Congenital cerebral palsy and prenatal exposure to self-reported maternal infections, fever, or smoking

Am J Obstet Gynecol. 2013 Oct;209(4):332.e1-332.e10. doi: 10.1016/j.ajog.2013.06.023. Epub 2013 Jun 18.


Objective: The objective of the study was to investigate the association between maternal self-reported infections, fever, and smoking in the prenatal period and the subsequent risk for congenital cerebral palsy (CP).

Study design: We included the 81,066 mothers of singletons born between 1996 and 2003 who participated in the Danish National Birth Cohort. Children were followed up through December 2008. Information on maternal infections, fever, smoking, and other demographic and lifestyle factors during pregnancy were reported by mothers in computer-assisted telephone interviews in early and midgestation. We identified 139 CP cases including 121 cases of spastic CP (sCP) as confirmed by the Danish National Cerebral Palsy Register. Cox proportional hazards regression models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs).

Results: Self-reported vaginal infections were associated with an increased risk of CP and sCP (aHR, 1.52; 95% CI, 1.04-2.24; and aHR, 1.73; 95% CI, 1.16-2.60, respectively) and particularly untreated vaginal infections were associated with an increased risk of sCP (aHR, 1.95; 95% CI, 1.16-3.26). Fever was associated with the risk of CP (aHR, 1.53; 95% CI, 1.06-2.21). Smoking 10 or more cigarettes per day during pregnancy was also associated with sCP (aHR, 1.80; 95% CI, 1.10-2.94). There was a modest excess in risk for children exposed to both heavy smoking and vaginal infections. No other self-reported infections were significantly associated with CP.

Conclusion: Self-reported vaginal infections, fever, and smoking 10 or more cigarettes per day during pregnancy were associated with a higher risk of overall CP and/or sCP.

Keywords: congenital cerebral palsy; maternal infections; pregnancy; smoking.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Cerebral Palsy / epidemiology*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Denmark / epidemiology
  • Female
  • Fever / epidemiology*
  • Herpes Genitalis / epidemiology
  • Herpes Labialis / epidemiology
  • Humans
  • Infant
  • Muscle Spasticity / epidemiology
  • Pregnancy
  • Pregnancy Complications, Infectious / epidemiology*
  • Prenatal Exposure Delayed Effects / epidemiology
  • Proportional Hazards Models
  • Smoking / epidemiology*
  • Urinary Tract Infections / epidemiology
  • Vaginitis / epidemiology
  • Young Adult