What factors in pregnancy are associated with CP? Epidemiologic associations with cerebral palsy

I am often asked if an infection or drugs in pregnancy caused CP. Its a heavy burden that many parents carry.


This article reviews the strongest associations: preterm birth, perinatal infection, multiple births (twin, triplets etc) and intrauterine growth restriction.


Forceps and vaccum delivery were NOT associated.


JR


What is associated with CP? Epidemiologic associations with cerebral palsy

Obstet Gynecol. 2011 Sep;118(3):576-82.

Epidemiologic associations with cerebral palsy.

O'Callaghan ME, MacLennan AH, Gibson CS, McMichael GL, Haan EA, Broadbent JL, Goldwater PN, Dekker GA; Australian Collaborative Cerebral PalsyResearch Group.

Source

Discipline of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, Robinson Institute, The University of Adelaide, Adelaide, South Australia. michael.ocallaghan@student.adelaide.edu.au

Abstract

OBJECTIVE:

To estimate epidemiologic risk factors for cerebral palsy.

METHODS:

Data were collected by linkage to state-based perinatal repositories and cerebral palsy registers and using a maternal questionnaire. The cohort included 587 individuals with cerebral palsy and 1,154 non-cerebral palsy controls.

RESULTS:

The following factors were associated with cerebral palsy: recorded maternal infection during pregnancy (41.4% patients compared with 31.3% controls; odds ratio [OR] 1.55, 95% confidence interval 1.26-1.91), small for gestational age ([birth weight less than third customized centile] 43.9% patients compared with 6.3% controls; OR 11.75, 6.25-22.08), gestational age less than 32 weeks (29.3% patients compared with 0.7% controls; OR 59.20, 28.87-121.38), multiple birth (OR 6.62, 4.00-10.95), a relative with cerebral palsy (OR 1.61, 1.12-2.32), breech position (13.7% patients compared with 6.0% controls; OR 2.48, 1.76-3.49), bleeding at any time in pregnancy (29.3% patients compared with 16.9% controls; OR 2.04, 1.61-2.58), male sex (58.8% patients compared with 45.8% controls; OR 1.68, 1.38-2.06), multiple miscarriage (7.7% patients compared with 3.5% controls; OR 2.30, 1.38-3.82), smoking (14.0% patients compared with 10.6% controls; OR 1.37, 1.02-1.85), and illicit drug use (3.3% patients compared with 1.5% controls; OR 2.22, 1.14-4.30). Factors not associated with cerebral palsy were "disappearing twin," diabetes, maternal body mass index, hypertension, alcohol consumption, anemia, maternal hypothyroidism, forceps or vacuum delivery, and maternal age.

CONCLUSION:

Preterm birth, intrauterine growth restriction, perinatal infection, and multiple birth present the largest risks for a cerebral palsyoutcome. Reassuringly, upper respiratory tract and gastrointestinal infections during pregnancy were not associated with cerebral palsy.

LEVEL OF EVIDENCE:

II.

Link to abstract