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Published on: May 18, 2010
Risk Factors for Term-Born Periventricular White Matter Injury in Children With Cerebral Palsy: A Case-Control Study
Amaar Marefi1, Nafisa Husein1, Mary Dunbar1
1From the Department of Neurology & Neurosurgery (A.M., N.H., M.O., M.I.S.), McGill University; Department of Pediatrics (M.D.,), Alberta Children's Hospital, University of Calgary, Departments of Pediatrics and Clinical Neurosciences (M.D., A.K.), University of Calgary; Alberta Children's Hospital Research Institute (N.L., A.K.), University of Calgary; Departments of Pediatrics and Community Health Sciences (N.L.), University of Calgary; Faculty of Nursing and Department of Psychiatry (N.L.), University of Calgary; and Centre for Outcomes Research and Evaluation (M.O.), Research Institute of the McGill University Health Center, Montréal, Quebec, Canada.
Insights
Pregnancy complications, antenatal toxin exposure, perinatal infection, and perinatal adversity are key risk factors for periventricular white matter injury (PVWMI) in term-born children with cerebral palsy (CP). These factors may interact to cause this CP subtype.
Area of Science:
- Neurology
- Pediatrics
- Obstetrics
Background:
- Cerebral palsy (CP) is a common neurodevelopmental disorder.
- Periventricular white matter injury (PVWMI) is a significant cause of CP in term-born infants.
- Identifying risk factors for PVWMI is crucial for prevention and early intervention.
Purpose of the Study:
- To identify risk factors associated with term-born children diagnosed with CP and PVWMI.
- To investigate the association between specific antenatal and perinatal factors and PVWMI.
Main Methods:
- A case-controlled study was conducted using data from the Canadian Cerebral Palsy Registry and the Alberta Pregnancy Outcomes and Nutrition (APrON) study.
- Cases were term-born children with CP and PVWMI confirmed by MRI reports.
- Multivariable analyses were used to assess associations between risk factors (pregnancy complications, antenatal toxin exposure, perinatal infection, perinatal adversity) and PVWMI.
Main Results:
- The study included 160 cases and 1,950 controls.
- PVWMI was significantly associated with pregnancy complications (OR=3.75), antenatal toxin exposure (OR=2.80), perinatal infection (OR=4.62), and perinatal adversity (OR=2.49).
- No significant association was found between PVWMI and being male (OR=1.37).
Conclusions:
- Pregnancy complications, antenatal toxin exposure, perinatal infection, and perinatal adversity are independently associated with PVWMI in term-born children.
- These findings suggest complex interactions between antenatal and perinatal factors contribute to this form of CP.
- Further research is needed to understand these interactions and develop targeted preventive strategies.
Objective:
The aim of this study was to identify possible risk factors associated with term-born children with cerebral palsy (CP) and periventricular white matter injury (PVWMI) on imaging.
Methods:
This is a case-controlled study restricted to term-born children with CP with the cases extracted from the Canadian Cerebral Palsy Registry and controls from Alberta Pregnancy Outcomes and Nutrition (APrON) study. A diagnosis of PVWMI was performed based on expert categorization of MRI reports. Risk factor variables were selected a priori; these included pregnancy complications, antenatal toxin exposure, perinatal infection, sex, small for gestational age, and perinatal adversity (i.e., neonatal encephalopathy presumably on the basis of intrapartum hypoxia-ischemia). We used multivariable analyses to calculate odds ratios (ORs) and their 95% CIs.
Results:
A total of 160 cases (7.06% of the registry sample) were compared with 1,950 controls. Of the term-born PVWMI participants, 59.4% were male and 13.5% were born to mothers of extreme maternal age. Multivariable analysis of each risk factor controlled for weight showed PVWMI is associated with pregnancy complications (OR = 3.35; 95% CI = 2.23-4.94), antenatal toxin exposure (OR = 2.45; 95% CI = 1.67-3.55), perinatal infection (OR = 3.61; 95% CI = 1.96-6.29), and perinatal adversity (OR = 2.03; 95% CI = 1.42-2.94). Term-born male participants were not more likely to experience PVWMI compared with female participants (OR = 1.37; 95% CI = 0.98-1.93). Multiple regression analyses suggested independent associations between PVWMI and pregnancy complications (OR = 3.75; 95% CI 2.46-5.62), antenatal toxin exposure (OR = 2.80; 95% CI 1.88-4.12), perinatal infection (OR = 4.62; 95% CI 2.46-8.42), and perinatal adversity (OR = 2.49; 95% CI = 1.71-3.69).
Discussion:
Risk factors such as pregnancy complications, antenatal toxin exposure, perinatal infection, and perinatal adversity are associated with PVWMI in term-born children, suggesting perhaps variable interactions between antenatal and perinatal factors to yield this under-recognized CP phenotype.
