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Risk of Cerebral Palsy among the Offspring of Immigrants

BACKGROUND: Cerebral palsy (CP) has a multifactorial etiology, and placental vascular disease may be one major risk factor. The risk of placental vascular disease may be lower among some immigrant groups. We studied the association between immigrant status and the risk of CP. METHODS: We conducted a...

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Autores principales: Ray, Joel G., Redelmeier, Donald A., Urquia, Marcelo L., Guttmann, Astrid, McDonald, Sarah D., Vermeulen, Marian J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4096602/
https://www.ncbi.nlm.nih.gov/pubmed/25019202
http://dx.doi.org/10.1371/journal.pone.0102275
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author Ray, Joel G.
Redelmeier, Donald A.
Urquia, Marcelo L.
Guttmann, Astrid
McDonald, Sarah D.
Vermeulen, Marian J.
author_facet Ray, Joel G.
Redelmeier, Donald A.
Urquia, Marcelo L.
Guttmann, Astrid
McDonald, Sarah D.
Vermeulen, Marian J.
author_sort Ray, Joel G.
collection PubMed
description BACKGROUND: Cerebral palsy (CP) has a multifactorial etiology, and placental vascular disease may be one major risk factor. The risk of placental vascular disease may be lower among some immigrant groups. We studied the association between immigrant status and the risk of CP. METHODS: We conducted a population-based retrospective cohort study of all singleton and twin livebirths in Ontario between 2002–2008, and who survived ≥28 days after birth. Each child was assessed for CP up to age 4 years, based on either a single inpatient or ≥2 outpatient pediatric diagnoses of CP. Relative to non-immigrants (n = 566,668), the risk of CP was assessed for all immigrants (n = 177,390), and further evaluated by World region of origin. Cox proportional hazard ratios (aHR) were adjusted for maternal age, income, diabetes mellitus, obesity, tobacco use, Caesarean delivery, year of delivery, physician visits, twin pregnancy, preterm delivery, as well as small- and large-for-gestational age birthweight. RESULTS: There were 1346 cases of CP, with a lower rate among immigrants (1.45 per 1000) than non-immigrants (1.92 per 1000) (aHR 0.77, 95% confidence interval [CI] 0.67 to 0.88). Mothers from East Asia and the Pacific (aHR 0.54, 95% CI 0.39 to 0.77) and the Caribbean (aHR 0.58, 95% CI 0.37 to 0.93) were at a significantly lower risk of having a child with CP. Whether further adjusting for preeclampsia, gestational hypertension, placental abruption or placental infraction, or upon using a competing risk analysis that further accounted for stillbirth and neonatal death, these results did not change. CONCLUSIONS: Immigration and ethnicity appear to attenuate the risk of CP, and this effect is not fully explained by known risk factors.
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spelling pubmed-40966022014-07-17 Risk of Cerebral Palsy among the Offspring of Immigrants Ray, Joel G. Redelmeier, Donald A. Urquia, Marcelo L. Guttmann, Astrid McDonald, Sarah D. Vermeulen, Marian J. PLoS One Research Article BACKGROUND: Cerebral palsy (CP) has a multifactorial etiology, and placental vascular disease may be one major risk factor. The risk of placental vascular disease may be lower among some immigrant groups. We studied the association between immigrant status and the risk of CP. METHODS: We conducted a population-based retrospective cohort study of all singleton and twin livebirths in Ontario between 2002–2008, and who survived ≥28 days after birth. Each child was assessed for CP up to age 4 years, based on either a single inpatient or ≥2 outpatient pediatric diagnoses of CP. Relative to non-immigrants (n = 566,668), the risk of CP was assessed for all immigrants (n = 177,390), and further evaluated by World region of origin. Cox proportional hazard ratios (aHR) were adjusted for maternal age, income, diabetes mellitus, obesity, tobacco use, Caesarean delivery, year of delivery, physician visits, twin pregnancy, preterm delivery, as well as small- and large-for-gestational age birthweight. RESULTS: There were 1346 cases of CP, with a lower rate among immigrants (1.45 per 1000) than non-immigrants (1.92 per 1000) (aHR 0.77, 95% confidence interval [CI] 0.67 to 0.88). Mothers from East Asia and the Pacific (aHR 0.54, 95% CI 0.39 to 0.77) and the Caribbean (aHR 0.58, 95% CI 0.37 to 0.93) were at a significantly lower risk of having a child with CP. Whether further adjusting for preeclampsia, gestational hypertension, placental abruption or placental infraction, or upon using a competing risk analysis that further accounted for stillbirth and neonatal death, these results did not change. CONCLUSIONS: Immigration and ethnicity appear to attenuate the risk of CP, and this effect is not fully explained by known risk factors. Public Library of Science 2014-07-14 /pmc/articles/PMC4096602/ /pubmed/25019202 http://dx.doi.org/10.1371/journal.pone.0102275 Text en © 2014 Ray et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Ray, Joel G.
Redelmeier, Donald A.
Urquia, Marcelo L.
Guttmann, Astrid
McDonald, Sarah D.
Vermeulen, Marian J.
Risk of Cerebral Palsy among the Offspring of Immigrants
title Risk of Cerebral Palsy among the Offspring of Immigrants
title_full Risk of Cerebral Palsy among the Offspring of Immigrants
title_fullStr Risk of Cerebral Palsy among the Offspring of Immigrants
title_full_unstemmed Risk of Cerebral Palsy among the Offspring of Immigrants
title_short Risk of Cerebral Palsy among the Offspring of Immigrants
title_sort risk of cerebral palsy among the offspring of immigrants
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4096602/
https://www.ncbi.nlm.nih.gov/pubmed/25019202
http://dx.doi.org/10.1371/journal.pone.0102275
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