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Published on: February 2, 2024
The special supplemental nutrition program and risk of cerebral palsy
Yunyue Shi1,2, Haoran Zhuo1,2, Giselle Bellia1,2
1Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, USA.
Insights
Maternal participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) during pregnancy was linked to a reduced risk of cerebral palsy (CP) in offspring. These findings highlight the importance of nutritional support programs for pregnant women.
Area of Science:
- Public Health
- Pediatrics
- Nutritional Epidemiology
Background:
- Cerebral palsy (CP) is the leading cause of childhood physical disability in the U.S.
- Investigating modifiable factors during pregnancy is crucial for CP prevention.
- The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritional support to at-risk populations.
Purpose of the Study:
- To examine the association between maternal WIC participation during pregnancy and the risk of CP in offspring.
- To explore potential mediating factors such as preterm birth and low birth weight.
Main Methods:
- Analysis of over 2 million California birth records (2007-2015) for Medi-Cal beneficiaries.
- CP cases identified through diagnostic records.
- Generalized linear models used to calculate relative risk (RR) and 95% confidence intervals (CI).
Main Results:
- Maternal WIC participation was associated with a 16% lower risk of CP (RR=0.84, 95% CI: 0.75, 0.95).
- The protective association was more pronounced in mothers with less than a high school education (RR=0.67, 95% CI: 0.55, 0.82).
- Preterm birth and low birth weight mediated 12-53% of the observed association.
Conclusions:
- Maternal WIC participation during pregnancy is associated with a reduced risk of cerebral palsy in offspring.
- Findings suggest that nutritional support programs may play a role in CP prevention, particularly for socioeconomically disadvantaged groups.
- Further research is warranted on maternal nutrition and health-seeking behaviors in CP etiology.
Background:
Cerebral Palsy (CP) is the most common childhood-onset physical disability in the United States. We investigated the association between maternal participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and CP risk in the offspring.
Methods:
We analyzed California statewide birth records of 2,090,427 live births (2007-2015) from 1,673,395 women insured by Medi-Cal (Medicaid). CP was ascertained using diagnostic records from the Department of Developmental Services (up to 2021). We used generalized linear models to estimate the relative risk (RR) and 95% confidence interval (CI) for CP according to maternal WIC participation during pregnancy. We estimated the mediating roles of preterm birth and low birth weight.
Results:
We observed a 16% lower risk of CP (RR = 0.84, 95% CI: 0.75, 0.95) associated with maternal WIC participation. The estimated association was stronger among mothers with less than a high school education (RR = 0.67, 95% CI: 0.55, 0.82). Preterm birth or low birth weight was estimated to mediate approximately 12-53% of the association between WIC participation and offspring CP risk.
Conclusion:
In this California cohort of Medi-Cal-insured mothers, maternal participation in WIC was associated with a lower CP risk in the offspring.
Impact Statement:
Analysis of over two million live births insured by Medi-Cal showed that maternal participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) during pregnancy is associated with a lower risk for cerebral palsy (CP) in the offspring. The observed protective associations were stronger among women with lower educational attainment and among the Hispanic subgroup in California. Preterm birth and low birth weight were estimated to explain part of the associations between WIC and CP. Our findings prompt further research into the role of maternal nutrition and health-seeking behaviors in the etiology of CP, especially among the socioeconomically disadvantaged population.
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