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Original research
Decreasing cerebral palsy prevalence in multiple births in the modern era: a population cohort study of European data
  1. Oliver Perra1,
  2. Judith Rankin2,
  3. Mary Jane Platt3,
  4. Elodie Sellier4,5,
  5. Catherine Arnaud6,7,
  6. Javier De La Cruz8,
  7. Ingeborg Krägeloh-Mann9,
  8. David G Sweet10,
  9. Solveig Bjellmo11,12
  1. 1 School of Nursing and Midwifery, Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
  2. 2 Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
  3. 3 Norwich Medical School, University of East Anglia, Norwich, UK
  4. 4 University Grenoble Alpes, CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG, Grenoble, France
  5. 5 RHEOP, Grenoble, France
  6. 6 Public Health Department; UMR 1027 SPHERE, Universite Toulouse III Paul Sabatier, Toulouse, France
  7. 7 Clinical Epidemiology Unit, University Hospital Centre Toulouse, Toulouse, France
  8. 8 Health Research Institute, University Hospital of Madrid, Madrid, Spain
  9. 9 Department of Paediatric Neurology and Developmental Medicine, University Children's Hospital, Eberhard Karls Universität Tübingen, Tubingen, Germany
  10. 10 Regional Neonatal Unit, Royal Maternity Hospital, Belfast Health and Social Care Trust, Belfast, UK
  11. 11 Department of Obstetrics and Gynecology, Helse More og Romsdal HF, Alesund, Norway
  12. 12 NTNU, Norwegian University of Science and Technology, Trondheim, Norway
  1. Correspondence to Dr Oliver Perra, School of Nursing and Midwifery; Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast BT9 7LB, UK; o.perra{at}qub.ac.uk

Abstract

Multiple births (twins or higher order multiples) are increasing in developed countries and may present higher risk for cerebral palsy (CP). However, few studies can reliably investigate trends over time because these outcomes are relatively rare.

Objective We pooled data from European CP registers to investigate CP birth prevalence and its trends among single and multiple births born between 1990 and 2008.

Design Population cohort study.

Setting 12 population-based registers from the Surveillance of Cerebral Palsy in Europe collaboration.

Participants 4 446 125 single and multiple live births, of whom 8416 (0.19%) had CP of prenatal or perinatal origin.

Main outcomes CP diagnosis ascertained in childhood using harmonised methods; CP subtype; Motor impairment severity among CP cases.

Results The rate of multiple births increased from 1990. Multiples displayed higher risk for CP (RR=4.27, 95% CI 4.00 to 4.57). For singletons and multiples alike, risk for CP was higher among births of lower gestational age (GA) or birth weight (BW). However, CP birth prevalence declined significantly among very preterm (<32 weeks) and very low BW (<1500 g) multiples. Singletons and multiples with CP displayed similar severity of motor impairment.

Conclusions Between 1990 and 2008, CP birth prevalence decreased steadily among multiples with low GA or BW. Furthermore, multiples with CP display similar profiles of severe motor impairment compared with CP singletons. Improvements in management of preterm birth since the 1990s may also have been responsible for providing better prospects for multiples.

  • epidemiology
  • multiple births
  • neonatology
  • neurodisability
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/archdischild-2020-318950

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    Footnotes

    • Twitter @oliver_perra, @dsweetbelfast

    • Contributors OP designed and conducted the analyses reported in this study and wrote the manuscript. JR contributed significantly to the design of these analyses. JR, MJP, ES, CA, JDLC, IK-M, DGS and SB all contributed significantly to the final draft of this manuscript by discussing results and their interpretations and by revising earlier drafts.

    • Funding Data reported are collected by the Surveillance of Cerebral Palsy in Europe (SCPE) collaboration. SCPE work was supported by grants from the European Commission (SCPE-NET 2008 13 07/FIB_H120_FY2014 OG).

    • Disclaimer The European Commission had no role in study design, data collection, data analysis, data interpretation, or the writing of the report.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The SCPE network has no specific ethical approval as it only gathers anonymised data. Each register had its own ethical approval that follows the legislative rules of its country.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available. Data have been obtained under request to the Joint Research Centre of the European Commission, which manages and provides them on behalf of the Surveillance of Cerebral Palsy in Europe.