Why is there a modifying effect of gestational age on risk factors for cerebral palsy?


Greenwood, C; Yudkin, P; Sellers, S; Impey, L; Doyle, P; (2005) Why is there a modifying effect of gestational age on risk factors for cerebral palsy? Archives of disease in childhood Fetal and neonatal edition, 90 (2). pp. 141-146. ISSN 1359-2998 DOI: https://doi.org/10.1136/adc.2004.052860

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Abstract

Objective: To investigate risk factors for cerebral palsy in relation to gestational age. Design: Three case-control studies within a geographically defined cohort. Setting: The former Oxfordshire Health Authority. Participants: A total of 235 singleton children with cerebral palsy not of postnatal origin, born between 1984 and 1993, identified from the Oxford Register of Early Childhood Impairment; 646 controls matched for gestation in three bands: <= 32 weeks; 33-36 weeks; >= 37 weeks. Results: Markers of intrapartum hypoxia and infection were associated with an increased risk of cerebral palsy in term and preterm infants. The odds ratio (OR) for hypoxia was 12.2 (95% confidence interval 1.2 to 119) at <= 32 weeks and 146 (7.4 to 3651) at >= 37 weeks. Corresponding ORs for neonatal sepsis were 3.1 (1.8 to 5.4) and 10.6 (2.1 to 51.9). In contrast, pre-eclampsia carried an increased risk of cerebral palsy at >= 37 weeks (OR 5.1 (2.2 to 12.0)) but a decreased risk at <= 32 weeks (OR 0.4 (0.2 to 1.0)). However, all infants <= 32 weeks with maternal pre-eclampsia were delivered electively, and their risk of cerebral palsy was no lower than that of other electively delivered <= 32 week infants (OR 0.9 (0.3 to 2.7)). Nearly 60% of <= 32 week controls were delivered after spontaneous preterm labour, itself an abnormal event. Conclusion: Inflammatory processes, including pre-eclampsia, are important in the aetiology of cerebral palsy. The apparent reduced risk of cerebral palsy associated with pre-eclampsia in very preterm infants is driven by the characteristics of the gestation matched control group. Use of the term "protective" in this context should be abandoned.

Item Type: Article
Keywords: BIRTH-WEIGHT, INTRAUTERINE GROWTH, MAGNESIUM-SULFATE, INFANTS, PREECLAMPSIA, ASSOCIATION, LABOR, TERM
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Non-Communicable Disease Epidemiology
Research Centre: Centre for Global Non-Communicable Diseases (NCDs)
Web of Science ID: 230340700011
URI: http://researchonline.lshtm.ac.uk/id/eprint/38487

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