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Original Contribution
Clinician's Corner
September 1, 2010

Cerebral Palsy Among Term and Postterm Births

Author Affiliations

Author Affiliations: Department of Public Health and Primary Health Care (Drs Moster, Vollset, and Lie) and Department of Clinical Medicine, Section for Pediatrics (Dr Markestad), University of Bergen, Bergen, Norway; Department of Pediatrics, Haukeland University Hospital, Bergen, Norway (Drs Moster and Markestad); Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, North Carolina (Dr Wilcox); and Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen (Drs Vollset and Lie).

JAMA. 2010;304(9):976-982. doi:10.1001/jama.2010.1271

Context Although preterm delivery is a well-established risk factor for cerebral palsy (CP), preterm deliveries contribute only a minority of affected infants. There is little information on the relation of CP risk to gestational age in the term range, where most CP occurs.

Objective To determine whether timing of birth in the term and postterm period is associated with risk of CP.

Design, Setting, and Participants Population-based follow-up study using the Medical Birth Registry of Norway to identify 1 682 441 singleton children born in the years 1967-2001 with a gestational age of 37 through 44 weeks and no congenital anomalies. The cohort was followed up through 2005 by linkage to other national registries.

Main Outcome Measures Absolute and relative risk of CP for children surviving to at least 4 years of age.

Results Of the cohort of term and postterm children, 1938 were registered with CP in the National Insurance Scheme. Infants born at 40 weeks had the lowest risk of CP, with a prevalence of 0.99/1000 (95% confidence interval [CI], 0.90-1.08). Risk for CP was higher with earlier or later delivery, with a prevalence at 37 weeks of 1.91/1000 (95% CI, 1.58-2.25) and a relative risk (RR) of 1.9 (95% CI, 1.6-2.4), a prevalence at 38 weeks of 1.25/1000 (95% CI, 1.07-1.42) and an RR of 1.3 (95% CI, 1.1-1.6), a prevalence at 42 weeks of 1.36/1000 (95% CI, 1.19-1.53) and an RR of 1.4 (95% CI, 1.2-1.6), and a prevalence after 42 weeks of 1.44 (95% CI, 1.15-1.72) and an RR of 1.4 (95% CI, 1.1-1.8). These associations were even stronger in a subset with gestational age based on ultrasound measurements: at 37 weeks the prevalence was 1.17/1000 (95% CI, 0.30-2.04) and the relative risk was 3.7 (95% CI, 1.5-9.1). At 42 weeks the prevalence was 0.85/1000 (95% CI, 0.33-1.38) and the relative risk was 2.4 (95% CI, 1.1-5.3). Adjustment for infant sex, maternal age, and various socioeconomic measures had little effect.

Conclusion Compared with delivery at 40 weeks' gestation, delivery at 37 or 38 weeks or at 42 weeks or later was associated with an increased risk of CP.