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Etiology and Risk of Cerebral Palsy (CP)

There are numerous ways and times during which cerebral palsy can occur. It is not one simple pathway (Sadowska et al, 2020). Several research studies have identified the risk factors for cerebral palsy and the reasons for brain damage which can lead to CP (Vitrikas et al, 2020).

Here are the prime risk factors for Cerebral Palsy (CP)

Delivery before 37 weeks
Birth weight of less than 2.5 kg

Prominent reasons for brain damage, which can lead to CP

Malformation of the brain in the developmental period
Genetic causes
In utero mother and fetus infections (Upadhyay et al, 2020)

Factors that may put the developing brain prone to injury: preconception, gestational period, and delivery (Stavsky et al, 2017).

Here are some CP statistics related to birth injuries according to the Cerebral Palsy Alliance Research Foundation (CPARF):

20% of CP cases are caused by labor and delivery events
70% are caused by events during pregnancy
Roughly 10% of asphyxia (lack of oxygen) events result in cerebral palsy

https://www.cerebralpalsyguide.com/cerebral-palsy/statistics/

Risk factors from the mother that develop during preconception

Systemic illness
Substance abuse
Maternal undernutrition
Swallowing harmful substances
Fertility issues
Previous spontaneous termination of pregnancy

The gestational period factors that may lead to brain damage

Maternal abnormalities of the central nervous system
Gestational diabetes
Excessive bleeding per vagina
Preeclampsia
Multiple gestations
Cotwin death
Genetic contributions
Encephalopathy of prematurity (Stavsky et al, 2017)

Risk factors during delivery

premature birth
C-section
vacuum-assisted delivery
Forceps delivery
Delivery after the due date
Labor induction
Prolonged labor
Asphyxia
Meconium aspiration syndrome (Patal et al, 2020).

Table 1: Risk factors for cerebral palsy
Source: Risk factors for cerebral palsy (Nahar et al, 2022; Sadowska et al, 2020; Stavsky et al, 2017; Patel et al, 2020)
Preconception	Before birth	During birth	After birth
Systemic illness of the mother	Premature birth	Premature birth	Hypoxic ischemic encephalopathy
Use of drugs and stimulants	Low birth weight	C-section	Infection
Immune system disorders preceding pregnancy	CNS malformation	Vacuum-assisted delivery	Hyperbilirubinemia
Spontaneous abortions	Maternal DM	Delivery after the due date	Cerebrovascular accidents
Socioeconomic factors	Prolonged rupture of membrane	Prolonged labor	Intracranial hemorrhage
Poisoning	Maternal hemorrhage	Asphyxia	CNS infection
Infections	Multiple gestations	Meconium aspiration	Respiratory distress syndrome
Impaired fertility	Cotwin death	Breech vaginal delivery	Artificial respiratory support
Treatment of fertility	Genetic factors	A high fever during delivery	Hypoglycemia neonatal convulsions
Genetic factor	Encephalopathy of prematurity	Perinatal stroke	Traumatic brain injury
	Congenital malformation		Near drowning
	Hypoxic ischemic encephalopathy		Meningitis
	In utero stroke		Sepsis
	In vitro fertilization		Neonatal encephalopathy
	Kernicterus
	Maternal disorder of clotting
	Meconium aspiration
	Fetal growth restriction
	Preeclampsia

Cerebral Palsy risk factors occur during.....?

References:

Nahar, P. S., Bhagawati, M. & Kunwar, A.J. (2022). A Review on Recent Advances of Cerebral Palsy. Oxid Med Cell Longev. 2022:2622310.

Patel, D. R., Neelakantan, M., Pandher, K. & Merrick, J. (2020). Cerebral palsy in children: a clinical overview. Translational Pediatrics . 9(1), S125–S135.

Sadowska. M., Sarecka, H, B. & Kopyta, I. (2020). Cerebral palsy: current opinions on definition, epidemiology, risk factors, classification and treatment options. Neuropsychiatric Disease and Treatment . 16,1505–1518.

Stavsky, M., Mor, O., Mastrolia, S. A. & Greenbaum, S. (2017). Cerebral palsy-trends in epidemiology and recent development in prenatal mechanisms of disease, treatment, and prevention. Frontiers In Pediatrics . 5, 2017.

Upadhyay, J., Tiwari, N., Ansar, M. N. (2020). Cerebral palsy: etiology, pathophysiology, and therapeutic interventions. Clinical and Experimental Pharmacology and Physiology . 47(12), 1891–1901.

Vitrikas, K., Dalton, H. &, Breish, D. (2020). Cerebral palsy: an overview. American Family Physician. 101(4),213–220.