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Published on: November 20, 2015
Perinatal factors associated with cerebral palsy in children born in Sweden
Kristina Thorngren-Jerneck1, Andreas Herbst
1Department of Pediatrics, Lund University Hospital, Lund, Sweden. kristina.thorngren-jerneck@med.lu.se
Insights
Preterm birth significantly increases the risk of cerebral palsy (CP), but most CP cases occur in term infants. Several obstetric factors and low Apgar scores are also linked to CP development.
Area of Science:
- Perinatal Medicine
- Neurology
- Public Health
Background:
- Cerebral palsy (CP) is a complex neurological disorder with significant lifelong impact.
- Identifying perinatal risk factors is crucial for targeted prevention and intervention strategies.
Purpose of the Study:
- To investigate perinatal factors associated with the development of cerebral palsy (CP).
Main Methods:
- A case-control study utilizing the Swedish Medical Birth Registry and Hospital Discharge Registry.
- Included 2,303 infants diagnosed with CP and 1.6 million controls born between 1984-1998.
- Calculated odds ratios (ORs) with 95% confidence intervals (CIs) to assess risk.
Main Results:
- Preterm birth (especially before 32 weeks) showed a highly increased risk for CP (OR 34-37).
- Other significant risk factors included abruptio placentae, maternal diabetes, preeclampsia, male sex, being a twin, advanced maternal age, primiparity, and smoking.
- In term infants, low Apgar scores, breech presentation, instrumental delivery, and emergency cesarean delivery were associated with CP.
Conclusions:
- While preterm birth is a major risk factor, the majority of CP cases (65%) occur in term infants.
- Several obstetric complications and low Apgar scores are key perinatal factors associated with CP.
Objective:
To identify perinatal factors associated with cerebral palsy (CP).
Methods:
This was a case-control study based on the Swedish Medical Birth Registry and the Swedish Hospital Discharge Registry, including 2,303 infants born in Sweden 1984-1998 with a diagnosis of CP and 1.6 million infants without this diagnosis. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.
Results:
Infants born preterm had a highly increased risk for CP, and constituted 35% of all cases; OR 34 (95% CI 29-39) in weeks 23-27, OR 37 (95% CI 32-42) in weeks 28-29, OR 26 (95% CI 23-30) in weeks 30-31, and OR 3.9 (95% CI 3.4-4.4) in weeks 32-36. Boys had a higher risk (sex ratio 1.36:1), particularly before term (sex ratio 1.55:1). Other factors associated with CP were being small or large for gestational age at birth, abruptio placentae (OR 8.6, 95% CI 5.6-13.3), maternal insulin-dependent diabetes mellitus type 1 (OR 2.1, 95% CI 1.4-3.1), preeclampsia (OR 1.5, 95% CI 1.3-2.4), being a twin (OR 1.4, 95% CI 1.1-1.6), maternal age older than 40 years (OR 1.4, 95% CI 1.1-1.8) or 35-39 years (OR 1.2, 95% CI 1.1-1.4), primiparity (OR 1.2, 95% CI 1.1-1.3), and smoking (OR 1.2, 95% CI 1.1-1.3). In term infants, low Apgar scores were associated with a high risk for CP; OR 62 (95% CI 52-74) at score 6 at 5 minutes, OR 498 (95% CI 458-542) at score 3. Other factors associated with CP in term infants were breech presentation at vaginal birth (OR 3.0, 95% CI 2.4-3.7), instrumental delivery (OR 1.9, 95% CI 1.6-2.3), and emergency cesarean delivery (OR 1.8, 95% CI 1.6-2.0).
Conclusion:
Preterm birth entails a high risk for CP, but 65% of these children are born at term. Several obstetric factors and low Apgar scores are associated with CP.
Level Of Evidence:
II-2.
