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

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