Maternal Diagnosis of Obesity and Risk of Cerebral Palsy in the Child

doi:10.1016/j.jpeds.2013.06.062

The Journal of Pediatrics

Volume 163, Issue 5, November 2013, Pages 1307-1312

https://doi.org/10.1016/j.jpeds.2013.06.062 Get rights and content

Objective

To examine the association between maternal hospital diagnoses of obesity and risk of cerebral palsy (CP) in the child.

Study design

For all California hospital births from 1991-2001, we linked infant and maternal hospitalization discharge abstracts to California Department of Developmental Services records of children receiving services for CP. We identified maternal hospital discharge diagnoses of obesity (International Classification of Diseases, 9th edition 646.1, 278.00, or 278.01) and morbid obesity (International Classification of Diseases, 9th edition 278.01), and performed logistic regression to explore the relationship between maternal obesity diagnoses and CP.

Results

Among 6.2 million births, 67 200 (1.1%) mothers were diagnosed with obesity, and 7878 (0.1%) with morbid obesity; 8798 (0.14%) children had CP. A maternal diagnosis of obesity (relative risk [RR] 1.30, 95% CI 1.09-1.55) or morbid obesity (RR 2.70, 95% CI 1.89-3.86) was associated with increased risk of CP. In multivariable analysis adjusting for maternal race, age, education, prenatal care, insurance status, and infant sex, both obesity (OR 1.27, 95% CI 1.06-1.52) and morbid obesity (OR 2.56, 95% CI 1.79-3.66) remained independently associated with CP. On stratified analyses, the association of obesity (RR 1.72, 95% CI 1.25-2.35) or morbid obesity (RR 3.79, 95% CI 2.35-6.10) with CP was only significant among women who were hospitalized prior to the birth admission. Adjusting for potential comorbidities and complications of obesity did not eliminate this association.

Conclusions

Maternal obesity may confer an increased risk of CP in some cases. Further studies are needed to confirm this finding.

Section snippets

Methods

We conducted a population-based study of all infants born in California hospitals during the 11-year period from January 1, 1991-December 31, 2001. Data were retrieved from 3 statewide sources: (1) the Office of Statewide Health Planning and Development (OSHPD) Patient Discharge Abstracts; (2) the Department of Health Services Linked Vital Statistics Birth and Infant Death file; and (3) the California Department of Developmental Services (DDS). Linkage of these 3 sources was performed using

Results

Among 6 221 001 infants born in California hospitals between 1991 and 2001, we identified 8397 cases of CP. Population prevalence of CP was 1.4 per 1000 live births. Among all mother–baby pairs in the birth population, maternal obesity was diagnosed in 67 200 (1.10%), and maternal morbid obesity was diagnosed in 7878 (0.13%). Compared with white women, black women were more likely to have a diagnosis of morbid obesity (RR 2.47, 95% CI 2.32-2.63), whereas Asian (RR 0.11, 95% CI 0.09-0.13) and

Discussion

Maternal obesity increases the risk of several maternal and obstetrical complications, including gestational diabetes, pregnancy-induced hypertension, preeclampsia,10, 11 chorioamnionitis, and cesarean delivery.22, 23 These complications can lead to prenatal hospitalizations and thus could potentially account for the increased risk of CP observed among obese mothers who were hospitalized in the prenatal period. However, adjusting for obesity-related pregnancy and obstetric complications did not

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Gestational age, birth weight, demographic factors, and maternal diagnoses are also available. The database has been used in multiple studies examining birth and neonatal outcomes.12-18 The study population consisted of live born infants from January 2005 to December 2012.
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In addition, excess weight increases obstetrical problems such as gestational diabetes, preeclampsia, complicated delivery, and cesarean section, which have also been related to an increased risk of CP (86). Three studies published in 2013—two in the United States and one in Sweden—observed a dose-response relationship between maternal obesity and the appearance of CP, with the risk tripling in the case of morbid obesity (87–89). A recent population study of 188,788 children in two Norwegian and Danish patient cohorts observed a CP incidence of 2.1 per 10,000 live births, with the risk being 60% higher in both overweight and obese women compared with lean and normal weight women.
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: Funded by the Cerebral Palsy International Research Foundation, the National Institutes of Health (R03-HD050575 and TL1 RR024129). The authors declare no conflicts of interest.

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Original ArticleMaternal Diagnosis of Obesity and Risk of Cerebral Palsy in the Child

Objective

Study design

Results

Conclusions

Section snippets

Methods

Results

Discussion

Am J Obstet Gynecol

Neurochem Int

Comput Biomed Res

Am J Obstet Gynecol

Int J Dev Neurosci

Semin Pediatr Neurol

Semin Fetal Neonatal Med

Cytokine

Placenta

Proposed definition and classification of cerebral palsy, April 2005

Dev Med Child Neurology

The epidemiology of cerebral palsy in term infants

Ment Retard Dev Disabil Res Rev

The origins of cerebral palsy—a consensus statement. The Australian and New Zealand Perinatal Societies

Med J Aust

Public health issues related to infection in pregnancy and cerebral palsy

Ment Retard Dev Disabil Res Rev

Prevalence of cerebral palsy in 8-year-old children in three areas of the United States in 2002: a multisite collaboration

Pediatrics

Rates of cerebral palsy in Victoria, Australia, 1970 to 2004: has there been a change?

Dev Med Child Neurol

Prevalence of overweight and obesity among women of childbearing age: results from the 2002 National Survey of Damily Growth

Matern Child Health J

The implications of maternal overweight and obesity on the course of pregnancy and birth outcomes

Matern Child Health J

Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis

JAMA

Original Article
Maternal Diagnosis of Obesity and Risk of Cerebral Palsy in the Child