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

Research output: Contribution to journalArticlepeer-review

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 languageEnglish
JournalDevelopmental Medicine and Child Neurology
Early online date02 Feb 2021
DOIs
Publication statusEarly online date - 02 Feb 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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