Prevalence and pathogenesis of congenital anomalies in cerebral palsy.

Abstract

Background: It has been hypothesised that cerebral palsy (CP) and other congenital anomalies are attributable to feto-fetal transfusion problems in a monochorionic multiple gestation. Thus more than one organ could be compromised leading to the coexistence of two or more anomalies in a fetus. Such anomalies in a singleton birth may be attributable to early demise of the co-conceptus as a vanishing twin.

Aim: To determine whether the coexistence of congenital anomalies and CP is greater than a chance finding by comparing the prevalence of congenital anomalies in children with cerebral palsy with that in the general population of children.

Methods: a population based register of children with cerebral palsy born 1966-1991 in the counties of Merseyside and Cheshire comprised the index population. Coexisting congenital anomalies were recorded. For comparison the population prevalence of congenital anomalies was obtained from 8 congenital malformation registers in the United Kingdom.

Results: children with cerebral palsy have highly significant increases in risk for microcephaly, isolated hydrocephaly, congenital anomalies of the eye, congenital cardiac anomalies, cleft lip and/or palate, atresias of the oesophagus and intestines, congenital dislocation of the hips and talipes. The relative risks ranged from 3.1 (95% CI 1.9 to 4.8; p<0.01) for congenital malformations of the cardiac septa to 116.0 (95% CI 84.0 to 162.3; p<0.0001) for microcephaly.

Conclusions:Congenital anomalies in children with CP are found much more than expected by chance. A common pathogenic mechanism may account for the coexistence of disparate congenital anomalies. An hypothesis is proposed for such a common pathogenic mechanism.