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Implications of vaginal instrumental delivery for children's school achievement: A population-based linked
David C Hsieh1, Lisa G Smithers2,3, Mairead Black4
1Department of Obstetrics and Gynaecology, Lyell McEwin Hospital, Adelaide, South Australia, Australia.
Insights
Vaginal instrumental delivery, including forceps and ventouse, does not appear to negatively impact children's school achievement. This large study found no significant adverse neurodevelopmental effects in children who experienced instrumental birth.
Area of Science:
- Obstetrics and Gynecology
- Developmental Pediatrics
- Public Health
Background:
- Vaginal instrumental delivery is a common obstetric procedure.
- The long-term neurodevelopmental outcomes for children born via instrumental delivery are not well-established.
Purpose of the Study:
- To investigate the association between vaginal instrumental delivery and neurodevelopmental outcomes in children.
- To assess school achievement as a measure of neurodevelopment following forceps or ventouse delivery compared to normal vaginal birth.
Main Methods:
- A population-based study linked perinatal data with school assessments (NAPLAN) for children born 1999-2008 in South Australia.
- Compared singleton births via forceps (n=5494), ventouse (n=6988), and normal delivery (n=80803).
- Used augmented inverse probability weighting (AIPW) to adjust for confounding maternal, perinatal, and sociodemographic factors.
Main Results:
- Unadjusted analyses showed no association between instrumental delivery and poor NAPLAN scores.
- AIPW analyses indicated minimal adverse effects of instrumental delivery on school achievement.
- Forceps delivery showed a small association with lower spelling scores (-0.022) compared to spontaneous vaginal births.
Conclusions:
- Instrumental vaginal delivery does not demonstrate an adverse effect on neurodevelopment.
- School performance at age eight, as measured by NAPLAN, is not negatively impacted by instrumental delivery in singleton, term-born children.
Background:
Vaginal instrumental delivery is a common obstetrical intervention, but its effect on children's later development is not well known.
Aims:
To determine if vaginal instrumental delivery is associated with adverse neurodevelopment as measured by school achievement.
Material And Methods:
We performed a whole-of-population study involving linkage of routinely collected perinatal data with school assessments among children born in South Australia from 1999 to 2008. Participants were singleton children born by forceps (n = 5494), ventouse (n = 6988), or normal delivery (n = 80 803). School achievement was measured through performance on the National Assessment Program in Literacy and Numeracy (NAPLAN), at around eight years of age. This assessment involved five domains and scores were categorised according to performing at or above National Minimum Standards (NMS). Effects of instrumental versus normal vaginal delivery were analysed via augmented inverse probability weighting (AIPW), taking into account a variety of maternal, perinatal and sociodemographic characteristics.
Results:
In unadjusted analyses, instrumental delivery was not associated with poor NAPLAN scores. AIPW analyses also suggested that instrumental delivery had minimal adverse effect on NAPLAN scores, with the largest difference being lower spelling scores among forceps-delivered children (-0.022 (95% CI -0.0053-0.009)) compared with spontaneous vaginal births. The findings were consistent among exploratory subgroup analyses involving births in the absence of prolonged labour, with APGAR ≥ 9, and among normotensive and non-diabetic mothers.
Conclusion:
In singleton children born at term, instrumental delivery does not have an adverse effect on neurodevelopment as measured by NAPLAN performance at age eight.