Perinatal & Pediatric
Association between severe maternal morbidity and cerebral palsy in children: A population-based birth cohort study Asma M. Ahmed* Asma Ahmed Bénédicte Driollet Emmalin Buajitti Jennifer A. Hutcheon Laura Rosella Seungmi Yang
Background
Severe maternal morbidity (SMM) has been linked to perinatal complications, but the evidence on associations with children’s neurodevelopmental disorders is unclear. We assessed associations between SMM and cerebral palsy (CP) in children.
Methods
A longitudinal cohort study of all live births in Ontario, Canada, between 2003 and 2019 followed up through 2020. SMM was identified from inpatient or emergency department diagnoses during the index pregnancy or postpartum (20 weeks gestation to 42 days postpartum) based on validated algorithms, and CP was defined as a single inpatient or 2 or more outpatient diagnoses at least two weeks apart between birth and the end of follow-up (age 1-17 years). We estimated crude and adjusted associations using Poisson regression models.
Results
Of 2,136,816 children included, 41,396 (2%) were exposed to SMM. In a median follow-up period of 9.5 years (IQR 5.2-13.7), 5,352 children were diagnosed with CP ((272 CP cases (0.7%) exposed to SMM). The average annual CP incidence was 7.5 per 10,000 child-years in those exposed to SMM and 2.5 per 10,000 in the unexposed. Children of mothers with SMM had an increased risk of CP (RR: 2.71 (95% CI: (2.39-3.06), adjusted for maternal sociodemographic and clinical factors). All SMM subtypes were associated with increased risks of CP, with the strongest associations observed for severe pre-eclampsia, HELLP syndrome, and eclampsia (RR: 3.29 (2.44-4.33), followed by other SMM subtypes (RR: 2.81 (2.30-3.39)) (Figure).
Conclusion
In this population-based study of over 2 million births, severe maternal morbidity was associated with increased risk of cerebral palsy. This risk was observed across major severe morbidity subtypes, including hypertensive disorders, hemorrhage, and sepsis. These findings highlight the potential benefits of optimizing maternal health and may support the need for early monitoring of children exposed to these adverse maternal events to detect early signs of cerebral palsy.
