title: Congenital cerebral palsy and prenatal exposure to self-reported maternal infections, fever, or smoking.
abstract: OBJECTIVE
  The objective of the study was to investigate the association between maternal self-reported infections, fever, and smoking in the prenatal period and the subsequent risk for congenital cerebral palsy (CP).
  
  
  METHODS
  We included the 81,066 mothers of singletons born between 1996 and 2003 who participated in the Danish National Birth Cohort. Children were followed up through December 2008. Information on maternal infections, fever, smoking, and other demographic and lifestyle factors during pregnancy were reported by mothers in computer-assisted telephone interviews in early and midgestation. We identified 139 CP cases including 121 cases of spastic CP (sCP) as confirmed by the Danish National Cerebral Palsy Register. Cox proportional hazards regression models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs).
  
  
  RESULTS
  Self-reported vaginal infections were associated with an increased risk of CP and sCP (aHR, 1.52; 95% CI, 1.04-2.24; and aHR, 1.73; 95% CI, 1.16-2.60, respectively) and particularly untreated vaginal infections were associated with an increased risk of sCP (aHR, 1.95; 95% CI, 1.16-3.26). Fever was associated with the risk of CP (aHR, 1.53; 95% CI, 1.06-2.21). Smoking 10 or more cigarettes per day during pregnancy was also associated with sCP (aHR, 1.80; 95% CI, 1.10-2.94). There was a modest excess in risk for children exposed to both heavy smoking and vaginal infections. No other self-reported infections were significantly associated with CP.
  
  
  CONCLUSIONS
  Self-reported vaginal infections, fever, and smoking 10 or more cigarettes per day during pregnancy were associated with a higher risk of overall CP and/or sCP.
authors.affiliation: Department of Epidemiology, Fielding School of Public Health, University of California-Los Angeles, Los Angeles, CA.
authors.forename: Elani
authors.initials: E
authors.lastname: Streja
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Miller
authors.forename: Bodil H
authors.initials: BH
authors.lastname: Bech
authors.forename: Naomi
authors.initials: N
authors.lastname: Greene
authors.forename: Lars Henning
authors.initials: LH
authors.lastname: Pedersen
authors.forename: Marshalyn
authors.initials: M
authors.lastname: Yeargin-Allsopp
authors.forename: Kim
authors.initials: K
authors.lastname: Van Naarden Braun
authors.forename: Diana E
authors.initials: DE
authors.lastname: Schendel
authors.forename: Deborah
authors.initials: D
authors.lastname: Christensen
authors.forename: Peter
authors.initials: P
authors.lastname: Uldall
authors.forename: Jørn
authors.initials: J
authors.lastname: Olsen
mesh_terms: D000293:Adolescent; D000328:Adult; D002547:Cerebral Palsy / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005334:Fever / Q000453:epidemiology*; D006558:Herpes Genitalis / Q000453:epidemiology; D006560:Herpes Labialis / Q000453:epidemiology; D006801:Humans; D007223:Infant; D009128:Muscle Spasticity / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology; D016016:Proportional Hazards Models; D012907:Smoking / Q000453:epidemiology*; D014552:Urinary Tract Infections / Q000453:epidemiology; D014627:Vaginitis / Q000453:epidemiology; D055815:Young Adult
keywords: congenital cerebral palsy; maternal infections; pregnancy; smoking