title: Maternal infections during pregnancy and cerebral palsy: a population-based cohort study.
abstract: BACKGROUND
  Cerebral palsy (CP) is a common motor disability in childhood. We examined the association between maternal infections during pregnancy and the risk of congenital CP in the child.
  
  
  METHODS
  Liveborn singletons in Denmark between 1997 and 2003 were identified from the Danish National Birth Registry and followed from 1 year of life until 2008. Redemption of antibiotics from the National Register of Medicinal Product Statistics and maternal infections reported by the National Hospital Register were used as markers of maternal infection during pregnancy. CP diagnoses were obtained from the Danish Cerebral Palsy Registry. Adjusted hazard ratio (HR) and 95% confidence interval (CI) were estimated by Cox proportional hazard models.
  
  
  RESULTS
  Of the 440 564 singletons with follow-up data, 840 were diagnosed with congenital CP. Maternal genito-urinary tract infections (HR 2.1, 95% CI 1.4, 3.2) were associated with CP in all births, in term births (HR 1.9, 95% CI 1.1, 3.2), in children with spastic CP (HR 2.1, 95% CI 1.4, 3.3), and among first-born children (HR 1.9, 95% CI 1.4, 3.3). Overall, we found associations between redeemed nitrofurantoin (HR 1.7, 95% CI 1.1, 2.8) and CP. Among trimester-specific exposures, CP risk was associated with prescriptions redeemed in the first trimester for any antibacterials, beta-lactam antibacterials, and nitrofurantoin, an antibiotic commonly used to treat lower urinary tract infection, and genito-urinary tract infections in the third trimester.
  
  
  CONCLUSIONS
  Genito-urinary tract infections and antibiotic use during pregnancy were associated with increased risks of CP, indicating that some maternal infections or causes of maternal infections present in prenatal life may be part of a causal pathway leading to CP.
authors.affiliation: Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Miller
authors.forename: Lars Henning
authors.initials: LH
authors.lastname: Pedersen
authors.forename: Elani
authors.initials: E
authors.lastname: Streja
authors.forename: Bodil H
authors.initials: BH
authors.lastname: Bech
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: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002547:Cerebral Palsy / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D018811:Maternal Exposure / Q000009:adverse effects; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000209:etiology; D012042:Registries; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: bacterial infections; congenital cerebral palsy; maternal infections; pregnancy