ABSTRACT
The purpose of this study was to investigate the impact of maternal prepregnancy and
pregnancy-related risk factors, complicated delivery, and perinatal morbidity on subsequent
handicaps in children. We surveyed a birth cohort of 4102 mothers and 4138 children
in Frederiksborg County, Denmark. Maternal risk factors were defined according to
guidelines published by the Danish National Board of Health, and perinatal morbidity
and handicaps according to World Health Organization guidelines. The incidence of
handicaps: (cerebral palsy, mental retardation [mild and severe], epilepsy, severe
defects of vision and hearing); was 44 of 4038 children (twins and neonatal deaths
were excluded). A combination of three or more maternal risk factors was found to
be a predictor of risk for children with later handicaps; the incidence of handicaps
was 11 times higher than in mothers with no risk factors. Eleven percent of all mothers
had three or more risk factors and they had 43% of the handicapped children. Multiparity
increased the risk in all risk categories. Of complications at delivery, intrapartum
asphyxia, as evident from Apgar scores of less than 7 at 1 minute and less than 10
at 10 minutes in particular, was a strong predictor of a later handicap. Premature
rupture of membranes for more than 24 hours was also significantly associated with
later handicaps. Perinatal morbidity was correlated with a later handicap. The perinatal
complication most strongly associated with later handicaps was low birthweight. Forty-eight
percent of the affected children had a birthweight of less than 2500 gm and were small
for gestational age.
We conclude that the incidence of handicaps could possibly be reduced if the causes
of the following maternal risk factors were identified and, if possible, eliminated:
previous delivery of a child with a birthweight less than 2500 gm, previous delivery
of a stillborn child, repeated abortions, severe infection during pregnancy, intrauterine
growth retardation, and preterm delivery. Improved intrapartum diagnosis and prevention
of asphyxia and treatment of children born with low Apgar scores would reduce the
incidence of handicaps, as would intervention to prevent premature rupture of the
membranes of more than 24 hour's duration.
