Early onset preeclampsia and cerebral palsy: a double hit model?
Background Cerebral palsy (CP) is a late sequel of pregnancy, and the role of preeclampsia is debatable. Objective The aims of this study were to determine the association between preeclampsia and cerebral palsy and to determine the risk factors for the development of cerebral palsy in these patient...
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| Veröffentlicht in: | American journal of obstetrics and gynecology 2016, Vol.214 (1), p.105.e1-105.e9 |
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| creator | Mor, Omer, BMSc Stavsky, Moshe, BMSc Yitshak-Sade, Maayan, MPH Mastrolia, Salvatore Andrea, MD Beer-Weisel, Ruthy, MD Rafaeli-Yehudai, Tal, MD Besser, Limor, MD, PHD Hamou, Batel, MD Mazor, Moshe, MD Erez, Offer, MD |
| description | Background Cerebral palsy (CP) is a late sequel of pregnancy, and the role of preeclampsia is debatable. Objective The aims of this study were to determine the association between preeclampsia and cerebral palsy and to determine the risk factors for the development of cerebral palsy in these patients. Study Design A retrospective population-based cohort study was designed that included 229,192 singleton pregnancies. The study population was divided into 2 groups: (1) patients with preeclampsia (n = 9749) and (2) normotensive gestations (n = 219,443). Generalized Estimating Equation multiple logistic regression models were performed to study the associations among preeclampsia, small for gestational age, gestational age at delivery, and the risk factors for the development of cerebral palsy in neonates of women with preeclampsia. Results The rate of cerebral palsy was double in patients with preeclampsia than in the normotensive group (0.2% vs 0.1%; P = .015); early onset preeclampsia and small for gestational age were independent risk factors for the subsequent development of cerebral palsy (odds ratio, 8.639 [95% confidence interval, 4.269–17.480]; odds ratio, 2.737 [95% confidence interval, 1.937–3.868], respectively). A second model was conducted to determine the risk factors for the development of cerebral palsy in women with preeclampsia. Birth asphyxia, complications of prematurity, and neonatal infectious morbidity, but not small for gestational age or gestational age at delivery, were independent risk factors for the development of cerebral palsy. Conclusion In a comparison with normal pregnant women, the rate of cerebral palsy is double among patients with preeclampsia, especially those with early-onset disease. Early-onset preeclampsia is an independent risk factor for cerebral palsy. Among women with preeclampsia, the presence of neonatal infectious morbidity, birth asphyxia, and complications of prematurity are independent risk factors for the development of cerebral palsy, which further supports the role of a multi-hit model in the pathogenesis of this syndrome. |
| doi_str_mv | 10.1016/j.ajog.2015.08.020 |
| format | Article |
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Objective The aims of this study were to determine the association between preeclampsia and cerebral palsy and to determine the risk factors for the development of cerebral palsy in these patients. Study Design A retrospective population-based cohort study was designed that included 229,192 singleton pregnancies. The study population was divided into 2 groups: (1) patients with preeclampsia (n = 9749) and (2) normotensive gestations (n = 219,443). Generalized Estimating Equation multiple logistic regression models were performed to study the associations among preeclampsia, small for gestational age, gestational age at delivery, and the risk factors for the development of cerebral palsy in neonates of women with preeclampsia. Results The rate of cerebral palsy was double in patients with preeclampsia than in the normotensive group (0.2% vs 0.1%; P = .015); early onset preeclampsia and small for gestational age were independent risk factors for the subsequent development of cerebral palsy (odds ratio, 8.639 [95% confidence interval, 4.269–17.480]; odds ratio, 2.737 [95% confidence interval, 1.937–3.868], respectively). A second model was conducted to determine the risk factors for the development of cerebral palsy in women with preeclampsia. Birth asphyxia, complications of prematurity, and neonatal infectious morbidity, but not small for gestational age or gestational age at delivery, were independent risk factors for the development of cerebral palsy. Conclusion In a comparison with normal pregnant women, the rate of cerebral palsy is double among patients with preeclampsia, especially those with early-onset disease. Early-onset preeclampsia is an independent risk factor for cerebral palsy. Among women with preeclampsia, the presence of neonatal infectious morbidity, birth asphyxia, and complications of prematurity are independent risk factors for the development of cerebral palsy, which further supports the role of a multi-hit model in the pathogenesis of this syndrome.</description><identifier>ISSN: 0002-9378</identifier><identifier>EISSN: 1097-6868</identifier><identifier>DOI: 10.1016/j.ajog.2015.08.020</identifier><identifier>PMID: 26283455</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; asphyxia ; Asphyxia Neonatorum - epidemiology ; Cerebral Palsy - epidemiology ; Cerebral Palsy - etiology ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature, Diseases - epidemiology ; Infant, Small for Gestational Age ; infection ; Infection - epidemiology ; inflammation ; Male ; multi-hit model ; Obstetrics and Gynecology ; Pre-Eclampsia - epidemiology ; Pregnancy ; prematurity ; Retrospective Studies ; Risk Factors ; SGA ; Young Adult</subject><ispartof>American journal of obstetrics and gynecology, 2016, Vol.214 (1), p.105.e1-105.e9</ispartof><rights>Elsevier Inc.</rights><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c547t-674fb65456d884ded769ad4c4f719d131d74262cb213f8e752be15871d5406503</citedby><cites>FETCH-LOGICAL-c547t-674fb65456d884ded769ad4c4f719d131d74262cb213f8e752be15871d5406503</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002937815008716$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,4010,27900,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26283455$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mor, Omer, BMSc</creatorcontrib><creatorcontrib>Stavsky, Moshe, BMSc</creatorcontrib><creatorcontrib>Yitshak-Sade, Maayan, MPH</creatorcontrib><creatorcontrib>Mastrolia, Salvatore Andrea, MD</creatorcontrib><creatorcontrib>Beer-Weisel, Ruthy, MD</creatorcontrib><creatorcontrib>Rafaeli-Yehudai, Tal, MD</creatorcontrib><creatorcontrib>Besser, Limor, MD, PHD</creatorcontrib><creatorcontrib>Hamou, Batel, MD</creatorcontrib><creatorcontrib>Mazor, Moshe, MD</creatorcontrib><creatorcontrib>Erez, Offer, MD</creatorcontrib><title>Early onset preeclampsia and cerebral palsy: a double hit model?</title><title>American journal of obstetrics and gynecology</title><addtitle>Am J Obstet Gynecol</addtitle><description>Background Cerebral palsy (CP) is a late sequel of pregnancy, and the role of preeclampsia is debatable. Objective The aims of this study were to determine the association between preeclampsia and cerebral palsy and to determine the risk factors for the development of cerebral palsy in these patients. Study Design A retrospective population-based cohort study was designed that included 229,192 singleton pregnancies. The study population was divided into 2 groups: (1) patients with preeclampsia (n = 9749) and (2) normotensive gestations (n = 219,443). Generalized Estimating Equation multiple logistic regression models were performed to study the associations among preeclampsia, small for gestational age, gestational age at delivery, and the risk factors for the development of cerebral palsy in neonates of women with preeclampsia. Results The rate of cerebral palsy was double in patients with preeclampsia than in the normotensive group (0.2% vs 0.1%; P = .015); early onset preeclampsia and small for gestational age were independent risk factors for the subsequent development of cerebral palsy (odds ratio, 8.639 [95% confidence interval, 4.269–17.480]; odds ratio, 2.737 [95% confidence interval, 1.937–3.868], respectively). A second model was conducted to determine the risk factors for the development of cerebral palsy in women with preeclampsia. Birth asphyxia, complications of prematurity, and neonatal infectious morbidity, but not small for gestational age or gestational age at delivery, were independent risk factors for the development of cerebral palsy. Conclusion In a comparison with normal pregnant women, the rate of cerebral palsy is double among patients with preeclampsia, especially those with early-onset disease. Early-onset preeclampsia is an independent risk factor for cerebral palsy. Among women with preeclampsia, the presence of neonatal infectious morbidity, birth asphyxia, and complications of prematurity are independent risk factors for the development of cerebral palsy, which further supports the role of a multi-hit model in the pathogenesis of this syndrome.</description><subject>Adult</subject><subject>asphyxia</subject><subject>Asphyxia Neonatorum - epidemiology</subject><subject>Cerebral Palsy - epidemiology</subject><subject>Cerebral Palsy - etiology</subject><subject>Female</subject><subject>Gestational Age</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Infant, Premature, Diseases - epidemiology</subject><subject>Infant, Small for Gestational Age</subject><subject>infection</subject><subject>Infection - epidemiology</subject><subject>inflammation</subject><subject>Male</subject><subject>multi-hit model</subject><subject>Obstetrics and Gynecology</subject><subject>Pre-Eclampsia - epidemiology</subject><subject>Pregnancy</subject><subject>prematurity</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>SGA</subject><subject>Young Adult</subject><issn>0002-9378</issn><issn>1097-6868</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUtv1TAQhS0EopeWP8ACZckmYez4FYQoqCpQqVIXlLXl2BNwcB7YCdL99yS6hQULVqPRnHM08w0hLyhUFKh83Ve2n75VDKioQFfA4BE5UGhUKbXUj8kBAFjZ1EqfkWc593vLGvaUnDHJdM2FOJD31zbFYzGNGZdiTogu2mHOwRZ29IXDhG2ysZhtzMc3hS38tLYRi-9hKYbJY7y8IE-6bYjPH-o5-frx-v7qc3l79-nm6sNt6QRXSykV71opuJBea-7RK9lYzx3vFG08ralXfNvKtYzWnUYlWItUaEW94CAF1Ofk1Sl3TtPPFfNihpAdxmhHnNZsqBI1UAZcbFJ2kro05ZywM3MKg01HQ8Hs5ExvdnJmJ2dAm43cZnr5kL-2A_q_lj-oNsHbkwC3K38FTCa7gKNDHxK6xfgp_D__3T92F8MYnI0_8Ii5n9Y0bvwMNZkZMF_2Z-2vowJgwyDr3zH8kdY</recordid><startdate>2016</startdate><enddate>2016</enddate><creator>Mor, Omer, BMSc</creator><creator>Stavsky, Moshe, BMSc</creator><creator>Yitshak-Sade, Maayan, MPH</creator><creator>Mastrolia, Salvatore Andrea, MD</creator><creator>Beer-Weisel, Ruthy, MD</creator><creator>Rafaeli-Yehudai, Tal, MD</creator><creator>Besser, Limor, MD, PHD</creator><creator>Hamou, Batel, MD</creator><creator>Mazor, Moshe, MD</creator><creator>Erez, Offer, MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>2016</creationdate><title>Early onset preeclampsia and cerebral palsy: a double hit model?</title><author>Mor, Omer, BMSc ; Stavsky, Moshe, BMSc ; Yitshak-Sade, Maayan, MPH ; Mastrolia, Salvatore Andrea, MD ; Beer-Weisel, Ruthy, MD ; Rafaeli-Yehudai, Tal, MD ; Besser, Limor, MD, PHD ; Hamou, Batel, MD ; Mazor, Moshe, MD ; Erez, Offer, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c547t-674fb65456d884ded769ad4c4f719d131d74262cb213f8e752be15871d5406503</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>asphyxia</topic><topic>Asphyxia Neonatorum - epidemiology</topic><topic>Cerebral Palsy - epidemiology</topic><topic>Cerebral Palsy - etiology</topic><topic>Female</topic><topic>Gestational Age</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Infant, Premature, Diseases - epidemiology</topic><topic>Infant, Small for Gestational Age</topic><topic>infection</topic><topic>Infection - epidemiology</topic><topic>inflammation</topic><topic>Male</topic><topic>multi-hit model</topic><topic>Obstetrics and Gynecology</topic><topic>Pre-Eclampsia - epidemiology</topic><topic>Pregnancy</topic><topic>prematurity</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>SGA</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mor, Omer, BMSc</creatorcontrib><creatorcontrib>Stavsky, Moshe, BMSc</creatorcontrib><creatorcontrib>Yitshak-Sade, Maayan, MPH</creatorcontrib><creatorcontrib>Mastrolia, Salvatore Andrea, MD</creatorcontrib><creatorcontrib>Beer-Weisel, Ruthy, MD</creatorcontrib><creatorcontrib>Rafaeli-Yehudai, Tal, MD</creatorcontrib><creatorcontrib>Besser, Limor, MD, PHD</creatorcontrib><creatorcontrib>Hamou, Batel, MD</creatorcontrib><creatorcontrib>Mazor, Moshe, MD</creatorcontrib><creatorcontrib>Erez, Offer, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of obstetrics and gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mor, Omer, BMSc</au><au>Stavsky, Moshe, BMSc</au><au>Yitshak-Sade, Maayan, MPH</au><au>Mastrolia, Salvatore Andrea, MD</au><au>Beer-Weisel, Ruthy, MD</au><au>Rafaeli-Yehudai, Tal, MD</au><au>Besser, Limor, MD, PHD</au><au>Hamou, Batel, MD</au><au>Mazor, Moshe, MD</au><au>Erez, Offer, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early onset preeclampsia and cerebral palsy: a double hit model?</atitle><jtitle>American journal of obstetrics and gynecology</jtitle><addtitle>Am J Obstet Gynecol</addtitle><date>2016</date><risdate>2016</risdate><volume>214</volume><issue>1</issue><spage>105.e1</spage><epage>105.e9</epage><pages>105.e1-105.e9</pages><issn>0002-9378</issn><eissn>1097-6868</eissn><abstract>Background Cerebral palsy (CP) is a late sequel of pregnancy, and the role of preeclampsia is debatable. Objective The aims of this study were to determine the association between preeclampsia and cerebral palsy and to determine the risk factors for the development of cerebral palsy in these patients. Study Design A retrospective population-based cohort study was designed that included 229,192 singleton pregnancies. The study population was divided into 2 groups: (1) patients with preeclampsia (n = 9749) and (2) normotensive gestations (n = 219,443). Generalized Estimating Equation multiple logistic regression models were performed to study the associations among preeclampsia, small for gestational age, gestational age at delivery, and the risk factors for the development of cerebral palsy in neonates of women with preeclampsia. Results The rate of cerebral palsy was double in patients with preeclampsia than in the normotensive group (0.2% vs 0.1%; P = .015); early onset preeclampsia and small for gestational age were independent risk factors for the subsequent development of cerebral palsy (odds ratio, 8.639 [95% confidence interval, 4.269–17.480]; odds ratio, 2.737 [95% confidence interval, 1.937–3.868], respectively). A second model was conducted to determine the risk factors for the development of cerebral palsy in women with preeclampsia. Birth asphyxia, complications of prematurity, and neonatal infectious morbidity, but not small for gestational age or gestational age at delivery, were independent risk factors for the development of cerebral palsy. Conclusion In a comparison with normal pregnant women, the rate of cerebral palsy is double among patients with preeclampsia, especially those with early-onset disease. Early-onset preeclampsia is an independent risk factor for cerebral palsy. Among women with preeclampsia, the presence of neonatal infectious morbidity, birth asphyxia, and complications of prematurity are independent risk factors for the development of cerebral palsy, which further supports the role of a multi-hit model in the pathogenesis of this syndrome.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26283455</pmid><doi>10.1016/j.ajog.2015.08.020</doi></addata></record> |
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| subjects | Adult asphyxia Asphyxia Neonatorum - epidemiology Cerebral Palsy - epidemiology Cerebral Palsy - etiology Female Gestational Age Humans Infant, Newborn Infant, Premature, Diseases - epidemiology Infant, Small for Gestational Age infection Infection - epidemiology inflammation Male multi-hit model Obstetrics and Gynecology Pre-Eclampsia - epidemiology Pregnancy prematurity Retrospective Studies Risk Factors SGA Young Adult |
| title | Early onset preeclampsia and cerebral palsy: a double hit model? |
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