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Risk Factors for Cerebral Palsy

A Case-Control Study in Greece

Department of Hygiene and Epidemiology, Athens University Medical School, Athens: Correspondence address: Eleni Petridou, MD Harvard School of Public Health Dept. of Epidemiology 677 Huntington Ave. Boston, MA 02115 USA, Department of Epidemiology, Harvard School of Public Health, Boston, USA

Mary Koussouri

Department of Hygiene and Epidemiology, Athens University Medical School, Athens, Department of Pediatrics, Penteli Children's Hospital, Athens

Nektaria Toupadaki

Department of Hygiene and Epidemiology, Athens University Medical School, Athens

Antigoni Papavassiliou

Department of Neurology, Penteli Children's Hospital, Athens

Sotiris Youroukos

First Department of Pediatrics, Athens University, Medical School, Athens

Effi Katsarou

Department of Neurology, Aglaia Kyriakou Children's Hospital, Athens, Greece

Dimitrios Trichopoulos

Department of Epidemiology, Harvard School of Public Health, Boston, USA

The purpose of this study was to investigate the relation between a series of maternal, antenatal, perinatal, socioeconomic and environmental variables and the occurrence of cerebral palsy (CP) in a setting different from those in which previous analytic epidemiologic studies had been undertaken. The study was of case-control design and included 103 children with cerebral palsy born between 1984 and 1988 and residents of the Greater Athens area at any time during 1991 and 1992. Controls were chosen among the neighbors of the index case or were healthy siblings of children with neurological diseases other than CP seen by the same neurologists as the children with CP; a total of 254 control children were eventually included. Statistical analysis was done by modeling the data through unconditional logistic regression. Statistically significant (p,<0.05) risk factors of potential causal importance were: twin membership (OR=10.2), gestational age (OR = 0.5 per 4 weeks), birth weight conditional on gestational age (OR = 0.9 per 100 g), congenital malformations (OR=7.5), unhealthy placenta (OR = 6.6), placenta previa (6 cases, no controls), abnormal amniotic fluid (OR = 3.6), head circumference more than 36 cm (OR = 9.0), general anesthesia during labor (OR = 4.3), forceps delivery (OR = 6.8), and birth trauma (OR = 11.5). Among children with no identifiable prenatal risk factors there was no excess prevalence of one or more perinatal risk factors in CP cases compared to controls, which implies that the latter factors impart their effect through interactions with co-existing prenatal or other risk factors.

Key Words: cerebral palsy • perinatal • prenatal risk factors • etiology

Scandinavian Journal of Public Health, Vol. 24, No. 1, 14-26 (1996)
DOI: 10.1177/140349489602400104


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