Pregnancy outcomes among individuals with cerebral palsy: a population-based cohort study

Objective — To examine the risks of maternal, neonatal and non-obstetrical medical complications in individuals with cerebral palsy (CP) compared to those without CP.

Design — Population-based cohort study.

Setting — Ontario, Canada.

Population — Females aged 13–54 years with a livebirth or stillbirth, 2004–2023.

Methods — Individuals with (N = 1400) and without CP (N = 2 276 561) were compared using modified Poisson regression, adjusted for socio-demographics, followed by clinical characteristics.

Main outcome measures — Maternal (e.g., severe maternal morbidity or mortality), neonatal (e.g., severe neonatal morbidity or mortality) and non-obstetrical medical complications (e.g., seizure disorders) in the perinatal period.

Results — After adjusting for socio-demographics, individuals with CP had an elevated risk, compared to those without CP, of severe maternal morbidity or mortality (adjusted relative risk [aRR] 1.79, 95% confidence interval [CI] 1.36–2.34), caesarean section (1.38, 1.27–1.50) and maternal hospital readmission (1.86; 1.34–2.58). Their newborns were at elevated risk for preterm birth (1.67, 1.43–1.94), small for gestational age (1.34, 1.19–1.52), congenital anomalies (1.77, 1.40–2.24) and severe neonatal morbidity or mortality (1.48, 1.28–1.71). Individuals with CP were also at elevated risk of seizure disorders (13.06, 10.45–16.33) and urinary tract infections (1.50, 1.25–1.79) perinatally. aRRs were slightly attenuated, but remained statistically significant after further adjusting for clinical characteristics.

Conclusion — Individuals with CP are at elevated risk of adverse pregnancy outcomes. Findings suggest the need for enhanced preconception counselling, perinatal monitoring and postpartum supports for individuals with CP, facilitated by multidisciplinary care teams.