Inducing First-Time Mothers Aged 35 And Over Could Reduce Stillbirth And Neonatal Deaths, Study Suggests | HuffPost Life

'This study represents the strongest evidence yet.'

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Life editor at HuffPost UK

For first-time mothers aged 35 and over, inducing labour early could reduce the risk of stillbirth and neonatal deaths, a new study has suggested.

The study of nearly 80,000 UK women, published in the journal PLOS Medicine, showed that inducing these women one to two weeks earlier was linked to the risk of baby death falling from 26 per 10,000 pregnancies to eight per 10,000 pregnancies.

“The number of first-time mothers over the age of 35 is rising,” said Hannah Knight, lead author from the London School of Hygiene & Tropical Medicine.

“This study represents the strongest evidence yet that moving the offer of induction forward to 40 weeks might reduce the risk of stillbirth in this specific age group, which we know face a greater risk of stillbirth and neonatal death.”

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Current UK national guidelines recommend induction of labour to be offered to pregnant women at between 41 and 42 weeks of gestation (one to two weeks after their due date).

In the study, the authors used data from English Hospital Episode Statistics covering 77,327 first-time mothers aged 35-50, to determine whether an earlier induction was associated with a change in risk to mother or child.

They compared women who were induced at 39, 40 and 41 weeks of gestation. They found that pregnant women who were induced at 40 weeks had a “lower risk of perinatal death of two thirds” compared to women who received care according to current guidelines.

Knight added: “Whilst our study suggests bringing forward the routine offer of induction of labour to 40 weeks of gestation in first-time mums aged 35 or over may reduce the risk of perinatal death, there are other important factors to consider.

“There are potential downsides to such a policy, such as acceptability of induction of labour to women and the increased demand on resources.

“Further studies are needed to examine the impact of such a change in policy on NHS costs and women’s satisfaction.”

Senior author Professor Gordon Smith, head of the department of obstetrics and gynaecology at the University of Cambridge, believes women over the age of 35 should consider inducing labour at their due date.

“Our best estimate is that one stillbirth would be prevented for every 562 inductions of labour,” he said.

“Some women might prefer to avoid induction and to accept this small risk. Other women may opt for induction given concerns about the possibility of stillbirth.

“But a key aspect of the paper is that this analysis provides the best evidence for the magnitude of the risk and allows women to make an informed choice.”

“Our best estimate is that one stillbirth would be prevented for every 562 inductions of labour."”
- Senior author Professor Gordon Smith, head of the department of obstetrics and gynaecology, University of Cambridge

Professor Lesley Regan, president of the Royal College of Obstetricians and Gynaecologists (RCOG), said the implications of such a change in policy - inducing all women aged 35 and over on their due date - would be “enormous” for both the health service and women themselves.

“Further research to determine the impact of such a change in practice is needed,” she explained.

“While induction is safe and studies have shown no short-term adverse impact on mother or baby, induction of labour represents an intervention, is associated with costs to the service, and can be a more prolonged process than spontaneous labour.

“These findings should help women over the age of 35 make an informed choice with regards to induction of labour and are likely to influence the production of future guidelines.

“Through our Each Baby Counts initiative and in partnership with the NHS and Department of Health, the RCOG is committed to halving the number of babies who are stillborn, suffer a neonatal death or severe brain injury by 2030.”

Before You Go

How To Help A Friend Through Miscarriage

Send Flowers(01 of15)

While not everyone is as open to talking about their feelings as I am, I think everyone loves to receive a bright bouquet of flowers –- it’s a nice way to say that you’re there for her, and you care, without forcing her to talk about her feelings. (credit:Getty)

Share Your Story(02 of15)

If you’ve gone through a similar experience, share your story with your grieving friend. While it’s unfortunate that miscarriage is so common, your friend can take comfort in not being alone. Knowing that others in their own network of friends have experienced the same thing makes it easier to work through the grieving process. (credit:Getty)

Pamper Her(03 of15)

There’s no better time for your friend to focus on taking care of themselves. A restful body will help to heal the mind. Gift your friend with a massage or a pedicure so she is forced to take time out to enjoy a little pampering. And if you can, join her! (credit:Getty)

Don’t Try To Tell Her That It'll All Be OK(04 of15)

Unfortunately, there isn’t really anything you can do to reassure your friend that they’ll feel better in a few weeks or months. It’s a grieving process –- one that affects everyone differently. All that you can do is lend an ear, hold a hand and wait it out with them. (credit:Getty)

Don't Pry(05 of15)

While you may be wondering what the doctors discovered or if your friend is going to try again -- wait for your friend to share those details with you. Don’t try to pry it out of her. She might not be ready to discuss the details with you yet, but if you let her know that you’re there for her and available if she wants to talk, then she will come to you when she's ready. (credit:Getty)

(06 of15)

1. Your fertility is mostly determined by genetics, which influences how many eggs you are born with. Doctors believe that the number of eggs you have at birth determines the length of time you will remain fertile. At birth, women have about two million eggs in their ovaries. For every egg ovulated during your reproductive life, about 1,000 eggs undergo programmed cell death. Other things, such as smoking cigarettes and certain types of chemotherapy, can accelerate egg cell death and promote an earlier menopause.

(07 of15)

2. Regular menstrual cycles are a sign of regular ovulation.Most women have regular cycles lasting between 24 and 35 days. This is usually a sign of regular, predictable ovulation. Women who do not ovulate regularly have irregular menstrual cycles. Those who do not ovulate at all may have a genetic condition called polycystic ovarian syndrome (PCOS).

(08 of15)

3. Basal temperature charting does not predict ovulation.An older method of tracking ovulation involves taking your oral body temperature each morning before getting out of bed. This is called basal body temperature. This method is used to spot a rise in basal temperature, which is a sign that progesterone is being produced. The main problem with using this method is that your temperature rises after ovulation has already occurred. This makes it more difficult to time intercourse at an optimal time for conception. A better method is to use over-the-counter urine ovulation predictor test kits such as Clearblue Easy. These kits test for the hormone that prompts ovulation, which is called luteinizing hormone (LH).

(09 of15)

4. Most women with blocked fallopian tubes are completely unaware they may have had a prior pelvic infection.About 10 percent of infertility cases are due to tubal disease, either complete blockage or pelvic scarring causing tubal malfunction. One major cause of tubal disease is a prior pelvic infection from a sexually transmitted disease such as chlamydia. These infections can cause so few symptoms that you may be completely unaware your tubes are affected. This is why fertility physicians will order a dye test of the tubes, called a hysterosalpingogram (HSG), if you have been trying and failing to conceive for 6 months or longer.

(10 of15)

5. In most cases, stress does not cause infertility. Except in rare cases of extreme physical or emotional distress, women will keep ovulating regularly. Conceiving while on vacation is likely less about relaxation than about coincidence and good timing of sex.

(11 of15)

6. By age 44, most women are infertile, even if they are still ovulating regularly. Even with significant fertility treatment, rates of conception are very low after age 43. Most women who conceive in their mid-40's with fertility treatment are using donated eggs from younger women.

(12 of15)

7. Having fathered a pregnancy in the past does not guarantee fertility. Sperm counts can change quite a bit with time, so never assume that a prior pregnancy guarantees fertile sperm. Obtaining a semen analysis is the only way to be sure the sperm are still healthy!

(13 of15)

8. For the most part, diet has little or nothing to do with fertility. Despite popular press, there is little scientific data showing that a particular diet or food promotes fertility. One limited study did suggest a Mediterranean diet with olive oil, fish and legumes may help promote fertility.

(14 of15)

9. Vitamin D may improve results of fertility treatments. A recent study from the University of Southern California suggested that women who were undergoing fertility treatments, but had low vitamin D levels, might have lower rates of conception. This vitamin is also essential during pregnancy. At Pacific Fertility Center, we recommend our patients take 2,000-4,000 IU per day.

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10. Being either underweight or overweight is clearly linked with lowered levels of fertility. The evidence in recent years is that obesity is clearly linked with a longer time to conception. Having a body mass index less than 18 or over 32 is associated with problems ovulating and conceiving, as well as problems during pregnancy.

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