Effects on (neuro)developmental and behavioral outcome at 2 years of age of induced labor compared with expectant management in intrauterine growth-restricted infants: long-term outcomes of the DIGITAT trial

Published:March 26, 2012DOI:


      We sought to study long-term (neuro)developmental and behavioral outcome of pregnancies complicated by intrauterine growth restriction at term in relation to induction of labor or an expectant management.

      Study Design

      Parents of 2-year-old children included in the Disproportionate Intrauterine Growth Intervention Trial at Term (DIGITAT) answered the Ages and Stages Questionnaire (ASQ) and Child Behavior Checklist (CBCL).


      We approached 582 (89.5%) of 650 parents. The response rate was 50%. Of these children, 27% had an abnormal score on the ASQ and 13% on the CBCL. Results of the ASQ and the CBCL for the 2 policies were comparable. Low birthweight, positive Morbidity Assessment Index score, and admission to intermediate care increased the risk of an abnormal outcome of the ASQ. This effect was not seen for the CBCL.


      In women with intrauterine growth restriction at term, neither a policy of induction of labor nor expectant management affect developmental and behavioral outcome when compared to expectant management.

      Key words

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        • Barker D.J.
        Fetal growth and adult disease.
        Br J Obstet Gynaecol. 1992; 99: 275-276
        • McIntire D.D.
        • Bloom S.L.
        • Casey B.M.
        • Leveno K.J.
        Birth weight in relation to morbidity and mortality among newborn infants.
        N Engl J Med. 1999; 340: 1234-1238
        • Boulet S.L.
        • Alexander G.R.
        • Salihu H.M.
        • Kirby R.S.
        • Carlo W.A.
        Fetal growth risk curves: defining levels of fetal growth restriction by neonatal death risk.
        Am J Obstet Gynecol. 2006; 195: 1571-1577
        • Dijxhoorn M.J.
        • Visser G.H.
        • Touwen B.C.
        • Huisjes H.J.
        Apgar score, meconium and acidemia at birth in small-for-gestational age infants born at term, and their relation to neonatal neurological morbidity.
        Br J Obstet Gynaecol. 1987; 94: 873-879
        • Soothill P.W.
        • Ajayi R.A.
        • Campbell S.
        • Nicolaides K.H.
        Prediction of morbidity in small and normally grown fetuses by fetal heart rate variability, biophysical profile score and umbilical artery Doppler studies.
        Br J Obstet Gynaecol. 1993; 100: 742-745
        • Jacobsson B.
        • Ahlin K.
        • Francis A.
        • Hagberg G.
        • Hagberg H.
        • Gardosi J.
        Cerebral palsy and restricted growth status at birth: population-based case-control study.
        BJOG. 2008; 115: 1250-1255
        • Jarvis S.
        • Glinianaia S.V.
        • Torrioli M.G.
        • et al.
        Cerebral palsy and intrauterine growth in single births: European collaborative study.
        Lancet. 2003; 362: 1106-1111
        • Leitner Y.
        • Fattal-Valevski A.
        • Geva R.
        • et al.
        Six-year follow-up of children with intrauterine growth retardation: long-term, prospective study.
        J Child Neurol. 2000; 15: 781-786
        • Low J.A.
        • Handley-Derry M.H.
        • Burke S.O.
        • et al.
        Association of intrauterine fetal growth retardation and learning deficits at age 9 to 11 years.
        Am J Obstet Gynecol. 1992; 167: 1499-1505
        • Hill R.M.
        • Verniaud W.M.
        • Deter R.L.
        • et al.
        The effect of intrauterine malnutrition on the term infant: a 14-year progressive study.
        Acta Paediatr Scand. 1984; 73: 482-487
        • Parkinson C.E.
        • Scrivener R.
        • Graves L.
        • Bunton J.
        • Harvey D.
        Behavioral differences of school-age children who were small-for-dates babies.
        Dev Med Child Neurol. 1986; 28: 498-505
        • Tenovuo A.
        • Kero P.
        • Korvenranta H.
        • Piekkala P.
        • Sillanpaa M.
        • Erkkola R.
        Developmental outcome of 519 small-for-gestational age children at the age of two years.
        Neuropediatrics. 1988; 19: 41-45
        • Many A.
        • Fattal-Valevski A.
        • Leitner Y.
        Neurodevelopmental and cognitive assessment of 6-year-old children born growth restricted.
        Int J Gynaecol Obstet. 2005; 89: 55-56
        • Fattal-Valevski A.
        • Leitner Y.
        • Kutai M.
        • et al.
        Neurodevelopmental outcome in children with intrauterine growth retardation: a 3-year follow-up.
        J Child Neurol. 1999; 14: 724-727
        • Leitner Y.
        • Fattal-Valevski A.
        • Geva R.
        • et al.
        Neurodevelopmental outcome of children with intrauterine growth retardation: a longitudinal, 10-year prospective study.
        J Child Neurol. 2007; 22: 580-587
        • van Wassenaer A.
        Neurodevelopmental consequences of being born SGA.
        Pediatr Endocrinol Rev. 2005; 2: 372-377
        • van den Broek A.J.
        • Kok J.H.
        • Houtzager B.A.
        • Scherjon S.A.
        Behavioral problems at the age of eleven years in preterm-born children with or without fetal brain sparing: a prospective cohort study.
        Early Hum Dev. 2010; 86: 379-384
        • Boers K.E.
        • Vijgen S.M.
        • Bijlenga D.
        • et al.
        Induction versus expectant monitoring for intrauterine growth restriction at term: randomized equivalence trial (DIGITAT).
        BMJ. 2010; 341: c7087
        • Verma A.
        • Okun N.B.
        • Maguire T.O.
        • Mitchell B.F.
        Morbidity assessment index for newborns: a composite tool for measuring newborn health.
        Am J Obstet Gynecol. 1999; 181: 701-708
        • Verma A.
        • Weir A.
        • Drummond J.
        • Mitchell B.F.
        Performance profile of an outcome measure: morbidity assessment index for newborns.
        J Epidemiol Community Health. 2005; 59: 420-426
        • Squires J.
        • Tombley E.
        ASQ-3 user's guide.
        3rd ed. Paul H Brookes Publishing, 2009
        • Achenbach T.M.
        • Rescorla L.A.
        Aseba preschool forms and profiles.
        University of Vermont, Research Center for Children, Youth and Families, Burlington, VT2000
        • Walther F.J.
        Growth and development of term disproportionate small-for-gestational age infants at the age of 7 years.
        Early Hum Dev. 1988; 18: 1-11
        • Grantham-McGregor S.M.
        Small for gestational age, term babies, in the first six years of life.
        Eur J Clin Nutr. 1998; 52: S59-S64
        • Figueras F.
        • Eixarch E.
        • Meler E.
        • et al.
        Small-for-gestational-age fetuses with normal umbilical artery Doppler have suboptimal perinatal and neurodevelopmental outcome.
        Eur J Obstet Gynecol Reprod Biol. 2008; 136: 34-38
        • van Wassenaer A.G.
        • Westera J.
        • van Schie P.E.
        • et al.
        Outcome at 4.5 years of children born after expectant management of early-onset hypertensive disorders of pregnancy.
        Am J Obstet Gynecol. 2011; 204: 510-519
        • Kenyon S.
        • Pike K.
        • Jones D.R.
        • et al.
        Childhood outcomes after prescription of antibiotics to pregnant women with preterm rupture of the membranes: 7-year follow-up of the ORACLE I trial.
        Lancet. 2008; 372: 1310-1318
        • Nilsen R.M.
        • Vollset S.E.
        • Gjessing H.K.
        • et al.
        Self-selection and bias in a large prospective pregnancy cohort in Norway.
        Paediatr Perinat Epidemiol. 2009; 23: 597-608