Maternal antenatal complications and the risk of neonatal cerebral white matter damage and later cerebral palsy in children born at an extremely low gestational age
Department of Obstetrics and Gynecology
Medical Subject Headings
Cerebral Palsy; Cerebral Ventricles; Female; Fetal Growth Retardation; Humans; Infant, Newborn; *Infant, Premature; Leukomalacia, Periventricular; Male; Multivariate Analysis; Obstetric Labor Complications; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Prospective Studies; Risk; United States; Uterine Cervical Incompetence
Obstetrics and Gynecology
In a 2002-2004 prospective cohort study of deliveries of infants at <28 weeks at 14 US>centers, the authors sought the antecedents of white matter damage evident in newborn cranial ultrasound scans (ventriculomegaly and an echolucent lesion) and of cerebral palsy diagnoses at age 2 years. Of the 1,455 infants enrolled, those whose mothers received an antenatal steroid tended to have lower risks of ventriculomegaly and an echolucent lesion than their peers (10% vs. 23%, P < 0.001 and 7% vs. 11%, P = 0.06, respectively). Risk of ventriculomegaly was increased for infants delivered because of preterm labor (adjusted odds ratio (OR) = 2.3, 95% confidence interval (CI): 1.1, 4.9), preterm premature rupture of fetal membranes (OR = 3.6, 95% CI: 1.5, 8.7), and cervical insufficiency (OR = 2.8, 95% CI: 1.4, 5.5) when compared with infants delivered because of preeclampsia. Risk of an echolucent lesion was increased for infants delivered because of preterm labor (OR = 2.7, 95% CI: 1.2, 5.7) and intrauterine growth retardation (OR = 3.3, 95% CI: 1.2, 9.4). The doubling of diparesis risk associated with preterm labor and with preterm premature rupture of fetal membranes did not achieve statistical significance, nor did the doubling of quadriparesis risk and the tripling of diparesis risk associated with cervical insufficiency.
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Citation: Am J Epidemiol. 2009 Oct 1;170(7):819-28. Epub 2009 Aug 27. Link to article on publisher's site
McElrath, Thomas F.; Allred, Elizabeth N.; Boggess, Kim A.; Kuban, Karl; O'Shea, T. Michael; Paneth, Nigel; Leviton, Alan; Bednarek, Francis; Ayata, Gamze; Delpapa, Ellen; and ELGAN Study Investigators, "Maternal antenatal complications and the risk of neonatal cerebral white matter damage and later cerebral palsy in children born at an extremely low gestational age" (2009). Obstetrics and Gynecology Publications and Presentations. Paper 13.