Cerebral palsy and restricted growth status at birth: population-based case–control study
Article first published online: 11 AUG 2008
© 2008 The Authors Journal compilation © RCOG 2008 BJOG An International Journal of Obstetrics and Gynaecology
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 115, Issue 10, pages 1250–1255, September 2008
How to Cite
Jacobsson, B., Ahlin, K., Francis, A., Hagberg, G., Hagberg, H. and Gardosi, J. (2008), Cerebral palsy and restricted growth status at birth: population-based case–control study. BJOG: An International Journal of Obstetrics & Gynaecology, 115: 1250–1255. doi: 10.1111/j.1471-0528.2008.01827.x
- Issue published online: 11 AUG 2008
- Article first published online: 11 AUG 2008
- Accepted 19 May 2008.
- Cerebral palsy;
- intrauterine growth restriction;
- preterm birth;
- smallness for gestational age
Objective To evaluate the association between growth status at birth and subsequent development of cerebral palsy in preterm and term infants.
Design Population-based case–controlled study.
Setting Cerebral palsy register in Western Sweden.
Subjects Cohort of 334 singletons born between 1983 and 1990, with cerebral palsy diagnosed from age 4, and 668 singletons matched for gestation, gender and delivery unit.
Method Growth status at birth was determined using small for gestational age (SGA) categories, with customised birthweight percentiles (SGAcust) based on the Swedish population.
Main outcome measures Proportion of babies that were SGAcust, comparing cases and controls in three gestational age categories: early preterm (24–33 weeks), late preterm (34–36 weeks) and term (37+ weeks).
Results Of the 334 children with cerebral palsy, 87 (26.6%) were born early preterm, 27 (8.1%) late preterm and 218 (66%) at term. Children who had been born at term were more likely to have been SGA <1st customised percentile (SGAcust1) than their matched controls (OR 6.6, 95% CI 2.3–18.6). In contrast, children with cerebral palsy born preterm were not more likely to have been SGAcust1 (OR 0.9, 95% CI 0.4–1.9), and this applied to early preterm as well as late preterm births. For less severely small babies (SGA between 1st and 5th customised percentiles), the association with cerebral palsy remained significant for term births (OR 5.2, 95% CI 2.7–10.1) but was again not significant for preterm births.
Conclusions Term singletons with severely SGA birthweights had a five- to seven-fold risk of developing cerebral palsy compared with gestational age-matched infants with birthweights within normal limits. For children born preterm, SGA was not more likely to be present in cases than in controls. These findings support the concept of cerebral palsy as a multifactorial condition and highlight the importance of antenatal surveillance of fetal growth.