Maternal infection and cerebral palsy in term infants with periventricular leucomalacia

Abstract

WITH PERIVENTRICULAR LEUCOMALACIA BO JACOBSSON, GUDRUN HAGBERG, HENRIK HAGBERG, Perinatal Center, Goteborg, Sweden Dept. of Pediatrics, Goteborg, Sweden OBJECTIVE: Previous studies have investigated maternal infection during delivery as a possible risk factor for cerebral palsy (CP) in term infants. Infants born at term with diagnosed CP and periventricular leukomalacia (PVL) have, however, been excluded. The aim of this study was to investigate the relationship between maternal infections during pregnancy and PVL combined with CP in the offspring. STUDY DESIGN: A population-based case-control study. Term infants with CP and PVL (CP/PVL) (n = 44) born in 1983-94 were included and matched with a control group (n = 88). All records were scrutinized for any infectious disease or use of antibiotics during pregnancy. Cystic and atrophic PVL were diagnosed by a computed tomographic scan. RESULTS: Mothers with any event of infectious disease noted in their records had an increased risk of having a child with CP/PVL (19/44 cases, 21/88 controls [OR 2.42 {1.12-5.25}]), and if the mothers had suffered any event of amore serious infectious disease during pregnancy, they had an even higher risk (6/44 cases, 1/88 controls [OR 13.74 {1.60-118}]). Apgar score < 7 at 1, 5, or 10 minutes did not constitute a risk factor for CP in this particular subgroup of infants. CONCLUSION: Infection in pregnant women was significantly associated with CP/PVL in term infants, especially in those pregnancies complicated by a more severe maternal infection. In spite of a previously demonstrated close correlation between Apgar score at birth and unexplained CP in term infants, depressed viability at birth did not confer an increased risk of CP/PVL. Speculatively, maternal infection during late mid-pregnancy may inflict fetal white matter injury, but not preterm birth, resulting in PVL/CP in infants born at term without signs of intrapartal asphyxia.