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OBJECTIVE: Induction of labour (IOL) from 37 weeks for various indications is associated with a reduction in perinatal deaths compared to expectant management, though absolute rates are small. The incidence of IOL has been rising. The effects of IOL from 37 weeks on childhood neurodevelopment however are not well studied. We aimed to study the influence of IOL for each week of 12 years. STUDY DESIGN: We performed a population-based study among liveborn singletons from 37+0-42+6 weeks of gestation in cephalic presentation born in 2003-2008 from uncomplicated pregnancies (no hypertensive disorders, diabetes or birthweight < p5). Children with congenital anomalies, of non-Western ethnicity and born after planned cesarean section were excluded. Birth records were linked with national data on standardized school achievement at age 11-12 (rates 501-550). We compared, using a fetus-at-risk approach and per week of gestation, school performance in those born after IOL to those born after expectant management, i.e. spontaneous onset of labour in the same week plus all those born at later gestations. Education scores were standardized to a mean of 0 and a S.D. of 1 and adjusted in the regression analyses. RESULTS: We included 226,684 children. At each week of gestation, IOL was associated with a decreased mean education score compared with expectant management (at 37 weeks -0.96, 95%CI -1.43 to -0.50; at 42 weeks -0.52, 95%CI -1.00 to -0.04; Table 1). Adjusted mean education z-score was -0.10 (-0.15 to -0.05) lower after IOL compared to expectant management at 37 weeks (Figure 1). At each gestational week between 38 and 42 weeks we found comparable differences in mean education z-score, favoring expectant management. CONCLUSION: Consistently, at every week of gestation from 37-42 weeks, IOL at term in uncomplicated pregnancies significantly reduces offspring school performance at age 12 compared to expectant management. Residual confounding may remain. These long-term effects should be incorporated in decisions around IOL.

The World Health Organization recommends artemisinin-based combination therapies (ACTs) for the treatment of uncomplicated falciparum malaria in the second and third trimesters of pregnancy. We conducted a meta-analysis to compare efficacy, safety and tolerability of ACTs versus quinine and other non-ACT antimalarials. The median PCR-adjusted failure rate by days 28 to 63 in the non-ACT group was 6 (range 0–37) per 100 women, lower in the ACT group overall (pooled risk ratio [PRR] random effects, 0.41; 95% confidence interval [CI], 0.16–1.05; 6 trials), and significantly lower compared with oral quinine (PRR, 0.20; 95% CI, 0.08–0.49; 4 trials). There were no differences in fetal deaths and congenital abnormalities. Compared with quinine, artemisinin-based combinations therapies were associated with less tinnitus (PRR, 0.19; 95% CI, 0.03–1.11; 4 studies), dizziness (PRR, 0.64; 95% CI, 0.44–0.93; 3 trials), and vomiting (PRR, 0.33; 95% CI, 0.15–0.73; 3 trials). Artemisinin-based combination therapies are better than quinine in the second and third trimesters; their use should be encouraged among health workers.