By J.Ron Eaker, M.D.
Cerebral Palsy is a condition that begins with a brain insult leading to abnormal development of certain areas especially related to muscle control and movement. The damage is often permanent, so the condition is not cured in the typical sense of the word but is managed depending on the severity and nature of the symptoms.
For years, many doctors (and lawyers) thought that a major cause of cerebral palsy was a lack of oxygen during the birth process. As an obstetrician, I can tell you that this possibility kept me up at night. First and foremost was the complete determination to thwart any situation that might result in any newborn suffering any trauma during birth, and secondly knowing that if an infant was diagnosed as having cerebral palsy, a shroud of suspicion would envelop the labor attendants.
Now, however, most scientists agree that only a small minority of infants with cerebral palsy attain that condition due to a birth issue. It is widely recognized that the insult leading to cerebral palsy can occur before birth (in utero) during birth, in the early neonatal period or the first few years of life as the brain is developing.
Some estimates show up to 90% of infants with cerebral palsy having developed it during gestation. What makes this maddening for both doctors and parents is that, in many cases, one specific cause is hard to identify. Conclusive tests show if the problem arose during the pregnancy, but they say nothing about a particular cause, or even what stage in the pregnancy the issue arose. There is always frustration in the unknowns, especially in today’s world where we look to medicine for the answers, but the fact is that for most instances we can’t say definitively what causes the problem.
However, we know certain things can increase the risk for an infant developing congenital cerebral palsy. It is valuable to examine these scenarios. Honestly, it is all you can do when it comes to prevention in this instance.
Premature births, especially when accompanied by low birth weight, are associated with CP. It seems that delivery beyond 32 weeks of gestation provides a bit of protection. There are many things that premature babies struggle with related to getting the right amount of oxygen to the still-developing brain. Babies born with a birth weight of under 3 pounds 5 ounces (1500g) also seem to have a greater risk of CP. Preterm delivery and low birth weight are directly related, so sometimes there is overlap in causes, again making a specific incident difficult to distinguish.
Another related, yet separate risk factor is multiple births (twins, triplets, etc.). I suspect that this is because, very often, multiple gestations result in either low birth weight or preterm delivery
Another surprising and unsuspected risk factor is in infertility treatments. Statistically, women who undergo assisted reproductive techniques such as in-vitro fertilization or the use of fertility-enhancing drugs have an increased risk of an infant with CP compared to the general population. However, it is imperative to keep these statistics in context. The actual incidence of CP in women undergoing advanced infertility treatment is very low. According to the National Institute of Health, CP occurs in about 3 of every 1000 births in women treated with in-vitro fertilization.
An area gaining more attention now is infections during pregnancy. It has been long known that viruses and pathogens that cross the placenta can set up an infection in the baby potentially leading to CP. Common examples are chickenpox, rubella (German measles), and cytomegalovirus (CMV).
Certain maternal medical problems are also associated with CP. These include thyroid problems, seizures disorders and intellectual disabilities. Please remember this is largely applicable to people whose thyroid condition is out of control or undetected. Women whose thyroid problems are properly balanced are at no greater risk.
It should be apparent from the risk factors that the best prevention tool for women who are contemplating pregnancy or who are already pregnant is to be in the best health possible. It should also be apparent that most causes of CP are not preventable, and feelings of guilt or shame are never warranted.
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