• Meta-analysis of 5 RCTs assessed IOL for suspected LGA pregnancies. • Induction of labor reduced shoulder dystocia compared with standard care. • IOL lowered cesarean delivery and increased spontaneous vaginal delivery. • Bayesian and trial sequential analyses confirmed robustness of findings. Meta-analysis of 5 RCTs assessed IOL for suspected LGA pregnancies. Induction of labor reduced shoulder dystocia compared with standard care. IOL lowered cesarean delivery and increased spontaneous vaginal delivery. Bayesian and trial sequential analyses confirmed robustness of findings. Suspected large-for-gestational-age (LGA) fetuses are associated with increased risks of shoulder dystocia and adverse delivery outcomes, yet evidence on the effectiveness of induction of labor (IOL) remains inconsistent. To evaluate whether IOL reduces shoulder dystocia and improves delivery outcomes in pregnancies with suspected LGA. PubMed, Embase, Cochrane Library, ClinicalTrials.gov and Wanfang were searched from inception to June 30, 2025, without language restrictions. Randomized controlled trials including pregnant individuals ≥ 35 weeks with suspected LGA fetuses (>90th percentile or > 4000 g), comparing IOL with standard care, and reporting delivery outcomes. Two reviewers independently performed screening, data extraction, and risk of bias assessment. Frequentist random-effects meta-analyses, Bayesian models, and trial sequential analysis were conducted. GRADE framework was used to assess evidence quality. Five trials (N = 4,083) were included. IOL reduced shoulder dystocia (RR 0.68, 95% CI 0.49–0.95) and cesarean delivery (RR 0.87, 95% CI 0.79–0.96), and increased spontaneous vaginal delivery (RR 1.12, 95% CI 1.05–1.18). Trial sequential analysis indicated adequate information size. Bayesian analyses supported probable benefit, with stronger effects in per-protocol analyses. IOL for suspected LGA pregnancies reduces shoulder dystocia and improves delivery outcomes. These findings support reconsideration of existing clinical guidelines and may inform individualized counseling.
Cheng et al. (Sun,) studied this question.