The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
Asphyxia-related risk factors and their timing in spastic cerebral palsy
Article first published online: 13 OCT 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 12, pages 1518–1528, November 2008
How to Cite
Nielsen, L., Schendel, D., Grove, J., Hvidtjørn, D., Jacobsson, B., Josiassen, T., Vestergaard, M., Uldall, P. and Thorsen, P. (2008), Asphyxia-related risk factors and their timing in spastic cerebral palsy. BJOG: An International Journal of Obstetrics & Gynaecology, 115: 1518–1528. doi: 10.1111/j.1471-0528.2008.01896.x
- Issue published online: 13 OCT 2008
- Article first published online: 13 OCT 2008
- Accepted 15 July 2008.
- Cerebral palsy;
- placental complications;
- prenatal asphyxia;
- small for gestational age;
- umbilical cord complications
Objective To investigate the association of asphyxia-related conditions (reducing blood flow or blood oxygen levels in the fetus) with spastic cerebral palsy (CP) considering different gestational age groups and the timing of risk.
Design Population-based case–control study.
Setting Danish Cerebral Palsy Register in eastern Denmark and Danish Medical Birth Register.
Population or Sample 271 singletons with spastic CP and 217 singleton controls, frequency matched by gestational age group, born 1982–1990 in eastern Denmark.
Methods Data were abstracted from medical records, and a priori asphyxia-related conditions and other risk factors were selected for analysis. Each factor was classified according to the time at which it was likely to first be present.
Main outcome measures Spastic CP.
Results Placental and cord complications accounted for the majority of asphyxia conditions. In multivariate analysis, placental infarction was significantly associated with a four-fold increased risk for spastic quadriplegia and cord around the neck was significantly associated with a three-fold increased risk for spastic CP overall. The combination of placental infarction and being small for gestational age (SGA) afforded an especially high risk for spastic quadriplegia. Placental and cord complications were present in 21% of cases and 12% of controls.
Conclusions The risk for spastic quadriplegia from placental infarction may be linked in some cases with abnormal fetal growth (17% of all children with spastic quadriplegia and 3% of control children both had an infarction and were SGA)—suggesting an aetiologic pathway that encompasses both factors. The risk for spastic CP from cord around the neck is not accounted for by other prepartum or intrapartum factors we examined. Considering the relative timing of risk factors provides a useful framework for studies of CP aetiology.