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2. Risk Factors for Term-Born Spastic Diplegic Cerebral Palsy: A Case-Control Study.

Author

Marefi, Amaar, Husein, Nafisa, Dunbar, Mary, Dewey, Deborah, Letourneau, Nicole, Oskoui, Maryam, Kirton, Adam, and Shevell, Michael

Subjects
*CEREBRAL palsy, *DELIVERY (Obstetrics), *CEREBRAL anoxia-ischemia, *PREGNANCY complications, *VERTICAL transmission (Communicable diseases), *CESAREAN section, *FETAL anoxia
Abstract

To identify if a predetermined set of potential risk factors are associated with spastic diplegic cerebral palsy (SDCP) in term-born children. This is a case-control study with cases (n = 134) extracted from the Canadian Cerebral Palsy Registry (CCPR) and controls (n = 1950) from the Alberta Pregnancy Outcomes and Nutrition (APrON) study. Our primary variable was the SDCP phenotype in term-born children. Possible risk factors were selected a priori and include extreme maternal age (<19 or >35 years), pregnancy complications, maternal disease, substance use, perinatal infection, mode of delivery, perinatal adversity (i.e., neonatal encephalopathy presumably on the basis of intrapartum hypoxia-ischemia), sex, and birth weight. Multivariable analyses were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Multivariable analysis revealed associations between term-born SDCP and pregnancy complications (OR = 4.73; 95% CI = 1.91 to 10.56), maternal disease (OR = 2.52; 95% CI = 1.57 to 3.93), substance use (OR = 3.11; 95% CI = 2.10 to 4.55), perinatal infection (OR = 2.72; 95% CI 1.32 to 5.10), Caesarean section (OR = 2.35; 95% CI = 1.62 to 3.40), and perinatal adversity (OR = 2.91; 95% CI = 1.94 to 4.50). Multiple regression analysis revealed associations between SDCP and pregnancy complications (OR = 3.28; 95% CI 1.20 to 8.15), maternal disease (OR = 2.52; 95% CI 1.50 to 4.12), substance use (OR = 3.59; 95% CI 2.37 to 5.40), perinatal infection (OR = 3.78, 95% CI 1.71 to 7.72), Caesarean section (OR = 2.72; 95% CI 1.82 to 4.03), and perinatal adversity (OR = 4.16; 95% CI 2.67 to 6.70). Antenatal (pregnancy complications, maternal disease, substance use) and perinatal (infections, Caesarean section, and perinatal adversity) risk factors are associated with an increased risk of SDCP in term-born children, suggesting variable interactions between risk factors to provide a clinicopathologic framework that is different from SDCP observed in preterm-born children. [ABSTRACT FROM AUTHOR]

Published
2024
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3. Risk Factors for Term-Born Periventricular White Matter Injury in Children With Cerebral Palsy: A Case-Control Study

Author

Marefi, Amaar, Husein, Nafisa, Dunbar, Mary, Dewey, Deborah, Letourneau, Nicole, Oskoui, Maryam, Kirton, Adam, and Shevell, Michael I.

Subjects
Male, Pregnancy Complications, Pregnancy, Risk Factors, Cerebral Palsy, Case-Control Studies, Humans, Female, White Matter, Research Article, Alberta
Abstract

OBJECTIVE: The aim of this study was to identify possible risk factors associated with term-born children with cerebral palsy (CP) and periventricular white matter injury (PVWMI) on imaging. METHODS: This is a case-controlled study restricted to term-born children with CP with the cases extracted from the Canadian Cerebral Palsy Registry and controls from Alberta Pregnancy Outcomes and Nutrition (APrON) study. A diagnosis of PVWMI was performed based on expert categorization of MRI reports. Risk factor variables were selected a priori; these included pregnancy complications, antenatal toxin exposure, perinatal infection, sex, small for gestational age, and perinatal adversity (i.e., neonatal encephalopathy presumably on the basis of intrapartum hypoxia-ischemia). We used multivariable analyses to calculate odds ratios (ORs) and their 95% CIs. RESULTS: A total of 160 cases (7.06% of the registry sample) were compared with 1,950 controls. Of the term-born PVWMI participants, 59.4% were male and 13.5% were born to mothers of extreme maternal age. Multivariable analysis of each risk factor controlled for weight showed PVWMI is associated with pregnancy complications (OR = 3.35; 95% CI = 2.23–4.94), antenatal toxin exposure (OR = 2.45; 95% CI = 1.67–3.55), perinatal infection (OR = 3.61; 95% CI = 1.96–6.29), and perinatal adversity (OR = 2.03; 95% CI = 1.42–2.94). Term-born male participants were not more likely to experience PVWMI compared with female participants (OR = 1.37; 95% CI = 0.98–1.93). Multiple regression analyses suggested independent associations between PVWMI and pregnancy complications (OR = 3.75; 95% CI 2.46–5.62), antenatal toxin exposure (OR = 2.80; 95% CI 1.88–4.12), perinatal infection (OR = 4.62; 95% CI 2.46–8.42), and perinatal adversity (OR = 2.49; 95% CI = 1.71–3.69). DISCUSSION: Risk factors such as pregnancy complications, antenatal toxin exposure, perinatal infection, and perinatal adversity are associated with PVWMI in term-born children, suggesting perhaps variable interactions between antenatal and perinatal factors to yield this under-recognized CP phenotype.

Published
2022

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