Key PointsQuestionWhat maternal labor-related and neonatal outcomes are experienced following elective induction of labor at 39 weeks of gestation compared with expectant management?FindingsIn this systematic review and meta-analysis of 14 studies with more than 1.6 million participants, induction of labor at 39 weeks of gestation was associated with improved maternal labor-related and neonatal complications, including a reduced likelihood of perineal injury, macrosomia, and low 5-minute Apgar score after birth. However, among nulliparous women only, induction of labor was associated with an increased likelihood of shoulder dystocia compared with expectant management.MeaningThese findings suggest that elective induction of labor at 39 weeks may be safe and beneficial for some women; however, potential risks should be discussed with nulliparous women.