title: Disproportionate fetal growth and the risk for congenital cerebral palsy in singleton births.
abstract: OBJECTIVE
  To investigate the association between proportionality of fetal and placental growth measured at birth and the risk for congenital cerebral palsy (CP).
  
  
  METHODS
  We identified all live-born singletons born in Denmark between 1995 and 2003 and followed them from 1 year of age until December 31st, 2008. Information on four indices of fetal growth: ponderal index, head circumference/ abdominal circumference ratio, cephalization index and birth weight/ placenta weight ratio was collected. Cox proportional hazards regression models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI). All measurements were evaluated as gestational age and sex specific z-scores and in z-score percentile groups, adjusted for potential confounders, and stratified on gestational age groups (<32, 32-36, 37-38, 39, 40, ≥ 41 weeks).
  
  
  RESULTS
  We identified 503,784 singleton births, of which 983 were confirmed cases of CP. Head/ abdominal circumference ratio (aHR:1.12; 95%CI:1.07-1.16) and cephalization index (aHR:1.14; 95%CI:1.11-1.16) were associated with the risk of CP irrespective of gestational age. Birth weight-placental weight ratio was also associated with CP in the entire cohort (aHR:0.90; 95%CI:0.83-0.97). Ponderal index had a u-shaped association with CP, where both children with low and high ponderal index were at higher risk of CP.
  
  
  CONCLUSIONS
  CP is associated with disproportions between birth weight, birth length, placental weight and head circumference suggesting pre and perinatal conditions contribute to fetal growth restriction in children with CP.
authors.affiliation: Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America.
authors.forename: Elani
authors.initials: E
authors.lastname: Streja
authors.affiliation: Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Miller
authors.affiliation: Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Chunsen
authors.initials: C
authors.lastname: Wu
authors.affiliation: Section of Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Bodil H
authors.initials: BH
authors.lastname: Bech
authors.affiliation: Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Section of Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Lars Henning
authors.initials: LH
authors.lastname: Pedersen
authors.affiliation: Section of Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark; National Centre for Register-based Research, Department of Economics and Business, Aarhus University, Aarhus, Denmark; Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.
authors.forename: Diana E
authors.initials: DE
authors.lastname: Schendel
authors.affiliation: The Danish Cerebral Palsy Registry, National Institute of Public Health, Southern University, Copenhagen, Denmark; Pediatric Department, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Uldall
authors.affiliation: Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America; Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Section of Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Jørn
authors.initials: J
authors.lastname: Olsen
mesh_terms: D000328:Adult; D001724:Birth Weight; D002547:Cerebral Palsy / Q000151:congenital* / Q000453:epidemiology* / Q000473:pathology; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D047109:Fetal Development / Q000502:physiology*; D005500:Follow-Up Studies; D005865:Gestational Age; D006257:Head / Q000033:anatomy & histology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010920:Placenta / Q000033:anatomy & histology / Q000502:physiology; D011247:Pregnancy; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking; D055815:Young Adult