Epidemiologic Associations With Cerebral Palsy
Epidemiologic Associations With Cerebral Palsy
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DOI：
10.1097/aog.0b013e31822ad2dc
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发表时间：
2011-09-01
影响因子：
7.2
通讯作者：
Dekker, Gustaaf A.
中科院分区：
文献类型：
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作者：
O'Callaghan, Michael E.;MacLennan, Alastair H.;Dekker, Gustaaf A.
目的：探讨脑瘫的流行病学危险因素。方法：通过链接到基于国家的围产期资料库和脑瘫登记，并使用产妇问卷收集数据。该队列包括587名脑瘫患者和1154名非脑瘫对照者。结果：以下因素与脑瘫相关：妊娠期孕产妇感染（41.4%患者与31.3%对照；比值比[OR] 1.55, 95%可信区间[OR] 1.26-1.91）、胎龄小（[出生体重小于第三个定制百分位数]43.9%患者与6.3%对照；OR 11.75, 6.25-22.08）、胎龄小于32周(29.3%患者与0.7%对照；OR 59.20, 28.87-121.38)、多胎（OR 6.62, 4.00-10.95）、有脑瘫亲属（OR 1.61, 1.12-2.32）、臀位（患者占13.7%，对照组为6.0%;OR 2.48, 1.76-3.49）、孕期任何时间出血（患者占29.3%，对照组为16.9%;OR 2.04, 1.61-2.58）、男性（患者占58.8%，对照组为45.8%;OR 1.68, 1.38-2.06）、多胎流产(患者占7.7%，对照组为3.5%；OR 2.30, 1.38-3.82)、吸烟（14.0%的患者与10.6%的对照组相比；OR 1.37, 1.02-1.85）和非法药物使用（3.3%的患者与1.5%的对照组相比；OR 2.22, 1.14-4.30）。与脑瘫无关的因素是“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、产钳或真空分娩以及母亲年龄。结论：早产、宫内生长受限、围产期感染和多胎是脑瘫预后的最大危险因素。令人欣慰的是，怀孕期间的上呼吸道和胃肠道感染与脑瘫无关。
OBJECTIVE: To estimate epidemiologic risk factors for cerebral palsy.METHODS: 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.RESULTS: 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.CONCLUSION: 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.