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Prenatal risk factors for cerebral palsy in very preterm singletons and twins
Florence Livinec1, Pierre-Yves Ancel, Stéphane Marret
1Research Unit on Perinatal Health and Women's Health, INSERM U149, Villejuif, France. livinec@vjf.inserm.fr
Insights
Spontaneous preterm labor and preterm premature rupture of membranes (PPROM) are key prenatal risk factors for cerebral palsy in very preterm singletons. These complications increased the risk compared to hypertension.
Area of Science:
- Neonatal research
- Obstetrics
- Pediatric neurology
Background:
- Cerebral palsy (CP) is a significant concern in very preterm infants.
- Identifying prenatal risk factors is crucial for prevention strategies.
- Differences in risk factors between singletons and twins require specific investigation.
Purpose of the Study:
- To determine the primary prenatal risk factors for cerebral palsy in very preterm singletons and twins.
- To compare the impact of specific pregnancy complications on CP risk in both groups.
Main Methods:
- Analysis of data from the Epipage study (1,954 very preterm children born in 1997).
- Inclusion of pregnancy complications and twin-specific factors (placental type, cotwin death).
- Logistic regression for singletons and generalized estimating equation models for twins.
Main Results:
- Cerebral palsy rates were 8% in singletons and 9% in twins.
- For singletons, spontaneous preterm labor and preterm premature rupture of membranes (PPROM) were associated with increased CP risk.
- These specific pregnancy complications did not show a significant link to CP in twins; monochorionic placenta showed a borderline association.
Conclusions:
- Spontaneous preterm labor and PPROM are significant prenatal risk factors for cerebral palsy in very preterm singletons.
- The identified risk factors for cerebral palsy in singletons do not directly translate to twins, suggesting different underlying mechanisms.
Objective:
To identify the main prenatal risk factors for cerebral palsy in very preterm singletons and twins.
Methods:
The data were from the Epipage study, which included all very preterm children (< 33 weeks) born in 1997 in 9 regions of France. The analysis included 1,954 children for whom a medical questionnaire was completed at the age of 2 years (83% of the surviving children). The risk factors studied were pregnancy complications and specific factors in twins (type of placenta and death of cotwin). Logistic regression analysis was carried out for singletons and generalized estimating equation models used for twins.
Results:
The proportion of cerebral palsy was 8% in singletons and 9% in twins. For singletons, spontaneous preterm labor (adjusted odds ratio [OR] 3.4, 95% confidence interval [CI] 1.7-6.7), preterm premature rupture of membranes (PPROM) with short latency (adjusted OR 4.9, 95% CI 2.0-11.8), and prolonged PPROM (adjusted OR 2.7, 95% CI 1.4-5.3) were associated with a higher risk of cerebral palsy than was hypertension. No such link was found between these pregnancy complications and cerebral palsy in twins. For twins, a monochorionic placenta (OR 1.9, 95% CI 1.0-3.6) increased the risk of cerebral palsy, but the OR became nonsignificant after adjustment (OR 1.7, 95% CI 0.8-3.4).
Conclusion:
In very preterm singletons, spontaneous preterm labor and PPROM increased the risk of cerebral palsy compared with hypertension.
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