Severe maternal morbidity linked to cerebral palsy risk in offspring

Exposure to severe maternal morbidity appears to put babies at risk of cerebral palsy, according to a study.

The study included 2,136,816 live births (mean gestational age 38.9 weeks, 51.3 percent male) between 2003 and 2019 and followed up through 2020 under a single-payer healthcare system. Severe maternal morbidity was determined from inpatient or emergency department diagnoses during the index pregnancy or postpartum (20 weeks of gestation to 42 days postpartum).

Severe maternal morbidity was categorized into the following: severe hypertensive disorders of pregnancy (severe pre-eclampsia, haemolysis, elevated liver enzymes, low platelets syndrome, and eclampsia combined), severe haemorrhage (eg, antepartum or postpartum haemorrhage with coagulation defect, red cell transfusion, procedures to the uterus, or hysterectomy), sepsis (puerperal sepsis or septicaemia during labour), and other severe maternal morbidities (eg, admission to intensive care, shock).

Cerebral palsy in offspring was defined as a single inpatient or 2 or more outpatient diagnoses at least 2 weeks apart between birth and the end of follow-up (age 1–17 years).

Of the children, 41,396 (2 percent) were exposed to severe maternal morbidity. Over a median follow-up of 9.5 years, cerebral palsy was diagnosed in 5,352 children (0.3 percent), of which 272 cases (0.7 percent) were exposed to severe maternal morbidity. The average annual cerebral palsy incidence rate was 7.5 per 10,000 child-years among children exposed to severe maternal morbidity vs 2.5 per 10,000 among those unexposed.

Children of mothers with vs without severe maternal morbidity were at heightened risk of cerebral palsy (rate ratio, 2.71, 95 percent confidence interval [CI], 2.39–3.06). All severe maternal morbidity subtypes considered were associated with increased risks of cerebral palsy, with the most pronounced association seen for severe hypertension disorders (adjusted rate ratio, 3.29, 95 percent CI, 2.44–4.33).

These findings underscore the importance of optimizing maternal health to mitigate the potential long-term adverse consequences of severe maternal morbidity in offspring. Children exposed to severe or life-threatening events during the perinatal period may benefit from enhanced surveillance for early cerebral palsy symptoms.