Neonatal Outcomes Following Elective Induction of Labor at 39 Weeks: A Systematic Review.

Abstract

Elective induction of labor (eIOL) at 39 weeks of gestation has gained prominence in obstetric practice, yet its impact on neonatal outcomes remains debated. This systematic review aimed to synthesize evidence on neonatal outcomes following eIOL at 39 weeks compared to expectant management, addressing critical knowledge gaps to inform clinical decision-making. Following PRISMA guidelines, a comprehensive search of PubMed, Scopus, Web of Science, and Embase identified 16 eligible studies. Inclusion criteria focused on low-risk pregnancies undergoing eIOL at 39 weeks, with neonatal outcomes as primary endpoints. Risk of bias was assessed using the Newcastle-Ottawa Scale for cohort studies and Cochrane RoB 2 for the RCT. Narrative synthesis was performed due to heterogeneity. Key findings demonstrated that eIOL at 39 weeks was associated with reduced cesarean delivery rates and lower perinatal mortality, without significant increases in adverse neonatal outcomes. However, subgroup analyses revealed variability: obese women benefited from reduced macrosomia and NICU admissions, while women with prior cesareans faced higher failed TOLAC rates. The RCT confirmed lower cesarean rates but no reduction in composite neonatal morbidity. eIOL at 39 weeks is a safe and effective strategy for reducing cesarean deliveries and perinatal mortality in low-risk populations, though benefits vary by subgroup. Shared decision-making, tailored to maternal characteristics, is essential. Future research should prioritize RCTs in high-risk populations and long-term neonatal follow-up.