Importance Elective births at 39 weeks' gestation are increasing. While this option may improve maternal and perinatal outcomes compared with expectant management, longer-term childhood developmental outcomes are uncertain. Objective To investigate the association between elective birth at 39 weeks' gestation and the risk of childhood developmental vulnerability. Design, Setting, and Participants For this cohort study, 2 causal inference analyses were conducted using Australian statewide, population-based data. Perinatal data from births between January 1, 2005, and December 31, 2013, were linked to childhood developmental outcomes at age 4 to 6 years (assessed using multiple imputation via inverse probability-weighted regression adjustment). Data analyses were conducted between September 7 and November 9, 2021. Exposures Two exposure groups were considered: (1) elective birth between 39 weeks and 0 days' and 39 weeks and 6 days' gestation vs expectant management and (2) birth via induction of labor vs planned cesarean delivery among those born electively at 39 weeks' gestation. Main Outcomes and Measures Childhood developmental vulnerability at school entry, defined as scoring below the 10th percentile in at least 2 of 5 developmental domains (physical health and well-being, social competence, emotional maturity, school-based language and cognitive skills, and communication skills and general knowledge). Results Of 176 236 births with linked outcome data, 88 165 met the inclusion criteria. Among these, 15 927 (18.1%) were elective births at 39 weeks' gestation (induction of labor or planned cesarean delivery), and 72 238 (81.9%) were expectantly managed with subsequent birth between 40 and 43 weeks' gestation. Compared with expectant management, elective birth at 39 weeks' gestation was not associated with an altered risk of childhood global developmental vulnerability (adjusted relative risk [aRR], 1.03; 95% CI, 0.96-1.12) or with developmental vulnerability in any of the individual domains. In an analysis restricted to elective births at 39 weeks' gestation, induction of labor (n = 7928) compared with planned cesarean delivery (n = 7999) was not associated with childhood developmental vulnerability (aRR, 0.96; 95% CI, 0.82-1.12) or with vulnerability in any individual domains. Conclusions and Relevance In this cohort study, elective birth at 39 weeks' gestation was not associated with childhood developmental vulnerability. For those born electively at 39 weeks' gestation, birth after induction of labor or by elective cesarean delivery had similar developmental outcomes.

中文翻译：

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妊娠 39 周择期分娩后儿童的发育结果。

重要性 妊娠 39 周的选择性分娩正在增加。虽然与期待管理相比，这种选择可能会改善孕产妇和围产期结局，但长期儿童发育结局尚不确定。目的 探讨妊娠 39 周择期分娩与儿童发育脆弱性风险之间的关系。设计、设置和参与者 对于这项队列研究，使用澳大利亚全州范围内基于人口的数据进行了 2 项因果推理分析。2005 年 1 月 1 日至 2013 年 12 月 31 日期间出生的围产期数据与 4 至 6 岁的儿童发育结果相关（通过逆概率加权回归调整使用多重插补进行评估）。数据分析于 2021 年 9 月 7 日至 11 月 9 日期间进行。暴露 考虑了两个暴露组：(1) 妊娠 39 周 0 天和 39 周 6 天之间的择期分娩与期待管理，以及 (2) 在 39 周择期出生的人中通过引产与计划剖宫产分娩' 怀孕。主要成果和措施 入学时的儿童发展脆弱性，定义为在 5 个发展领域（身体健康和福祉、社交能力、情绪成熟度、校本语言和认知技能以及交流）中至少有 2 个得分低于第 10 个百分位技能和一般知识）。结果 在具有关联结果数据的 176 236 例新生儿中，88 165 例符合纳入标准。其中，孕39周择期分娩（引产或计划剖宫产）15 927例（18.1%），72 238例（81. 9%）在妊娠 40 到 43 周之间进行了后续分娩的预期管理。与期待治疗相比，妊娠 39 周择期分娩与儿童整体发育脆弱性风险改变（调整后相对风险 [aRR]，1.03；95% CI，0.96-1.12）或任何发育脆弱性无关个人领域。在一项仅限于妊娠 39 周择期分娩的分析中，与计划剖宫产 (n = 7999) 相比，引产 (n = 7928) 与儿童发育脆弱性无关 (aRR, 0.96; 95% CI, 0.82-1.12) ) 或在任何个别域中存在漏洞。结论和相关性 在这项队列研究中，妊娠 39 周的择期分娩与儿童发育脆弱性无关。