Case-control study of antenatal and intrapartum risk factors for cerebral palsy in very preterm singleton babies

The increase in survival of very preterm babies during the 1980s was accompanied by a sharp increase in the rate of cerebral palsy in this group. The relation between antenatal and intrapartum factors and cerebral palsy in such babies has not been well defined. To identify adverse and protective antenatal and intrapartum factors we undertook a case-control study of 59 very preterm babies who developed cerebral palsy, identified from a population-based register, and 234 randomly selected controls. The frequency of cerebral palsy decreased with increasing gestational age and birthweight. Antenatal complications occurred in 215 (73%) of the women with preterm deliveries. Factors associated with an increased risk of cerebral palsy after adjustment for gestational age were chorioamnionitis (odds ratio 4·2 [95% Cl 1·4-12·0]) prolonged rupture of membranes (2·3 [1·2-4·2]), and maternal infection (2·3 [1·2-4·5]). Pre-eclampsia was associated with a reduced risk of cerebral palsy (0·4 [0·2-0·9]), as was delivery without labour (0·3 [0·2-0·7]). There was no increased risk of cerebral palsy with intrauterine growth retardation (1·0 [0·9-1·1]). The effect of rigorous management of adverse antenatal factors on the frequency of cerebral palsy in very preterm babies should be tested in randomised controlled trials.