Elective induction versus expectant management for suspected large-for-gestational-age fetuses: a systematic review and meta-analysis
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
Suspected large-for-gestational-age (LGA) fetuses present a clinical dilemma: early induction may reduce birth trauma but raise intervention risks. Previous reviews lacked recent data.
Objectives
To assess whether elective induction at 37–39 weeks reduces adverse maternal and neonatal outcomes compared with expectant management in pregnancies with suspected LGA fetuses.
Methods
We systematically searched PubMed, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov through May 2025, with no language restrictions. We included randomised controlled trials (RCTs) comparing elective induction (37–39 weeks) with expectant management in singleton pregnancies with suspected LGA fetuses. Two reviewers independently screened studies, extracted data, and assessed the risk of bias using RoB 2.0. Outcomes were pooled using fixed- or random-effects meta-analysis, and the certainty of evidence was evaluated using the GRADE framework.
Main Results
Three RCTs (n = 3,984) met the inclusion criteria. Induction significantly reduced shoulder dystocia (RR 0.65, 95% CI 0.46–0.91), caesarean birth (RR 0.87, 95% CI 0.79–0.95), and increased spontaneous vaginal birth (RR 1.12, 95% CI 1.06–1.19). No differences were seen in instrumental delivery, severe perineal trauma, or perinatal death. Induction lowered mean birthweight (–177 g, 95% CI –279 to –76) but was associated with increased neonatal phototherapy (RR 1.63, 95% CI 1.19–2.23). Certainty of evidence was moderate for most primary outcomes.
Conclusions
For suspected LGA fetuses, induction around 38 weeks reduces birth trauma and caesarean risk without increasing major maternal or neonatal morbidity. Clinical discussions should weigh these benefits against patient preferences and contextual factors.
Funding
This study received no external funding.
Suspected large-for-gestational-age (LGA) fetuses present a clinical dilemma: early induction may reduce birth trauma but raise intervention risks. Previous reviews lacked recent data.
Objectives
To assess whether elective induction at 37–39 weeks reduces adverse maternal and neonatal outcomes compared with expectant management in pregnancies with suspected LGA fetuses.
Methods
We systematically searched PubMed, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov through May 2025, with no language restrictions. We included randomised controlled trials (RCTs) comparing elective induction (37–39 weeks) with expectant management in singleton pregnancies with suspected LGA fetuses. Two reviewers independently screened studies, extracted data, and assessed the risk of bias using RoB 2.0. Outcomes were pooled using fixed- or random-effects meta-analysis, and the certainty of evidence was evaluated using the GRADE framework.
Main Results
Three RCTs (n = 3,984) met the inclusion criteria. Induction significantly reduced shoulder dystocia (RR 0.65, 95% CI 0.46–0.91), caesarean birth (RR 0.87, 95% CI 0.79–0.95), and increased spontaneous vaginal birth (RR 1.12, 95% CI 1.06–1.19). No differences were seen in instrumental delivery, severe perineal trauma, or perinatal death. Induction lowered mean birthweight (–177 g, 95% CI –279 to –76) but was associated with increased neonatal phototherapy (RR 1.63, 95% CI 1.19–2.23). Certainty of evidence was moderate for most primary outcomes.
Conclusions
For suspected LGA fetuses, induction around 38 weeks reduces birth trauma and caesarean risk without increasing major maternal or neonatal morbidity. Clinical discussions should weigh these benefits against patient preferences and contextual factors.
Funding
This study received no external funding.
Date Issued
2026-03-27
Date Acceptance
2026-02-04
Citation
BMC Pregnancy and Childbirth, 2026, 26
ISSN
1471-2393
Publisher
BMC
Journal / Book Title
BMC Pregnancy and Childbirth
Volume
26
Copyright Statement
© The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
10.1186/s12884-026-08787-x
Subjects
Induction of labour
Macrosomia
Shoulder dystocia
Obstetrics
Meta-analysis
Publication Status
Published
Article Number
338
Date Publish Online
2026-02-20