Risk Factors for Cerebral Palsy in Moldova

Ecaterina Bufteac Gincota; Reidun Jahnsen; Larisa Spinei; Guro L Andersen

doi:10.3390/medicina57060540

Risk Factors for Cerebral Palsy in Moldova

Medicina (Kaunas). 2021 May 28;57(6):540. doi: 10.3390/medicina57060540.

Authors

Ecaterina Bufteac Gincota^{1

2}, Reidun Jahnsen^{3

4}, Larisa Spinei⁵, Guro L Andersen^{6

7}

Affiliations

¹ Department of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St Olavs Plass, 0130 Oslo, Norway.
² Early Intervention Center 'Voinicel', Drumul Taberei Str, Nr 2A, MD-2008 Chisinau, Moldova.
³ Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP), Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway.
⁴ Institute of Health and Society, CHARM, University of Oslo, P.O. Box 1130, Blindern, 0318 Oslo, Norway.
⁵ Department of the Social Medicine and Management, State Medical and Pharmacy University 'N. Testimitanu', MD-2004 Chisinau, Moldova.
⁶ Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP), Vestfold Hospital Trust, P.O. Box 2168, 3103 Tonsberg, Norway.
⁷ Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, P.O. Box 8905, 7491 Trondheim, Norway.

Abstract

Background and Objectives: This is the first study assessing risk factors for cerebral palsy (CP) among children born in Moldova. The aim of this study was to identify and describe risk factors for cerebral palsy (CP) among children born in Moldova, which is one of the low-middle income countries in Europe. Materials and Methods: We identified 351 children with CP born during 2009 and 2010 in Moldova. Detailed information on 417 children without CP served as a reference group. Logistic regression analyses were applied to the calculate crude and adjusted odds ratios (OR) for CP with 95% confidence intervals (CI) in addition to attributable fraction (AF). Results: Among children with CP (40.5% girls), 26% had spastic unilateral, 54% bilateral, 13% dyskinetic, 5% ataxic and 2% unclassified CP. Significant risk factors for CP included maternal alcohol consumption during pregnancy (OR 1.7, p = 0.002), maternal hypertension (OR 2.0, p < 0.001), children born to mothers from the rural areas (OR 1.6, p < 0.001), maternal age ≥35 years (OR 0.6, p = 0.018), maternal epilepsy (OR 4.3, p < 0.001), breech delivery (OR 3.1, p = 0.001), home births (OR 6.3, p = 0.001), umbilical cord around neck (OR 2.2, p < 0.001), AVD (OR 3.1, p < 0.001), male gender (OR 1.3, p < 0.001), SGA (OR 1.3, p = 0.027), multiple gestations (OR 1.7, p < 0.001) and hyperbilirubinemia (OR 4.5, p < 0.001). Multivariable analyses showed that the AF of CP was 64% for rural residence (OR 2.8, p = 0.002), 87% for home birth (7.6, p = 0.005), 79% for pre-labor rupture of membrane (OR 4.9, p = 0.001), 66% for breech delivery (OR 2.9, p = 0.002) and 81% for hyperbilirubinemia (OR 5.4, p < 0.001). Conclusions: A combination of factors related to the mother, the delivery and the child were risk factors for CP in Moldova, many of them possibly avoidable. Improved pregnancy and maternity care would potentially reduce the risk of CP. A national CP registry in Moldova is suggested as an opportunity to follow up on these findings.

Keywords: Moldova; asphyxia; cerebral palsy; hyperbilirubinemia; prevention; quality registry; risk factors.

MeSH terms

Adult
Cerebral Palsy* / epidemiology
Cerebral Palsy* / etiology
Child
Europe
Female
Humans
Male
Maternal Health Services*
Moldova / epidemiology
Pregnancy
Registries
Risk Factors