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closeAIMS questions the validity of this conclusion.
Posted by nhigson on 03 Nov 2023 at 14:51 GMT
This comment is being posted on behalf of AIMS (Association for Improvements in the Maternity Services). For our full review of this paper see www.aims.org.uk/campaigni...
The authors suggest that induction at 39 weeks may be of benefit to those from lower socioeconomic groups. AIMS questions the validity of this conclusion. These are our main concerns:
Women with certain risk factors were removed from the induction group, but not the expectant management group. This introduces bias because there would be some women with these risk factors who may not have been offered, or who declined induction. This would make the expectant management group a higher risk sample than the induction group.
The expectant management group excluded women who went into spontaneous labour between 39 and 40 weeks, which other studies (Glantz JC. Obstet Gynecol 115:70-6. 2010; Stock SJ et al BMJ 2012; 344: e2838) have shown tends to produce results which are more favourable to induction, than if they are included.
The research was promoted with the headline “New research indicates early induction of labour may reduce inequalities in pregnancy outcomes.” However the only groups for which there was evidence of benefit was low risk women of low socioeconomic status. The researchers found no evidence that it might reduce the inequalities of outcome suffered by women of Black or Asian heritage.
The reduction in stillbirth rates observed in the induction group was almost exactly matched by an increase in the neonatal death rates. Early induction might avoid one perinatal (stillbirth plus neonatal) death out of every 10,000 births, but for 9,999 it would make no difference - a rather less dramatic finding than the headline implies.
The main benefit of early induction appears to be that it would avoid the need for 42 out of every 10,000 babies to be ventilated.
A policy of offering induction at 39 weeks to all low risk women in the most deprived 40% or even the most deprived 20% of the population seems impractical. AIMS believes that this would impact severely on the ability of our already over-stretched maternity services to deliver safe care for all.
There are likely to be many reasons for the observed inequalities in maternity outcomes, but reaching for the blunt instrument of more inductions is a case of wanting to treat the symptom, not the cause. AIMS believes that what is needed is sensitive and supportive pre-pregnancy and maternity care, preferably with a Continuity of Carer model.