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Intrauterine growth and spastic cerebral palsy. I. Association with birth weight for gestational age
1University Department of Medicine, Queen Elizabeth II Medical Centre, Nedlands, Western Australia.
Insights
Children with spastic cerebral palsy often have lower birth weights. Poor intrauterine growth, especially in later gestation, increases the risk of cerebral palsy, though the exact cause remains unclear.
Area of Science:
- Neurology
- Pediatrics
- Obstetrics
Background:
- Spastic cerebral palsy (CP) is a common neurodevelopmental disorder.
- Intrauterine growth restriction (IUGR) is a known risk factor for adverse neonatal outcomes.
Purpose of the Study:
- To investigate the association between birth weight and spastic cerebral palsy.
- To explore the role of intrauterine growth in the development of spastic CP.
- To examine potential causal pathways linking poor growth to brain damage.
Main Methods:
- Retrospective cohort study of 171 white children diagnosed with spastic CP.
- Comparison of birth weights with a population-based reference group matched for key demographic and obstetric factors.
- Stratified analysis by gestational age at delivery.
- Investigation of potential causal mechanisms including intrapartum hypoxia, hypoglycemia, and hypothermia.
Main Results:
- Children with spastic CP exhibited significantly lower birth weights compared to the reference population.
- Approximately 22% of spastic CP cases could be attributed to birth weight below the 10th percentile, assuming a causal link.
- The risk associated with poor intrauterine growth was highest for infants delivered between 34 and 37 weeks' gestation.
- Intrapartum hypoxia was the only investigated pathway that may play a causal role, accounting for less than 2% of cases.
Conclusions:
- Spastic cerebral palsy is associated with poor intrauterine growth in infants born after 33 weeks' gestation.
- While IUGR is a significant risk factor, the precise causal mechanisms leading to spastic CP remain unidentified.
- Further research is needed to elucidate the pathways linking intrauterine growth and brain development in spastic CP.
Abstract:
Birth weight, gestational age at delivery, and other factors were collected for 171 white children with spastic cerebral palsy. Their birth weights were compared with the birth weight distribution expected for a population of the same race, gestation, sex, maternal height, and parity, born in the same geographic area, and during the same time period. Birth weights of children with spastic cerebral palsy tended to be significantly lower than the median birth weight of their comparison population. Analysis stratified by gestation at delivery suggested that if the reduced birth weight were causally associated with the spastic cerebral palsy, 22% of cases were attributable to being below the 10th percentile of the comparison population birth weight distribution. The risk of spastic cerebral palsy associated with poor intrauterine growth was dependent on gestation at delivery; poorly grown infants delivered between 34 and 37 weeks' gestation were at highest risk. Some probable pathways by which growth retardation could result in brain damage (intrapartum hypoxia, hypoglycemia, and hypothermia) were investigated. Only intrapartum hypoxia may have played a causal role but probably accounted for less than 2% of all cases. These data suggest that spastic cerebral palsy is associated with poor intrauterine growth in infants of more than 33 weeks' gestation, but no important causal mechanism has yet been identified.