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Declining prevalence of cerebral palsy in children born at term in Denmark
Mads L Larsen1,2,3, Gija Rackauskaite4, Gorm Greisen3,5
1Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Insights
Declining cerebral palsy (CP) rates in term-born children are multifactorial. Key factors include reduced maternal smoking and post-term births, alongside improved neonatal care. This study analyzes obstetric and neonatal influences over time.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Pediatric Neurology
Background:
- Cerebral palsy (CP) prevalence in term-born infants has shown a decline.
- Understanding the contributing obstetric and neonatal factors is crucial for public health initiatives.
Purpose of the Study:
- To investigate the reasons behind the decreasing prevalence of cerebral palsy (CP) in term-born children in Denmark.
- To evaluate obstetric and neonatal factors associated with CP and their temporal trends.
Main Methods:
- A large cohort study included 987,495 children born after 37 weeks gestation between 1997 and 2013.
- Log-binomial regression analyses were used to calculate risk ratios for CP associated with various factors.
- The temporal changes in the prevalence of significant risk factors were assessed.
Main Results:
- Antenatal risk factors for CP included high maternal BMI, smoking, nulliparity, male sex, gestational age, and low birthweight.
- During the study period, maternal smoking and post-term births significantly decreased, while high maternal BMI increased.
- Neonatal period risk factors showed an increase in diagnosed birth defects and neonatal intensive care admissions.
Conclusions:
- The declining prevalence of CP is likely multifactorial.
- Reduced maternal smoking rates and fewer post-term births contribute to this decline.
- Centralization and advancements in neonatal treatment also play a significant role.
Aim:
To investigate reasons for the declining prevalence of cerebral palsy (CP) in children born at term in Denmark by evaluating obstetric and neonatal factors associated with CP, and their changes over time.
Method:
In this cohort study, we included 987 495 children (504 600 [51.1%] males and 482 895 [48.9%] females) born after 37 completed gestational weeks during birth years 1997 to 2013. Risk ratios of CP for each factor were calculated with log-binominal regression analyses. Significant factors were evaluated concerning their development in prevalence over time.
Results:
In the antenatal period, there were significant associations with an increased risk of CP and high maternal body mass index (BMI), smoking during pregnancy, nulliparity, male sex, gestational age, and low birthweight. In the study period, fewer females smoked during pregnancy and fewer children were born post-term, dropping from 22.6% to 11.4% and 9.4% to 2.5% respectively. Conversely, the proportion of females with high BMI increased. Most significant risk factors were found in the neonatal period, with an increase in children with diagnosed birth defects and children admitted to neonatal care.
Interpretation:
Reasons for the declining prevalence of CP appear to be multifactorial and likely include the decline in maternal smoking and children born post-term along with centralization and advances in neonatal treatment.
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