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American Journal of Epidemiology Advance Access originally published online on August 27, 2009
American Journal of Epidemiology 2009 170(7):819-828; doi:10.1093/aje/kwp206
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Maternal Antenatal Complications and the Risk of Neonatal Cerebral White Matter Damage and Later Cerebral Palsy in Children Born at an Extremely Low Gestational Age

Thomas F. McElrath, Elizabeth N. Allred, Kim A. Boggess, Karl Kuban, T. Michael O'Shea, Nigel Paneth and Alan Leviton for the ELGAN Study Investigators

Correspondence to Dr. Thomas F. McElrath, Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 (e-mail: tmcelrath{at}partners.org).

Received for publication December 12, 2008. Accepted for publication June 12, 2009.

In a 2002–2004 prospective cohort study of deliveries of infants at <28 weeks at 14 US centers, the authors sought the antecedents of white matter damage evident in newborn cranial ultrasound scans (ventriculomegaly and an echolucent lesion) and of cerebral palsy diagnoses at age 2 years. Of the 1,455 infants enrolled, those whose mothers received an antenatal steroid tended to have lower risks of ventriculomegaly and an echolucent lesion than their peers (10% vs. 23%, P < 0.001 and 7% vs. 11%, P = 0.06, respectively). Risk of ventriculomegaly was increased for infants delivered because of preterm labor (adjusted odds ratio (OR) = 2.3, 95% confidence interval (CI): 1.1, 4.9), preterm premature rupture of fetal membranes (OR = 3.6, 95% CI: 1.5, 8.7), and cervical insufficiency (OR = 2.8, 95% CI: 1.4, 5.5) when compared with infants delivered because of preeclampsia. Risk of an echolucent lesion was increased for infants delivered because of preterm labor (OR = 2.7, 95% CI: 1.2, 5.7) and intrauterine growth retardation (OR = 3.3, 95% CI: 1.2, 9.4). The doubling of diparesis risk associated with preterm labor and with preterm premature rupture of fetal membranes did not achieve statistical significance, nor did the doubling of quadriparesis risk and the tripling of diparesis risk associated with cervical insufficiency.

cerebral palsy; cervix uteri; fetal membranes, premature rupture; infant, premature; leukomalacia, periventricular; obstetric labor, preterm; pre-eclampsia; steroids

Abbreviations: ELGAN, Extremely Low Gestational Age Newborns; pPROM, preterm premature rupture of fetal membranes


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