From the Discipline of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, Robinson Institute, The University of Adelaide, Adelaide, South Australia; SA Clinical Genetics Service, SA Pathology at Women's and Children's Hospital, Adelaide, South Australia; Discipline of Paediatrics, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, South Australia; and Departments of Microbiology and Infectious Diseases, SA Pathology at Women's and Children's Hospital, Adelaide, South Australia.
Obstet Gynecol. 2011 Sep;118(3):576-582. doi: 10.1097/AOG.0b013e31822ad2dc.
To estimate epidemiologic risk factors for cerebral palsy.
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.
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.
Preterm birth, intrauterine growth restriction, perinatal infection, and multiple birth present the largest risks for a cerebral palsy outcome. Reassuringly, upper respiratory tract and gastrointestinal infections during pregnancy were not associated with cerebral palsy.
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评估脑瘫的流行病学风险因素。
通过与州级围产期存储库和脑瘫登记处的数据链接，并使用母亲问卷收集数据。该队列包括 587 名脑瘫患者和 1154 名非脑瘫对照。
以下因素与脑瘫相关：孕期记录的母体感染（41.4%的患者与 31.3%的对照；比值比[OR]1.55，95%置信区间 1.26-1.91）、小于胎龄儿（[出生体重低于第三个定制百分位数]43.9%的患者与 6.3%的对照；OR 11.75，6.25-22.08）、孕龄小于 32 周（29.3%的患者与 0.7%的对照；OR 59.20，28.87-121.38）、多胎妊娠（OR 6.62，4.00-10.95）、有脑瘫亲属（OR 1.61，1.12-2.32）、臀位（13.7%的患者与 6.0%的对照；OR 2.48，1.76-3.49）、孕期任何时候出血（29.3%的患者与 16.9%的对照；OR 2.04，1.61-2.58）、男性（58.8%的患者与 45.8%的对照；OR 1.68，1.38-2.06）、多次流产（7.7%的患者与 3.5%的对照；OR 2.30，1.38-3.82）、吸烟（14.0%的患者与 10.6%的对照；OR 1.37，1.02-1.85）和非法药物使用（3.3%的患者与 1.5%的对照；OR 2.22，1.14-4.30）。与脑瘫无关的因素包括“消失的双胞胎”、糖尿病、母亲体重指数、高血压、饮酒、贫血、母亲甲状腺功能减退、产钳或真空分娩和母亲年龄。
早产、宫内生长受限、围产期感染和多胎妊娠是脑瘫结局的最大风险。令人安心的是，孕期上呼吸道和胃肠道感染与脑瘫无关。
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