title: Cerebral palsy and perinatal mortality after pregnancy-induced hypertension across the gestational age spectrum: observations of a reconstructed total population cohort.
abstract: OBJECTIVE
  Pregnancy-induced hypertension/pre-eclampsia (PIH/PE) is associated with cerebral palsy (CP) in term births but if sufficiently severe to necessitate preterm delivery predicts a lower risk of CP than observed in gestational peers. We investigated whether this apparent 'protection' was attributable to inappropriately chosen comparison groups and/or an increased risk of perinatal death.
  
  
  METHODS
  Perinatal information was collected from medical records of children with CP, individually matched neonatal survivors without CP, and representative samples of perinatal deaths of Western Australian birth cohorts from 1980 to 1995. Compared with these data, the sensitivity of statutorily collected PIH/PE data was assessed for each outcome group. Using these sensitivities, the estimated risks of death and CP in births to all women with and without PIH/PE were compared.
  
  
  RESULTS
  Sensitivity of statutory PIH/PE data decreased with increasingly poor outcome. Reconstructed cohorts showed that PIH/PE increased the risks both of CP and of perinatal death in births at lower gestations except in births <27 weeks, where the risk of perinatal death only increased greatly.
  
  
  CONCLUSIONS
  PIH/PE does not protect against poor outcome at any gestational age. Previously reported protective effects originate from inappropriate control for gestational age and not from higher gestation-specific perinatal mortality.
authors.affiliation: Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.
authors.forename: Eve
authors.initials: E
authors.lastname: Blair
authors.affiliation: Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.|Department of Health Western Australia, Perth, WA, Australia.
authors.forename: Linda
authors.initials: L
authors.lastname: Watson
mesh_terms: D001315:Australia; D002547:Cerebral Palsy / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005865:Gestational Age; D006801:Humans; D046110:Hypertension, Pregnancy-Induced; D007231:Infant, Newborn; D008297:Male; D054238:Perinatal Mortality; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology*; D012307:Risk Factors