Are Extremely Low Gestational Age Newborns Born to Obese Women at Increased Risk of Cerebral Palsy at 2 Years?

Abstract

The authors hypothesized that the risk of cerebral palsy at 2 years in children born extremely preterm to overweight and obese women is increased relative to the risk among children born to neither overweight nor obese women. In a multicenter prospective cohort study, the authors created multinomial logistic regression models of the risk of diparetic, quadriparetic, and hemiparetic cerebral palsy that included the prepregnancy body mass index of mothers of 1014 children born extremely preterm, cerebral palsy diagnoses of children at 2 years, as well as information about potential confounders. Overweight and obese women were not at increased risk of giving birth to a child who had cerebral palsy. The risk ratios associated with overweight varied between 1.1 for quadriparesis (95% CI = 0.5, 2.1) to 2.0 for hemiparesis (95% CI = 0.4, 9.8). The risk ratios associated with obesity varied between 0.7 for diparesis (95% CI = 0.2, 2.5) to 2.5 for hemiparesis (95% CI = 0.4, 13).

Maternal Overweight, Inflammation and Neurological Consequences for the Preterm Child: Results of the ELGAN Study

“…Maternal overweight and maternal obesity grade II and grade III were associated with an increased risk of 29, 45 or even 125% 53 . In contrast to this, the data from the ELGAN study did not reveal any increased risk for CP in children born very prematurely to overweight or obese mothers in comparison to mothers with a normal weight 55 . As in the effect modification described above through spontaneous versus induced delivery, the lack of a connection in the case of extremely premature infants could be due to a greater “inflammatory background noise” as compared to infants born at term.…”

“…Mütterliches Übergewicht und mütterliche Adipositas Grad II und Grad III waren mit einem erhöhten Risiko von 29, 45 oder sogar 125% assoziiert 53 . Im Gegensatz dazu ergaben die Daten der ELGAN-Studie bei sehr frühgeborenen Kindern kein erhöhtes Risiko für eine CP bei übergewichtigen oder adipösen Müttern im Vergleich zu normalgewichtigen Müttern 55 . Wie bei der oben beschriebenen Effektmodifikation durch spontan versus induzierte Geburt könnte das Fehlen eines Zusammenhanges bei extrem Frühgeborenen durch ein höheres „inflammatorisches Hintergrundrauschen“ im Vergleich zu Termingeborenen bedingt sein.…”

Pre-pregnancy BMI-associated miRNA and mRNA expression signatures in the placenta highlight a sexually-dimorphic response to maternal underweight status

“…The ELGAN cohort was established to identify factors contributing to the risk of adverse neurocognitive outcomes among infants born extremely preterm (pregnancy ending with a live birth prior to completing 28 weeks of gestation). Study procedures were approved by the Institutional Review Board at each of the participating institutions, and methods of subject recruitment and sample collection have been described elsewhere (38)(39)(40). In short, from 2002 to 2004, women giving birth at one of the participating sites prior to completing 28 weeks of gestation were asked to enroll in the ELGAN study.…”

Placental programming, perinatal inflammation, and neurodevelopment impairment among those born extremely preterm

“…121 However, ELGAN Study children who were born to mothers with pre-pregnancy obesity were not more likely to develop cerebral palsy. 122 In studying associations between maternal obesity and offspring outcomes, a number of potential confounding factors should be considered. Obese women are more likely to experience adversities and exposures arising from low SES, and more often experience micronutrient deficiencies, emotional distress, and mental health dysfunctions.…”

“…121 However, ELGAN Study children who were born to mothers with pre-pregnancy obesity were not more likely to develop cerebral palsy. 122 …”