Abstract

BackgroundCerebral palsy is the most frequent motor disability in childhood, but little is known about its etiology. It has been suggested that cerebral palsy risk may be increased by prenatal thyroid hormone disturbances. The objective of this study was to investigate whether maternal thyroid disorder is associated with increased risk of cerebral palsy.MethodsA population-based cohort study using two study populations. 1) 1,270,079 children born in Denmark 1979–2007 identified in nationwide registers, and 2) 192,918 children born 1996–2009 recruited into the Danish National Birth Cohort and The Norwegian Mother and Child Cohort study, combined in the MOthers and BAbies in Norway and Denmark (MOBAND) collaboration cohort. Register-based and self-reported information on maternal thyroid disorder was studied in relation to risk of cerebral palsy and its unilateral and bilateral spastic subtypes using multiple logistic regression. Children were followed from the age of 1 year to the age of 6 years, and cerebral palsy was identified in nationwide registers with verified diagnoses.ResultsIn register data, hypothyroidism was recognized in 12,929 (1.0%), hyperthyroidism in 9943 (0.8%), and unclassifiable thyroid disorder in 753 (< 0.1%) of the mothers. The odds ratio for an association between maternal thyroid disorder and bilateral spastic cerebral palsy was 1.0 (95% CI: 0.7–1.5). Maternal thyroid disorder identified during pregnancy was associated with elevated risk of unilateral spastic cerebral palsy (odds ratio 3.1 (95% CI: 1.2–8.4)). In MOBAND, 3042 (1.6%) of the mothers reported a thyroid disorder in pregnancy, which was not associated with cerebral palsy overall (odds ratio 1.2 (95% CI: 0.6–2.4)).ConclusionsMaternal thyroid disorder overall was not related to bilateral spastic cerebral palsy, but maternal thyroid disorder identified in pregnancy was associated with increased risk of unilateral spastic cerebral palsy. These findings should be replicated in studies making use of maternal blood samples.

Highlights

  • Cerebral palsy is the most frequent motor disability in childhood, but little is known about its etiology

  • Thyroid hormone is required for many aspects of brain development, including myelination of nerve cells, and insufficient myelination is often present in individuals with Cerebral palsy (CP) [8, 15]

  • Thyroid diseases are difficult to stabilize with treatment, especially in pregnancy [18], and it is not unusual for overtreatment to lead women diagnosed with hypothyroidism to have elevated thyroid hormone levels and women with hyperthyroidism to have reduced thyroid hormone levels

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Summary

Introduction

Cerebral palsy is the most frequent motor disability in childhood, but little is known about its etiology. It has been suggested that cerebral palsy risk may be increased by prenatal thyroid hormone disturbances. The objective of this study was to investigate whether maternal thyroid disorder is associated with increased risk of cerebral palsy. Endogenous fetal thyroid hormone production begins around 10-18th week of gestation. The fetus, depends on maternal thyroid hormone entirely in early pregnancy, and from mid-gestation fetal thyroid hormone. We aimed to investigate the association between maternal thyroid disorder in pregnancy and risk of cerebral palsy in the child in two study populations in Denmark and Norway, each one with a distinct research advantage. One study population permitted examination of different thyroid disorder and CP subtypes in a very large study sample, while the other provided opportunities for performing analyses that controlled for lifestyle factors

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