Cerebral palsy in twins and higher multiple births: a Europe‐Australia population‐based study

The Surveillance Of Cerebral Palsy Europe Group And The Australian Cerebral Palsy Register Group

doi:10.1111/dmcn.14827

Cerebral palsy in twins and higher multiple births: a Europe‐Australia population‐based study

The Surveillance Of Cerebral Palsy Europe Group And The Australian Cerebral Palsy Register Group

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16 Citations (Scopus)

223 Downloads (Pure)

Abstract

Aim:

To describe the birth prevalence, temporal trends, and clinical outcomes of twins, triplets, or quadruplets with cerebral palsy (CP).

Method:

This was a cross-sectional study using data for twins, triplets, and quadruplets with prenatally or perinatally acquired CP and pooled from the Surveillance of Cerebral Palsy in Europe network (born 1992–2009) and Australian Cerebral Palsy Register (born 1993–2009). Children were at least 4 years old at time of registration. Children born in regions with population ascertainment and available denominator data were included in prevalence calculations (n=1033 twins, 81 triplets, and 11 quadruplets). Clinical data from children registered in all participating registers were described, including 2163 twins (56% male), 187 triplets (59% male), and 20 quadruplets (45% male).

Results:

The birth prevalence of CP was higher with increasing plurality (twins 6.5 per 1000 live births [95% confidence interval {CI} 6.1–6.9], triplets 17.1 [95% CI 13.6–21.2], quadruplets 50.7 [95% CI 25.6–88.9]); however, prevalence by gestational age was similar across all pluralities. Between 1992–1994 and 2007–2009, prevalence of CP among twins declined (p=0.001) but prevalence of CP among triplets did not change significantly over time (p=0.55). The distributions of Gross Motor Function Classification System, epilepsy, and impairments of intellect, vision, and hearing were similar regardless of plurality.

Interpretation:

The data combined from two CP register networks indicated that triplets and quadruplets had increased risk of CP compared to twins. The higher prevalence of CP in triplets and quadruplets is due to their higher risk of preterm birth. Prevalence of CP among twins significantly declined in Europe and Australia. Clinical outcomes were similar for all multiple births.

Original language	English
Pages (from-to)	712-720
Journal	Developmental Medicine and Child Neurology
Volume	63
Issue number	6
Early online date	02 Feb 2021
DOIs	https://doi.org/10.1111/dmcn.14827
Publication status	Published - 01 Jun 2021

Bibliographical note

Funding Information:
The ACPR and the New South Wales/Australian Capital Territory CP registers are funded by the Cerebral Palsy Alliance Research Foundation. The Victorian Cerebral Palsy Register receives funding from the Victorian Department of Health and Human Services and the Royal Children’s Hospital Foundation. The Western Australian Register of Developmental Anomalies‐Cerebral Palsy is funded as a statutory data collection of the Department of Health, Western Australia. SG, SM, HSS, and NB received salary support from the Cerebral Palsy Alliance Research Foundation. HSS received salary support through a National Health and Medical Research Council of Australia Early Career Fellowship (no. 1144566) and Australasian Cerebral Palsy Clinical Trials Network. SM received salary support through a National Health and Medical Research Council of Australia Early Career Fellowship (no. 1111270).

Publisher Copyright:
© 2021 Mac Keith Press

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Developmental Neuroscience
Clinical Neurology

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Cerebral palsy in twins and higher multiple births: a Europe‐Australia population‐based study
Copyright 2021 Mac Keith Press. This work is made available online in accordance with the publisher’s policies. Please refer to any applicable terms of use of the publisher.
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Cite this

@article{bb230b0ff6ed4dadb7ae35e414df0270,

title = "Cerebral palsy in twins and higher multiple births: a Europe‐Australia population‐based study",

abstract = "Aim:To describe the birth prevalence, temporal trends, and clinical outcomes of twins, triplets, or quadruplets with cerebral palsy (CP).Method:This was a cross-sectional study using data for twins, triplets, and quadruplets with prenatally or perinatally acquired CP and pooled from the Surveillance of Cerebral Palsy in Europe network (born 1992–2009) and Australian Cerebral Palsy Register (born 1993–2009). Children were at least 4 years old at time of registration. Children born in regions with population ascertainment and available denominator data were included in prevalence calculations (n=1033 twins, 81 triplets, and 11 quadruplets). Clinical data from children registered in all participating registers were described, including 2163 twins (56% male), 187 triplets (59% male), and 20 quadruplets (45% male).Results:The birth prevalence of CP was higher with increasing plurality (twins 6.5 per 1000 live births [95% confidence interval {CI} 6.1–6.9], triplets 17.1 [95% CI 13.6–21.2], quadruplets 50.7 [95% CI 25.6–88.9]); however, prevalence by gestational age was similar across all pluralities. Between 1992–1994 and 2007–2009, prevalence of CP among twins declined (p=0.001) but prevalence of CP among triplets did not change significantly over time (p=0.55). The distributions of Gross Motor Function Classification System, epilepsy, and impairments of intellect, vision, and hearing were similar regardless of plurality.Interpretation:The data combined from two CP register networks indicated that triplets and quadruplets had increased risk of CP compared to twins. The higher prevalence of CP in triplets and quadruplets is due to their higher risk of preterm birth. Prevalence of CP among twins significantly declined in Europe and Australia. Clinical outcomes were similar for all multiple births.",

author = "Elodie Sellier and Shona Goldsmith and Sarah McIntyre and Oliver Perra and Gija Rackauskaite and Nadia Badawi and Asma Fares and Hayley Smithers-Sheedy and A. Ego and C. Tronc and C. Arnaud and M. Delobel and {Mc Manus}, V. and A. Lyons and Oliver Perra and K. McConnel and K. Himmelmann and M. Pahlman and O. Hensey and V. Dowding and J. Kurinczuk and G. Rackauskaite and B. Laursen and Torrioli, {M. G.} and M. Marcelli and Andersen, {G. L.} and {Julsen Hollung}, S. and M. Bottos and G. Gaffney and {de la Cruz}, J. and C. Pallas and D. Neubauer and A. Radsel and D. Virella and T. Folha and A. Greitane and K. Hollody and G. Csabi and I. Dakovic and S. Sigur{\dh}ard{\'o}ttir and I. Einarsson and E. Haberlandt and E. Ortibus and I. Franki and V. Mejaski-Bosnjak and C. Gibson and N. Gibson and T. Martin and S. Reid and L. Watson and {The Surveillance Of Cerebral Palsy Europe Group And The Australian Cerebral Palsy Register Group}",

note = "Funding Information: The ACPR and the New South Wales/Australian Capital Territory CP registers are funded by the Cerebral Palsy Alliance Research Foundation. The Victorian Cerebral Palsy Register receives funding from the Victorian Department of Health and Human Services and the Royal Children{\textquoteright}s Hospital Foundation. The Western Australian Register of Developmental Anomalies‐Cerebral Palsy is funded as a statutory data collection of the Department of Health, Western Australia. SG, SM, HSS, and NB received salary support from the Cerebral Palsy Alliance Research Foundation. HSS received salary support through a National Health and Medical Research Council of Australia Early Career Fellowship (no. 1144566) and Australasian Cerebral Palsy Clinical Trials Network. SM received salary support through a National Health and Medical Research Council of Australia Early Career Fellowship (no. 1111270). Publisher Copyright: {\textcopyright} 2021 Mac Keith Press Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = jun,

day = "1",

doi = "10.1111/dmcn.14827",

language = "English",

volume = "63",

pages = "712--720",

journal = "Developmental Medicine and Child Neurology",

issn = "0012-1622",

publisher = "Wiley-Blackwell",

number = "6",

}

TY - JOUR

T1 - Cerebral palsy in twins and higher multiple births: a Europe‐Australia population‐based study

AU - Sellier, Elodie

AU - Goldsmith, Shona

AU - McIntyre, Sarah

AU - Perra, Oliver

AU - Rackauskaite, Gija

AU - Badawi, Nadia

AU - Fares, Asma

AU - Smithers-Sheedy, Hayley

AU - Ego, A.

AU - Tronc, C.

AU - Arnaud, C.

AU - Delobel, M.

AU - Mc Manus, V.

AU - Lyons, A.

AU - Perra, Oliver

AU - McConnel, K.

AU - Himmelmann, K.

AU - Pahlman, M.

AU - Hensey, O.

AU - Dowding, V.

AU - Kurinczuk, J.

AU - Rackauskaite, G.

AU - Laursen, B.

AU - Torrioli, M. G.

AU - Marcelli, M.

AU - Andersen, G. L.

AU - Julsen Hollung, S.

AU - Bottos, M.

AU - Gaffney, G.

AU - de la Cruz, J.

AU - Pallas, C.

AU - Neubauer, D.

AU - Radsel, A.

AU - Virella, D.

AU - Folha, T.

AU - Greitane, A.

AU - Hollody, K.

AU - Csabi, G.

AU - Dakovic, I.

AU - Sigurðardóttir, S.

AU - Einarsson, I.

AU - Haberlandt, E.

AU - Ortibus, E.

AU - Franki, I.

AU - Mejaski-Bosnjak, V.

AU - Gibson, C.

AU - Gibson, N.

AU - Martin, T.

AU - Reid, S.

AU - Watson, L.

AU - The Surveillance Of Cerebral Palsy Europe Group And The Australian Cerebral Palsy Register Group

N1 - Funding Information: The ACPR and the New South Wales/Australian Capital Territory CP registers are funded by the Cerebral Palsy Alliance Research Foundation. The Victorian Cerebral Palsy Register receives funding from the Victorian Department of Health and Human Services and the Royal Children’s Hospital Foundation. The Western Australian Register of Developmental Anomalies‐Cerebral Palsy is funded as a statutory data collection of the Department of Health, Western Australia. SG, SM, HSS, and NB received salary support from the Cerebral Palsy Alliance Research Foundation. HSS received salary support through a National Health and Medical Research Council of Australia Early Career Fellowship (no. 1144566) and Australasian Cerebral Palsy Clinical Trials Network. SM received salary support through a National Health and Medical Research Council of Australia Early Career Fellowship (no. 1111270). Publisher Copyright: © 2021 Mac Keith Press Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/6/1

Y1 - 2021/6/1

N2 - Aim:To describe the birth prevalence, temporal trends, and clinical outcomes of twins, triplets, or quadruplets with cerebral palsy (CP).Method:This was a cross-sectional study using data for twins, triplets, and quadruplets with prenatally or perinatally acquired CP and pooled from the Surveillance of Cerebral Palsy in Europe network (born 1992–2009) and Australian Cerebral Palsy Register (born 1993–2009). Children were at least 4 years old at time of registration. Children born in regions with population ascertainment and available denominator data were included in prevalence calculations (n=1033 twins, 81 triplets, and 11 quadruplets). Clinical data from children registered in all participating registers were described, including 2163 twins (56% male), 187 triplets (59% male), and 20 quadruplets (45% male).Results:The birth prevalence of CP was higher with increasing plurality (twins 6.5 per 1000 live births [95% confidence interval {CI} 6.1–6.9], triplets 17.1 [95% CI 13.6–21.2], quadruplets 50.7 [95% CI 25.6–88.9]); however, prevalence by gestational age was similar across all pluralities. Between 1992–1994 and 2007–2009, prevalence of CP among twins declined (p=0.001) but prevalence of CP among triplets did not change significantly over time (p=0.55). The distributions of Gross Motor Function Classification System, epilepsy, and impairments of intellect, vision, and hearing were similar regardless of plurality.Interpretation:The data combined from two CP register networks indicated that triplets and quadruplets had increased risk of CP compared to twins. The higher prevalence of CP in triplets and quadruplets is due to their higher risk of preterm birth. Prevalence of CP among twins significantly declined in Europe and Australia. Clinical outcomes were similar for all multiple births.

AB - Aim:To describe the birth prevalence, temporal trends, and clinical outcomes of twins, triplets, or quadruplets with cerebral palsy (CP).Method:This was a cross-sectional study using data for twins, triplets, and quadruplets with prenatally or perinatally acquired CP and pooled from the Surveillance of Cerebral Palsy in Europe network (born 1992–2009) and Australian Cerebral Palsy Register (born 1993–2009). Children were at least 4 years old at time of registration. Children born in regions with population ascertainment and available denominator data were included in prevalence calculations (n=1033 twins, 81 triplets, and 11 quadruplets). Clinical data from children registered in all participating registers were described, including 2163 twins (56% male), 187 triplets (59% male), and 20 quadruplets (45% male).Results:The birth prevalence of CP was higher with increasing plurality (twins 6.5 per 1000 live births [95% confidence interval {CI} 6.1–6.9], triplets 17.1 [95% CI 13.6–21.2], quadruplets 50.7 [95% CI 25.6–88.9]); however, prevalence by gestational age was similar across all pluralities. Between 1992–1994 and 2007–2009, prevalence of CP among twins declined (p=0.001) but prevalence of CP among triplets did not change significantly over time (p=0.55). The distributions of Gross Motor Function Classification System, epilepsy, and impairments of intellect, vision, and hearing were similar regardless of plurality.Interpretation:The data combined from two CP register networks indicated that triplets and quadruplets had increased risk of CP compared to twins. The higher prevalence of CP in triplets and quadruplets is due to their higher risk of preterm birth. Prevalence of CP among twins significantly declined in Europe and Australia. Clinical outcomes were similar for all multiple births.

U2 - 10.1111/dmcn.14827

DO - 10.1111/dmcn.14827

M3 - Article

AN - SCOPUS:85100135978

SN - 0012-1622

VL - 63

SP - 712

EP - 720

JO - Developmental Medicine and Child Neurology

JF - Developmental Medicine and Child Neurology

IS - 6

ER -

Cerebral palsy in twins and higher multiple births: a Europe‐Australia population‐based study

Abstract

Bibliographical note

ASJC Scopus subject areas

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