Authors:
Blair EM, Nelson KB
Authors notes:
American Journal of Obstetrics and Gynecology. 2014;Online:1.e1-1.e7
Keywords:
Birth asphyxia, Birth defects, Pregnancy-induced hypertension, Smoking, Term and late preterm birth
Abstract:
The objective of the study was to improve the understanding of etiological paths to cerebral palsy (CP) that include fetal growth restriction by examining factors associated with growth restriction that modify CP risk.
More than 80% of term and late preterm markedly growth-restricted singletons were born following a normotensive pregnancy and were at statistically significantly increased risk of CP, whereas growth-restricted births following a hypertensive pregnancy were not.
Neither a clinical diagnosis of birth asphyxia nor potentially asphyxiating birth events occurred more frequently among growth-restricted than among appropriately grown infants with CP.
Major birth defects, particularly cerebral defects, occurred in an increasing proportion of CP with increasing growth deficit.
The factor most predictive of CP in growth-restricted singletons was a major birth defect, present in 53% of markedly growth-restricted neonates with later CP.
Defects observed in CP were similar whether growth restricted or not, except for an excess of isolated congenital microcephaly in those born growth restricted.
The highest observed CP risk was in infants with both growth restriction and a major birth defect.
The risk of CP was increased in antenatally growth-restricted singletons born at or near term to normotensive mothers.
In growth-restricted singletons, a major birth defect was the dominant predictor, associated with a 30-fold increase in odds of CP.
Identification of birth defects in the growth-restricted fetus or neonate may provide significant prognostic information.