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What are the Pre- and Perinatal Risk Factors for Deformational Plagiocephaly? A Systematic Review and Meta-Analysis
Danuza Gandra Rossi1, Natalia Fernandes Cardoso Lima2, Marcela Baraúna Magno3
1Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
Summary
Prematurity, multiple pregnancy, male sex, and advanced maternal age may increase the risk of deformational plagiocephaly (DP) in infants. However, evidence is very limited and requires cautious interpretation.
Area of Science:
- Pediatrics
- Obstetrics
- Public Health
Background:
- Deformational plagiocephaly (DP) is a common condition in infants.
- Identifying pre- and perinatal risk factors is crucial for understanding and potentially preventing DP.
Purpose of the Study:
- To systematically review and meta-analyze pre- and perinatal risk factors associated with infant deformational plagiocephaly (DP).
Main Methods:
- A systematic review and meta-analysis adhering to PRISMA and PECOS guidelines.
- Searches of electronic databases and grey literature, including updated searches in April 2026.
- Quality assessment using the Newcastle-Ottawa Scale and evidence certainty using GRADE.
Main Results:
- Thirteen studies involving 31,147 participants revealed that prematurity (<37 weeks), multiple pregnancy, male sex, and maternal age ≥35 years were associated with increased DP risk.
- A prevalence of 12.9% for DP was observed across the included studies.
- Methodological limitations included confounding control and diagnostic heterogeneity, leading to very low certainty of evidence.
Conclusions:
- Prematurity, multiple pregnancy, male infant sex, and advanced maternal age are potential risk markers for deformational plagiocephaly.
- The current evidence supporting these associations is of very low certainty.
- Further high-quality research with standardized diagnostic criteria is necessary to confirm these findings.
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