Cognitive and academic outcomes of large-for-gestational-age babies born
at early-term: a systematic review and meta-analysis
Abstract
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