Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.
JAMA Pediatr. 2023 Jan 1;177(1):53-61. doi: 10.1001/jamapediatrics.2022.4535.
Although maternal unintentional injury during pregnancy has shown negative impacts on the mother and fetus, the evidence on its long-term associations with children's neurodevelopment is limited.
To examine the association between maternal unintentional injury and cerebral palsy (CP) in offspring.
DESIGN, SETTING, AND PARTICIPANTS: This was a population-based, longitudinal, cohort study of all in-hospital live births born between April 1, 2002, and March 31, 2017, in a publicly funded health care system setting of Ontario, Canada. Infants born more than 20 weeks' gestation were included and followed up until March 31, 2018. Excluded from the analysis were stillbirths, infants with missing or invalid records, and births with missing or invalid birth characteristics. Data were analyzed from March 1 to June 30, 2021.
Maternal unintentional injury during pregnancy ascertained based on inpatient or emergency department diagnoses.
CP diagnosis between birth and the end of follow-up in 2018 with the CP case definition of a single inpatient or 2 or more outpatient diagnoses at least 2 weeks apart between birth and age 16 years.
Of 2 110 177 children included in this study (mean [SD] gestational age, 38.8 [1.9] weeks; 1 082 520 male [51.3%]), 81 281 (3.9%) were exposed in utero to maternal unintentional injury. During a median (IQR) follow-up time of 8 (4-12) years, 5317 children (0.3%) were diagnosed with CP (292 CP cases [5.5%] were exposed to maternal unintentional injury). The mean incidence rates of CP were 4.36 and 2.93 per 10 000 child-years in the exposed and the unexposed group, respectively. Children exposed to maternal unintentional injury had a modest increase in the risk of CP, compared with those unexposed (hazard ratio [HR], 1.33; 95% CI, 1.18-1.50) after adjusting for maternal sociodemographic and clinical characteristics. Severe injuries that resulted in hospitalization and delivery within 1 week from the injury conferred higher risks of CP (adjusted HR, 2.18; 95% CI, 1.29-3.68 and adjusted HR, 3.40; 95% CI, 1.93-6.00, respectively). Results were robust in multiple bias analyses.
In this Canadian population-based birth cohort study, in utero exposure to maternal unintentional injury was associated with an increased risk of CP, with a higher risk with more severe injuries. These findings fill an important gap in knowledge on the potential role of maternal injury on children's neurodevelopment outcomes. Public health professionals and stakeholders should be aware of these potential long-term consequences on offspring when designing programs and providing recommendations about safety during pregnancy. Early monitoring and developmental assessment of children exposed to maternal injury might be warranted.
尽管妊娠期间母亲非故意受伤已显示出对母亲和胎儿的负面影响，但有关其与儿童神经发育长期关联的证据有限。
研究母亲非故意受伤与后代脑瘫（CP）之间的关联。
设计、地点和参与者：这是一项基于人群的纵向队列研究，纳入了 2002 年 4 月 1 日至 2017 年 3 月 31 日期间在加拿大安大略省一个公共资助医疗保健系统中出生的所有住院活产儿。纳入了妊娠 20 周以上的婴儿，并随访至 2018 年 3 月 31 日。分析中排除了死胎、记录缺失或无效的婴儿，以及出生特征缺失或无效的分娩。数据于 2021 年 3 月 1 日至 6 月 30 日进行分析。
妊娠期间母亲非故意受伤是根据住院或急诊诊断确定的。
在 2018 年随访结束时，根据 CP 的单一住院或至少 2 周间隔的 2 次或以上门诊诊断的 CP 病例定义，诊断 CP。
本研究共纳入了 2110177 名儿童（平均[SD]胎龄，38.8[1.9]周；1082520 名男性[51.3%]），其中 81281 名（3.9%）在子宫内暴露于母亲非故意受伤。在中位数（IQR）随访时间为 8（4-12）年期间，有 5317 名儿童（0.3%）被诊断为 CP（292 例 CP 病例[5.5%]暴露于母亲非故意受伤）。暴露组和未暴露组 CP 的平均发生率分别为每 10000 名儿童年 4.36 例和 2.93 例。与未暴露组相比，暴露于母亲非故意受伤的儿童 CP 风险略有增加（风险比[HR]，1.33；95%CI，1.18-1.50），调整了母亲社会人口统计学和临床特征后。导致住院和受伤后 1 周内分娩的严重伤害与 CP 风险升高相关（调整后的 HR，2.18；95%CI，1.29-3.68 和调整后的 HR，3.40；95%CI，1.93-6.00）。在多项偏倚分析中，结果均稳健。
在这项加拿大基于人群的出生队列研究中，子宫内暴露于母亲非故意受伤与 CP 风险增加相关，受伤越严重，风险越高。这些发现填补了有关母亲受伤对儿童神经发育结果潜在作用的知识空白。在制定关于妊娠安全的计划和提供建议时，公共卫生专业人员和利益相关者应意识到这些对后代的潜在长期影响。可能需要对暴露于母亲受伤的儿童进行早期监测和发育评估。
