Disproportionate fetal growth and the risk for congenital cerebral palsy in singleton births

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  • Elani Streja, Department of Epidemiology, School of Public Health, UCLA, Los Angeles, Denmark
  • Jessica E Miller, Department of Epidemiology, School of Public Health, UCLA, Los Angeles, Denmark
  • Chunsen Wu
  • Bodil Hammer Bech
  • Lars Henning Pedersen
  • Diana Schendel
  • Peter Uldall, The Danish Cerebral Palsy Registry, University of Southern Denmark, Rigshospitalet, Børneafdelingen, Denmark
  • Jørn Olsen

OBJECTIVE: To investigate the association between proportionality of fetal and placental growth measured at birth and the risk for congenital cerebral palsy (CP).

STUDY DESIGN: We identified all live-born singletons born in Denmark between 1995 and 2003 and followed them from 1 year of age until December 31st, 2008. Information on four indices of fetal growth: ponderal index, head circumference/ abdominal circumference ratio, cephalization index and birth weight/ placenta weight ratio was collected. Cox proportional hazards regression models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI). All measurements were evaluated as gestational age and sex specific z-scores and in z-score percentile groups, adjusted for potential confounders, and stratified on gestational age groups (<32, 32-36, 37-38, 39, 40, ≥41 weeks).

RESULTS: We identified 503,784 singleton births, of which 983 were confirmed cases of CP. Head/ abdominal circumference ratio (aHR:1.12; 95%CI:1.07-1.16) and cephalization index (aHR:1.14; 95%CI:1.11-1.16) were associated with the risk of CP irrespective of gestational age. Birth weight-placental weight ratio was also associated with CP in the entire cohort (aHR:0.90; 95%CI:0.83-0.97). Ponderal index had a u-shaped association with CP, where both children with low and high ponderal index were at higher risk of CP.

CONCLUSIONS: CP is associated with disproportions between birth weight, birth length, placental weight and head circumference suggesting pre and perinatal conditions contribute to fetal growth restriction in children with CP.

Original languageEnglish
Pages (from-to)e0126743
Publication statusPublished - 14 May 2015

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