Antenatal causes of cerebral palsy: associations between inherited thrombophilias, viral and bacterial infection, and inherited susceptibility to infection.
Cerebral palsy rates of 2 in every 1,000 births have varied little over the last 40 years, despite improvements in obstetric care. In the past, cerebral palsy was thought to be due to poor obstetric care and management; however, epidemiological studies have refuted this, suggesting that there is usually an antenatal timing to the neuropathology of cerebral palsy. There are many known risk factors for cerebral palsy, including multiple gestation, prematurity, and low birth weight. Recently, intrauterine infection, maternal pyrexia, and the presence of thrombophilic disorders (thrombophilia) have been identified as major risk factors for subsequent cerebral palsy. This review examines the links between intrauterine infection, the fetal inflammatory response, and thrombophilia as possible causes of cerebral palsy. The interactions of viral or bacterial infections during pregnancy, normal or abnormal fetal cytokine responses, and hereditary fetal thrombophilias as antenatal causes of the neuropathology of cerebral palsy are now areas of research priority.


BACKGROUND
Obstetricians & Gynecologists, Family Physicians


OBJECTIVE
After completion of this article, the reader will be able to describe the condition cerebral palsy, list the risk factors for the development of cerebral palsy, outline the ultrasound findings associated with cerebral palsy, and point out other conditions associated with cerebral palsy.
Gibson
Catherine S
CS
Department of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, South Australia. gibson@mail.wch.sa.gov,au
MacLennan
Alastair H
AH
Goldwater
Paul N
PN
Dekker
Gustaaf A
GA
D002547:Cerebral Palsy / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics; D002821:Chorioamnionitis / Q000150:complications; D016207:Cytokines / Q000009:adverse effects; D005260:Female; D005315:Fetal Diseases; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007969:Leukomalacia, Periventricular / Q000209:etiology / Q000503:physiopathology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D012307:Risk Factors; D019851:Thrombophilia / Q000150:complications / Q000235:genetics; D014409:Tumor Necrosis Factor-alpha / Q000009:adverse effects
D016207:Cytokines; D014409:Tumor Necrosis Factor-alpha