Risk Factors for Term-Born Spastic Diplegic Cerebral Palsy: A Case-Control Study

Amaar Marefi; Nafisa Husein; Mary Dunbar; Deborah Dewey; Nicole Letourneau; Maryam Oskoui; Adam Kirton; Michael Shevell; Members of Canadian CP Registry

doi:10.1016/j.pediatrneurol.2024.03.012

Risk Factors for Term-Born Spastic Diplegic Cerebral Palsy: A Case-Control Study

Pediatr Neurol. 2024 Jun:155:26-32. doi: 10.1016/j.pediatrneurol.2024.03.012. Epub 2024 Mar 20.

Authors

Amaar Marefi¹, Nafisa Husein¹, Mary Dunbar², Deborah Dewey³, Nicole Letourneau⁴, Maryam Oskoui⁵, Adam Kirton⁶, Michael Shevell⁷; Members of Canadian CP Registry

Collaborators

Members of Canadian CP Registry:
John Andersen, David Buckley, Darcy Fehlings, Lee Burkholder, Louise Koclas, Ram Mishal, Nicole Pigeon, Ellen Wood

Affiliations

¹ Department of Neurology & Neurosurgery, McGill University, Montréal, Québec, Canada; Department of Pediatrics, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec, Canada.
² Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
³ Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta.
⁴ Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta; Faculty of Nursing and Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
⁵ Department of Neurology & Neurosurgery, McGill University, Montréal, Québec, Canada; Department of Pediatrics, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Center, Montréal, Québec, Canada.
⁶ Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
⁷ Department of Neurology & Neurosurgery, McGill University, Montréal, Québec, Canada; Department of Pediatrics, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec, Canada. Electronic address: michael.shevell@mcgill.ca.

PMID: 38581726
DOI: 10.1016/j.pediatrneurol.2024.03.012

Abstract

Background: To identify if a predetermined set of potential risk factors are associated with spastic diplegic cerebral palsy (SDCP) in term-born children.

Methods: This is a case-control study with cases (n = 134) extracted from the Canadian Cerebral Palsy Registry (CCPR) and controls (n = 1950) from the Alberta Pregnancy Outcomes and Nutrition (APrON) study. Our primary variable was the SDCP phenotype in term-born children. Possible risk factors were selected a priori and include extreme maternal age (<19 or >35 years), pregnancy complications, maternal disease, substance use, perinatal infection, mode of delivery, perinatal adversity (i.e., neonatal encephalopathy presumably on the basis of intrapartum hypoxia-ischemia), sex, and birth weight. Multivariable analyses were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).

Results: Multivariable analysis revealed associations between term-born SDCP and pregnancy complications (OR = 4.73; 95% CI = 1.91 to 10.56), maternal disease (OR = 2.52; 95% CI = 1.57 to 3.93), substance use (OR = 3.11; 95% CI = 2.10 to 4.55), perinatal infection (OR = 2.72; 95% CI 1.32 to 5.10), Caesarean section (OR = 2.35; 95% CI = 1.62 to 3.40), and perinatal adversity (OR = 2.91; 95% CI = 1.94 to 4.50). Multiple regression analysis revealed associations between SDCP and pregnancy complications (OR = 3.28; 95% CI 1.20 to 8.15), maternal disease (OR = 2.52; 95% CI 1.50 to 4.12), substance use (OR = 3.59; 95% CI 2.37 to 5.40), perinatal infection (OR = 3.78, 95% CI 1.71 to 7.72), Caesarean section (OR = 2.72; 95% CI 1.82 to 4.03), and perinatal adversity (OR = 4.16; 95% CI 2.67 to 6.70).

Interpretation: Antenatal (pregnancy complications, maternal disease, substance use) and perinatal (infections, Caesarean section, and perinatal adversity) risk factors are associated with an increased risk of SDCP in term-born children, suggesting variable interactions between risk factors to provide a clinicopathologic framework that is different from SDCP observed in preterm-born children.

Keywords: Case-control; Cerebral palsy; Risk factors; Spastic diplegia; Term-born.

MeSH terms

Adult
Case-Control Studies
Cerebral Palsy* / epidemiology
Cerebral Palsy* / etiology
Female
Humans
Infant, Newborn
Male
Pregnancy
Pregnancy Complications / epidemiology
Registries
Risk Factors

Supplementary concepts

Cerebral palsy, spastic, diplegic