Abstract
This case-control study investigated the association between timing and duration of breech presentation in pregnancy and developmental dysplasia of the hip (DDH). Children with DDH aged 3years or younger (n = 191) were compared with healthy controls (n = 209). Data on outcome, exposure and, covariates were collected using a parents' self-report online questionnaire. Term children with breech presentation at one or more check-ups after 30.0weeks gestation had a twofold higher risk of developing DDH compared to children who had never presented in breech (OR 2.01; 95% CI [1.28, 3.15]). The strength of the association increased with duration of breech presentation (5-8weeks: OR 2.65; 95% CI [1.36, 5.18]; 9-12weeks: OR 3.63; 95% CI [1.82, 7.24]). Children who had presented in breech at least once in gestational period 37.0-birth had a 3.24 (95% CI [1.86, 5.65]) times higher risk of DDH, whereas the risk for children with breech presentation in gestational period 30.0-36.6 only was not increased. Also after adjusting for confounders, children who had presented in breech after gestational week 37.0-birth had a more than threefold higher risk of DDH (OR 3.33; 95% CI [1.81, 6.13]) compared to children who were never in breech or in gestational period 30.0-36.6 only.
Highlights
Developmental dysplasia of the hip (DDH) comprises a spectrum of disorders of the developing infant hip including hips that are unstable at birth and dysplastic hips with or without luxation when the child grows older (Shaw et al, 2016)
Risk factors for DDH reported by two meta-analyses include female gender, positive family history of DDH, and breech presentation in pregnancy and/or at birth (De Hundt et al, 2012; Ortiz-Neira et al, 2012)
Multivariable logistic regression analysis was performed to evaluate the association between DDH and exposure variable “timing of breech presentation,” adjusted for potential confounders
Summary
Developmental dysplasia of the hip (DDH) comprises a spectrum of disorders of the developing infant hip including hips that are unstable (dislocatable or dislocated) at birth and dysplastic hips with or without (sub) luxation when the child grows older (Shaw et al, 2016). Risk factors for DDH reported by two meta-analyses include female gender, positive family history of DDH, and breech presentation in pregnancy and/or at birth (De Hundt et al, 2012; Ortiz-Neira et al, 2012). Evidence on increased risk of DDH for firstborn children (Ortiz-Neira et al, 2012) and for children with clicking hips at clinical examination (De Hundt et al, 2012) is conflicting. No significant increase of risk was found for prematurity, multiple gestation pregnancy, and mode of delivery (De Hundt et al, 2012; OrtizNeira et al, 2012)
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