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Cerebral palsy and perinatal mortality after pregnancy‐induced hypertension across the gestational age spectrum: observations of a reconstructed total population cohort
Author(s) -
Blair Eve,
Watson Linda
Publication year - 2016
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.13014
Subject(s) - medicine , cerebral palsy , gestation , obstetrics , gestational age , pregnancy , population , gestational hypertension , cohort , pediatrics , cohort study , genetics , environmental health , psychiatry , biology
Aim Pregnancy‐induced hypertension/pre‐eclampsia ( PIH / PE ) is associated with cerebral palsy ( CP ) in term births but if sufficiently severe to necessitate preterm delivery predicts a lower risk of CP than observed in gestational peers. We investigated whether this apparent ‘protection’ was attributable to inappropriately chosen comparison groups and/or an increased risk of perinatal death. Method Perinatal information was collected from medical records of children with CP , individually matched neonatal survivors without CP , and representative samples of perinatal deaths of Western Australian birth cohorts from 1980 to 1995. Compared with these data, the sensitivity of statutorily collected PIH / PE data was assessed for each outcome group. Using these sensitivities, the estimated risks of death and CP in births to all women with and without PIH / PE were compared. Results Sensitivity of statutory PIH / PE data decreased with increasingly poor outcome. Reconstructed cohorts showed that PIH / PE increased the risks both of CP and of perinatal death in births at lower gestations except in births <27 weeks, where the risk of perinatal death only increased greatly. Interpretation PIH / PE does not protect against poor outcome at any gestational age. Previously reported protective effects originate from inappropriate control for gestational age and not from higher gestation‐specific perinatal mortality.