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Maternal Infections during Pregnancy and Cerebral Palsy: A Population‐based Cohort Study
Author(s) -
Miller Jessica E.,
Pedersen Lars Henning,
Streja Elani,
Bech Bodil H.,
YearginAllsopp Marshalyn,
Van Naarden Braun Kim,
Schendel Diana E.,
Christensen Deborah,
Uldall Peter,
Olsen Jørn
Publication year - 2013
Publication title -
paediatric and perinatal epidemiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 88
eISSN - 1365-3016
pISSN - 0269-5022
DOI - 10.1111/ppe.12082
Subject(s) - medicine , hazard ratio , pregnancy , cerebral palsy , confidence interval , nitrofurantoin , pediatrics , population , obstetrics , cohort study , antibiotics , ciprofloxacin , physical therapy , genetics , environmental health , microbiology and biotechnology , biology
Background Cerebral palsy ( CP ) is a common motor disability in childhood. We examined the association between maternal infections during pregnancy and the risk of congenital CP in the child. Methods Liveborn singletons in D enmark between 1997 and 2003 were identified from the D anish N ational B irth R egistry and followed from 1 year of life until 2008. Redemption of antibiotics from the N ational R egister of M edicinal P roduct S tatistics and maternal infections reported by the N ational H ospital R egister were used as markers of maternal infection during pregnancy. CP diagnoses were obtained from the D anish C erebral P alsy R egistry. Adjusted hazard ratio ( HR ) and 95% confidence interval ( CI ) were estimated by C ox proportional hazard models. Results Of the 440 564 singletons with follow‐up data, 840 were diagnosed with congenital CP . Maternal genito‐urinary tract infections ( HR 2.1, 95% CI 1.4, 3.2) were associated with CP in all births, in term births ( HR 1.9, 95% CI 1.1, 3.2), in children with spastic CP ( HR 2.1, 95% CI 1.4, 3.3), and among first‐born children ( HR 1.9, 95% CI 1.4, 3.3). Overall, we found associations between redeemed nitrofurantoin ( HR 1.7, 95% CI 1.1, 2.8) and CP . Among trimester‐specific exposures, CP risk was associated with prescriptions redeemed in the first trimester for any antibacterials, beta‐lactam antibacterials, and nitrofurantoin, an antibiotic commonly used to treat lower urinary tract infection, and genito‐urinary tract infections in the third trimester. Conclusion Genito‐urinary tract infections and antibiotic use during pregnancy were associated with increased risks of CP , indicating that some maternal infections or causes of maternal infections present in prenatal life may be part of a causal pathway leading to CP .