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Sweden has seen a significant decrease in infant mortality rates for pregnancies extending beyond 41 weeks, with the proportion of babies dying before or during labor dropping by 47%. This remarkable reduction, reported in a large national study, coincides with changes in the procedures surrounding pregnancy induction.
A typical pregnancy lasts around 40 weeks, but approximately 22% of women in Sweden experience pregnancies that extend beyond this due date. While Sweden generally has a low rate of stillbirths and neonatal deaths, the risk increases for pregnancies that surpass 41 weeks. This has prompted ongoing discussions about the necessity of inducing labor for women who go past their expected delivery date.
A recent study published in PLOS Medicine analyzed over 150,000 births from Sweden, focusing on women who were at least one week overdue. The study aimed to evaluate changes in infant mortality and morbidity after 2020 when the country’s maternity hospitals adjusted their induction practices.
The shift in procedure followed a 2019 study that demonstrated improved survival outcomes for babies when labor was induced at 41 weeks, as opposed to the previous practice of waiting until 42 weeks. The 2020 policy change now offers women induction at 41 weeks or an individualized assessment to determine the necessity of induction.
Key Findings and Impact
Comparing two periods—2017–2019 and 2020–September 2023—the study found a 47% decrease in the number of stillbirths and infant deaths within four weeks of birth. In the earlier period, 124 infants (1.7 per 1,000) died, while in the later period, that number dropped to 74 infants (0.9 per 1,000). The two periods encompassed a similar number of pregnancies beyond 41 weeks.
The study also noted a reduction in neonatal mortality and severe morbidity, though there was a slight increase in the rate of emergency cesarean sections, particularly for pregnancies between 39 and 40 weeks. Despite the increased cesarean section rate, the study highlights the overall improvement in outcomes, with fewer infants facing adverse birth outcomes.
However, the exact interventions responsible for the improved survival rates remain unclear. Researchers have not definitively determined whether the decrease in mortality is primarily due to routine inductions after 41 weeks or if the intensive monitoring of pregnant women is enough to identify those who need induction.
Preventing Deaths, Saving Lives
Professor Karin Källén, a statistician at Lund University and one of the driving forces behind the study, pointed out that the reduction in neonatal deaths could prevent 18 infant deaths annually in Sweden. With around 22,000 women annually pregnant at 41 weeks, the shift in induction protocols is seen as a key factor in saving lives.
Ulla-Britt Wennerholm, Adjunct Professor of Obstetrics and Gynecology at the University of Gothenburg, emphasized that the study supports a more active management approach for pregnancies that extend past 41 weeks. She also acknowledged that while the overall risk remains low for both mother and baby, the substantial difference between the two periods highlights the effectiveness of the updated care guidelines.
The research was based on data from Sweden’s National Pregnancy Registry, the Swedish Neonatal Quality Registry, and Statistics Sweden. It specifically included women with low-risk pregnancies, who were healthy, carrying a baby in a head-first position, and had no prior cesarean deliveries.
Conclusion
This study reinforces the importance of adapting medical practices based on emerging research. The reduction in infant mortality following the introduction of more proactive induction protocols underscores the potential benefits of early intervention, offering valuable insights for future maternal and neonatal care strategies.
For more details, the study can be accessed in PLOS Medicine under the title “Maternal and Perinatal Outcomes After Implementation of a More Active Management in Late- and Postterm Pregnancies in Sweden.”
Source: Karin Källén et al, Maternal and Perinatal Outcomes After Implementation of a More Active Management in Late- and Postterm Pregnancies in Sweden: A Population-Based Cohort Study, PLOS Medicine (2025). DOI: 10.1371/journal.pmed.1004504.
