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. 2021 Jun;63(6):712-720.
doi: 10.1111/dmcn.14827. Epub 2021 Feb 2.

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

Elodie Sellier  1   2 , Shona Goldsmith  3 , Sarah McIntyre  3 , Oliver Perra  4 , Gija Rackauskaite  5 , Nadia Badawi  3   6 , Asma Fares  7 , Hayley Smithers-Sheedy  3 ; Surveillance Of Cerebral Palsy Europe Group And The Australian Cerebral Palsy Register Group
Collaborators, Affiliations
Free article

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

Elodie Sellier et al. Dev Med Child Neurol. 2021 Jun.
Free article

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.

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References

REFERENCES

    1. Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol 2007; 109: 8-14.
    1. Korzeniewski SJ, Slaughter J, Lenski M, Haak P, Paneth N. The complex aetiology of cerebral palsy. Nat Rev Neurol 2018; 14: 528-43.
    1. Australian Cerebral Palsy Register. Report of the Australian Cerebral Palsy Register, birth years 1995-2012 [Internet]. Allambie Heights, NSW, Australia: ACPR. 2018. Available at: https://cpregister.com/publications-and-other-resources/ (accessed 21 December 2020).
    1. Umstad MP, Hale L, Wang YA, Sullivan EA. Multiple deliveries: the reduced impact of in vitro fertilisation in Australia. Aust N Z J Obstet Gynaecol 2013; 53: 158-64.
    1. Heino A, Gissler M, Hindori-Mohangoo AD, et al. Variations in multiple birth rates and impact on perinatal outcomes in Europe. PLoS One 2016; 11: e0149252.

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