may have a small benefit. Evidence from RCTs or observation studies is
needed.
Fundings : University of Warwick; UKRI (EP/X023206/1)
Keywords : cognitive, intelligence, academic performance,
early-term delivery, large-for-gestational-age, macrosomia,
meta-analysis, systematic review