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Why is there a modifying effect of gestational age on risk factors for cerebral palsy?
C Greenwood1, P Yudkin, S Sellers
1National Perinatal Epidemiology Unit and The Women's Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK. Catherine.Greenwood@orh.nhs.uk
Insights
Intrapartum hypoxia and infection increase cerebral palsy risk in infants. Pre-eclampsia appears protective in preterm infants but this is due to control group selection, not a true protective effect.
Area of Science:
- Neurology
- Obstetrics
- Pediatrics
Background:
- Cerebral palsy (CP) is a complex neurological disorder.
- Gestational age is a critical factor influencing CP risk.
- Understanding risk factors across gestation is crucial for prevention.
Purpose of the Study:
- To investigate risk factors for cerebral palsy (CP) in relation to gestational age.
- To clarify the role of intrapartum events and maternal conditions in CP etiology.
- To re-evaluate the association between pre-eclampsia and CP risk in preterm infants.
Main Methods:
- Three case-control studies within a defined cohort (Oxfordshire Health Authority).
- 235 singleton children with CP (non-postnatal origin) born 1984-1993.
- 646 controls matched for gestational age (
Main Results:
- Intrapartum hypoxia and infection significantly increased CP risk in both term and preterm infants.
- Pre-eclampsia showed an increased risk in term infants but an apparent decreased risk in preterm infants (
- The apparent reduced risk of CP with maternal pre-eclampsia in very preterm infants was an artifact of control group selection.
Conclusions:
- Inflammatory processes, including pre-eclampsia, play a significant role in the etiology of cerebral palsy.
- The perceived protective effect of pre-eclampsia in very preterm infants is a methodological bias.
- The term "protective" should not be used for pre-eclampsia in relation to CP in very preterm infants.
Objective:
To investigate risk factors for cerebral palsy in relation to gestational age.
Design:
Three case-control studies within a geographically defined cohort.
Setting:
The former Oxfordshire Health Authority.
Participants:
A total of 235 singleton children with cerebral palsy not of postnatal origin, born between 1984 and 1993, identified from the Oxford Register of Early Childhood Impairment; 646 controls matched for gestation in three bands:
Results:
Markers of intrapartum hypoxia and infection were associated with an increased risk of cerebral palsy in term and preterm infants. The odds ratio (OR) for hypoxia was 12.2 (95% confidence interval 1.2 to 119) at
Conclusion:
Inflammatory processes, including pre-eclampsia, are important in the aetiology of cerebral palsy. The apparent reduced risk of cerebral palsy associated with pre-eclampsia in very preterm infants is driven by the characteristics of the gestation matched control group. Use of the term "protective" in this context should be abandoned.
