Grether J K, Nelson K B
California Birth Defects Monitoring Program, California Department of Health Services, Emeryville 94608-1811, USA.
JAMA. 1997 Jul 16;278(3):207-11.
Exposure to maternal or placental infection is related to risk of preterm birth and, in premature infants, of brain lesions predictive of cerebral palsy (CP). Few studies have investigated whether maternal infection is associated with risk of CP in children of normal birth weight.
To investigate maternal infection during the admission for delivery as a possible risk factor for CP in infants born weighing 2500 g or more.
Population-based case-control study.
All hospitals in 4 northern California counties, 1983 through 1985.
A total of 46 children with disabling spastic CP who had no recognized prenatal brain lesions and 378 randomly selected control children weighing 2500 g or more at birth and surviving to age 3 years.
Disabling spastic CP and signs of neonatal morbidity.
Maternal fever exceeding 38 degrees C in labor was associated with increased risk of unexplained CP (odds ratio [OR], 9.3; 95% confidence interval [CI], 2.7-31.0), as was a clinical diagnosis of chorioamnionitis. One or more indicators of maternal infection were present in 2.9% of control children, 22% of children with CP (OR, 9.3; 95% CI, 3.7-23.0), and 37% of those with the spastic quadriplegic subtype of CP (OR, 19.0; 95% CI, 6.5-56.0). Newborns exposed to maternal infection, both cases and controls, had 5-minute Apgar scores below 6 more often than those unexposed. Among children with CP, those born to infected women were more often hypotensive, needed intubation, had neonatal seizures, and received a clinical diagnosis of hypoxic-ischemic encephalopathy.
Intrauterine exposure to maternal infection was associated with a marked increase in risk of CP in infants of normal birth weight. Maternal infection was also linked with low Apgar scores, other evidence of hypotension [corrected] and need for resuscitation, and neonatal seizures-signs commonly attributed to birth asphyxia.
孕产妇或胎盘感染与早产风险相关，对于早产儿而言，还与预测脑瘫（CP）的脑损伤风险相关。很少有研究调查孕产妇感染是否与正常出生体重儿童的脑瘫风险有关。
调查分娩入院时的孕产妇感染是否为出生体重2500克或以上婴儿患脑瘫的可能危险因素。
基于人群的病例对照研究。
1983年至1985年加利福尼亚州北部4个县的所有医院。
共有46例患有致残性痉挛性脑瘫且无公认产前脑损伤的儿童，以及378名随机选择的对照儿童，这些对照儿童出生时体重2500克或以上，且存活至3岁。
致残性痉挛性脑瘫和新生儿发病体征。
分娩时孕产妇体温超过38摄氏度与不明原因脑瘫风险增加相关（比值比[OR]，9.3；95%置信区间[CI]，2.7 - 31.0），绒毛膜羊膜炎的临床诊断也是如此。2.9%的对照儿童、22%的脑瘫儿童（OR，9.3；95% CI，3.7 - 23.0）以及37%的痉挛性四肢瘫亚型脑瘫儿童（OR，19.0；95% CI，6.5 - 56.0）存在一项或多项孕产妇感染指标。暴露于孕产妇感染的新生儿，无论病例组还是对照组，5分钟阿氏评分低于6分的情况比未暴露者更常见。在脑瘫儿童中，感染妇女所生的儿童更常出现低血压、需要插管、有新生儿惊厥，并被临床诊断为缺氧缺血性脑病。
宫内暴露于孕产妇感染与正常出生体重婴儿患脑瘫的风险显著增加相关。孕产妇感染还与低阿氏评分、其他低血压[校正后]证据及复苏需求以及新生儿惊厥有关，这些体征通常归因于出生窒息。
