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Judith K. Grether, PhD; Karin B. Nelson, MD

JAMA. 1997;278(3):207-211.

Abstract
Context.
—Exposure to maternal or placental infection is related to risk of preterm birth and, in premature infants, of brain lesions predictive of cerebral palsy (CP). Few studies have investigated whether maternal infection is associated with risk of CP in children of normal birth weight.

Objective.
—To investigate maternal infection during the admission for delivery as a possible risk factor for CP in infants born weighing 2500 g or more.

Design.
—Population-based case-control study.

Setting.
—All hospitals in 4 northern California counties, 1983 through 1985.

Participants.
—A total of 46 children with disabling spastic CP who had no recognized prenatal brain lesions and 378 randomly selected control children weighing 2500 g or more at birth and surviving to age 3 years.

Main Outcome Measures.
—Disabling spastic CP and signs of neonatal morbidity.

Results.
—Maternal fever exceeding 38°C in labor was associated with increased risk of unexplained CP (odds ratio [OR], 9.3; 95% confidence interval [CI], 2.7-31.0), as was a clinical diagnosis of chorioamnionitis. One or more indicators of maternal infection were present in 2.9% of control children, 22% of children with CP (OR, 9.3; 95% CI, 3.7-23.0), and 37% of those with the spastic quadriplegic subtype of CP (OR, 19.0; 95% CI, 6.5-56.0). Newborns exposed to maternal infection, both cases and controls, had 5-minute Apgar scores below 6 more often than those unexposed. Among children with CP, those born to infected women were more often hypotensive, needed intubation, had neonatal seizures, and received a clinical diagnosis of hypoxic-ischemic encephalopathy.

Conclusion.
—Intrauterine exposure to maternal infection was associated with a marked increase in risk of CP in infants of normal birth weight. Maternal infection was also linked with low Apgar scores, other evidence of hypertension and need for resuscitation, and neonatal seizures—signs commonly attributed to birth asphyxia.

Author Affiliations
From the California Birth Defects Monitoring Program, California Department of Health Services, Emeryville (Dr Grether), and the Neuroepidemiology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Md (Dr Nelson).

Footnotes
Reprints: Judith K. Grether, PhD, California Birth Defects Monitoring Program, 1900 Powell St, Suite 1050, Emeryville. CA 94608-1811.

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