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Cerebral palsy: effects of twinning, birthweight, and gestational age
K Williams1, E Hennessy, E Alberman
1Department of Epidemiology and Medical Statistics, St Bartholomew's & Royal London School of Medicine, London.
Insights
Being a twin, low gestational age, and reduced birthweight are independent risk factors for cerebral palsy. The elevated risk in twins is not solely due to prematurity or low birthweight.
Area of Science:
- Neurology
- Pediatrics
- Public Health
Background:
- Cerebral palsy (CP) is a leading cause of childhood disability.
- Multiple births have a higher incidence of CP compared to singleton births.
- Factors influencing CP risk in multiple births require further investigation.
Purpose of the Study:
- To investigate the independent effects of birthweight and gestational age on cerebral palsy risk.
- To compare CP risk between singleton and multiple births.
- To elucidate the contribution of prematurity and low birthweight to CP risk in twins.
Main Methods:
- Retrospective cohort study using the North East Thames Regional Health Authority Interactive Child Health System.
- Inclusion of children born between 1980-1986 with diagnosed cerebral palsy.
- Exclusion of cases with postneonatal onset, progressive conditions, or mild signs.
- Logistic regression analysis to assess associations between twin status, gestational age, and birthweight.
Main Results:
- Crude CP rates were 1.0/1000 for singletons and 7.4/1000 for twins.
- Adjusted analysis revealed significantly increased CP risk for twins with birthweights < 1400g.
- Lower fetal growth, lower gestational age, and twin status were identified as independent risk factors for cerebral palsy.
Conclusions:
- The heightened risk of cerebral palsy in twins is not fully attributable to prematurity and low birthweight.
- Gestational age and birthweight are critical independent determinants of cerebral palsy risk in both singleton and multiple births.
- Further research is warranted to understand the multifactorial etiology of CP in twins.
Aims:
To determine the effects of birthweight and gestational age on the risk of cerebral palsy for multiple and singleton births.
Methods:
Children on the North East Thames Regional Health Authority Interactive Child Health System, born between 1 January 1980 and 31 December 1986, and notified as having cerebral palsy, were included. Cases of postneonatal onset, of known progressive, or non-cerebral pathology and with only mild signs were excluded. Rates and relative risks were calculated using the most complete data, which related to 1985-86, and comprised 102,059 singletons and 2367 twins. Logistic regression was used to examine the associations between being a twin, gestational age, and birthweight.
Results:
The crude rate per 1000 survivors at 1 year of age was 1.0 in singletons and 7.4 in twins. The relative risk was greatest in twins weighing more than 2499 g (4.5). However, after adjusting for reduced birthweight of twins it was the relative risk of twins weighing less than 1400 g that was significantly increased. Logistic regression confirmed that lower fetal growth, lower gestational age, and being a twin are all independent risk factors for cerebral palsy.
Conclusion:
The increased risk to twins of cerebral palsy is not entirely explained by their increased risk of prematurity and low birthweight.