Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, SC 29203, USA.
Paediatr Perinat Epidemiol. 2011 Mar;25(2):100-10. doi: 10.1111/j.1365-3016.2010.01157.x. Epub 2010 Aug 16.
Pre-eclampsia is a leading cause of preterm birth, which is strongly associated with cerebral palsy (CP). However, there is controversy about whether pre-eclampsia is associated with increased risk of CP. We evaluated the association between pre-eclampsia and CP in 122,476 mother-child pairs insured by the South Carolina Medicaid programme, with births between 1996 and 2002. Prenatal billing records were linked to the children's Medicaid billing records after birth until December 2008. The odds of CP were modelled using logistic regression with generalised estimating equations. There were 337 children (0.28%) diagnosed with CP by at least two different health care providers, and 4226 (3.5%) women were diagnosed with pre-eclampsia at least twice during pregnancy. Children whose mothers had pre-eclampsia were almost twice as likely to have CP compared with children of mothers without pre-eclampsia [odds ratio (OR)=1.94, 95% confidence interval (CI) 1.25, 2.97]. The association was only significant for pre-eclampsia diagnosed prior to 37 weeks' gestation. Full term (gestational age ≥ 37 weeks) infants whose mothers were diagnosed with pre-eclampsia prior to 37 weeks had increased odds of CP compared with full term children whose mothers did not have pre-eclampsia (OR=3.41, 95% CI 1.40, 8.31). Preterm infants whose mothers had pre-eclampsia were at significantly increased risk of CP compared with full term infants whose mothers did not have pre-eclampsia (OR=5.88, 95% CI 3.40, 10.17). The greatest risk for CP was in preterm infants whose mothers did not have pre-eclampsia (OR=8.12, 95% CI 6.49, 10.17 compared with full term infants without exposure to pre-eclampsia). We conclude that pre-eclampsia with onset before 37 weeks' gestation is a significant risk factor for CP. Some of the association is probably attributable to high risk of preterm birth because of early pre-eclampsia, while a 'direct' effect of pre-eclampsia on fetal brain development also seems likely.
子痫前期是早产的主要原因，而早产与脑瘫（CP）密切相关。然而，子痫前期是否会增加脑瘫的风险仍存在争议。我们评估了 1996 年至 2002 年间在南卡罗来纳州医疗补助计划中投保的 122476 对母婴对子痫前期与脑瘫之间的关系。产前计费记录与产后直至 2008 年 12 月的儿童医疗补助计费记录相关联。使用广义估计方程的逻辑回归模型来模拟 CP 的可能性。至少有两名不同的医疗保健提供者诊断出 337 名儿童（0.28%）患有脑瘫，有 4226 名（3.5%）妇女在怀孕期间至少两次被诊断患有子痫前期。与母亲没有子痫前期的儿童相比，患有子痫前期的儿童患脑瘫的可能性几乎是其两倍[比值比（OR）=1.94，95%置信区间（CI）1.25，2.97]。这种关联仅在妊娠 37 周前诊断出子痫前期时才具有统计学意义。与足月（胎龄≥37 周）但母亲在妊娠 37 周前被诊断为子痫前期的婴儿相比，足月且母亲没有子痫前期的婴儿患脑瘫的可能性更高（OR=3.41，95%CI 1.40，8.31）。与足月且母亲没有子痫前期的婴儿相比，母亲在妊娠 37 周前患有子痫前期的早产儿患脑瘫的风险显著增加（OR=5.88，95%CI 3.40，10.17）。与足月且母亲没有子痫前期的婴儿相比，母亲没有子痫前期的早产儿患脑瘫的风险最大（OR=8.12，95%CI 6.49，10.17 与未暴露于子痫前期的足月婴儿相比）。我们的结论是，妊娠 37 周前发病的子痫前期是脑瘫的一个重要危险因素。部分原因可能是由于早期子痫前期导致早产风险增加，而子痫前期对胎儿大脑发育的“直接”影响似乎也很有可能。
