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Cerebral palsy in four northern California counties, births 1983 through 1985
S K Cummins1, K B Nelson, J K Grether
1Division of Behavioral and Developmental Pediatrics, University of California, San Francisco.
Insights
Low birth weight and advanced maternal age are key risk factors for cerebral palsy (CP). While perinatal care has advanced, these demographic factors significantly influence CP distribution in newborns.
Area of Science:
- Neurology
- Pediatrics
- Public Health
Background:
- Cerebral palsy (CP) distribution is influenced by demographic shifts and advancements in perinatal medicine.
- Understanding risk factors is crucial for public health interventions and resource allocation.
Purpose of the Study:
- To investigate the characteristics of children with moderate or severe congenital CP in a large, recent American population-based cohort.
- To examine the impact of demographic factors and perinatal care on CP prevalence.
Main Methods:
- A population-based cohort study in four northern California counties (1983-1985).
- Identified children with CP surviving to age 3 using state service agency records and clinical review.
- Compared birth certificate data of 192 children with CP against 155,636 survivors without CP.
Main Results:
- Low birth weight (<2500 gm) accounted for 47.4% of CP cases; infants <1000 gm contributed 7.8% of CP despite being 0.20% of survivors.
- Maternal age ≥40 years and high parity significantly increased CP risk (3.3/1000 and 6.9/1000, respectively).
- Early gestational age and being born to teenaged parents were associated with increased CP risk; Black children had slightly higher prevalence, linked to lower birth weight.
Conclusions:
- Low birth weight and advanced maternal age remain significant contributors to cerebral palsy.
- Despite advances in perinatal medicine, these demographic factors continue to shape CP distribution.
- Further research into the interplay of genetics, environment, and socioeconomic factors is warranted.
Abstract:
To examine the impact of demographic shifts and changes in perinatal medicine on the distribution of cerebral palsy (CP), we investigated characteristics of affected children in a large, recent population-based American cohort study. Children with moderate or severe congenital CP born in four northern California counties in 1983 through 1985 and surviving to age 3 years were identified through records of state service agencies and clinical examination or record review by a single physician. We compared information from birth certificates for 192 children with CP and 155,636 survivors without CP born in those counties in the same period. Children with birth weights < 2500 gm contributed 47.4% of the CP in this population; those < 1000 gm, who were 0.20% of survivors, contributed 7.8%. Children with birth weights of 4000 to 4500 gm were at lowest risk. Among singletons, prevalence of CP was lowest (0.92/1000) in infants born to women aged 25 to 34 years, and was significantly higher in children whose mothers were 40 years or older (3.3/1000), especially if they were high in parity (6.9/1000). Children of teenaged mothers or fathers were at somewhat increased risk of CP. Early gestational age at birth was also an important independent risk factor. Prevalence of CP was slightly higher in black children, apparently related to a greater tendency to be low in birth weight. The time during pregnancy when prenatal care began was similar for children with CP and for the general population. For the 95% of children born weighing > or = 2500 gm, birth in a hospital lacking a special care nursery was not associated with increased risk of CP. Almost 8% of CP occurred in children born weighing < 1000 gm, a group that produced few survivors in the past; 28.1% occurred in children born weighing < 1500 gm. Neither early initiation of prenatal care nor, for that large majority of neonates weighing > 1500 gm, delivery at a hospital with specialized facilities was associated with a lower risk of CP.