Study Finds Higher Rate of Pregnancy Complications in Women with CP

Women with cerebral palsy (CP) are more likely to experience pregnancy complications, including preterm birth and the need for cesarean section, a new study suggests.

The study, “Pregnancy outcome in women with cerebral palsy: A nationwide population‐based cohort study,” was published in Acta Obstetricia et Gynecologica Scandinavica.

It is estimated that about one in nine women with CP have biological children,  but there have been relatively few studies about that low number of births, detailing pregnancy complications and higher risks that women with CP may have.

In this study, researchers analyzed data from the Swedish Medical Birth Register, which included information about 1,248,178 births (corresponding to 808,639 women without CP) that took place in Sweden from 1997 to 2011. Of these, there were 770 births in which the pregnant woman (a total of 512 women) had CP.

The researchers then used statistical models to compare the rates of various pregnancy complications in births to women with or without CP. These models took into account potentially important factors, such as the parents’ age, body mass index, smoking status in early pregnancy, parity (the number of times the person had been pregnant), and the presence of epilepsy.

Relative to those without CP, CP pregnancies were at an increased (2.82-fold) risk of preterm birth, defined as birth before 37 weeks of gestation. The risk of extreme preterm birth — prior to 28 weeks of gestation — was especially high among CP pregnancies, with a 4.65-fold relative increase in risk. This increased risk was found for both spontaneous and medically indicated preterm births.

CP pregnancies also were significantly (2.45-fold) more likely to end in planned delivery via C-section, although interestingly, the rates of emergency cesarean delivery were comparable in CP and non-CP pregnancies. There  also was a slight (1.35-fold), but significant, increase in likelihood of induced labor among CP pregnancies.

Additionally, babies born from CP pregnancies were significantly more likely (1.77-fold increase) to have a low (less than 7) Apgar score at five minutes. Apgar is a measurement of infant health outside the womb. Although not necessarily predictive, a low Apgar score (less than 7) at 5 minutes may be indicative of an increased risk of cerebral palsy or other neurological problems.

Babies born from CP pregnancies also were significantly more likely (1.65-fold increase) to be small for their gestational age (SGA). In their paper, the researchers noted that, “An increased prevalence of SGA may be related to a higher risk of pregnancy complications for reasons that are still unknown,” suggesting that future research seeking to determine why CP pregnancies are more likely to result in small babies is warranted.

CP pregnancies were not at significantly increased risk of stillbirth or of resulting in babies who were large for their gestational age.

Overall, researchers concluded that the relatively higher risk of pregnancy complications among mothers with CP suggests, “this group deserves extra surveillance during antenatal care, preferably by an obstetrician with good knowledge about CP and its comorbidities [related conditions] in cooperation with a neurologist.”

They added: “Any development of pregnancy complications, as well as physical problems like pain and skeletomuscular challenges, and psychosocial issues need to be addressed and managed accordingly.”