Infertility Treatment and Umbilical Cord Length–Novel Markers of Childhood Epilepsy?
et al. (2013) Infertility Treatment and Umbilical Cord Length-Novel Markers of Childhood
Epilepsy? PLoS ONE 8(2): e55394. doi:10.1371/journal.pone.0055394
Infertility Treatment and Umbilical Cord Length-Novel Markers of Childhood Epilepsy?
Sari Ra isa nen 0
Arja Sokka 0
Leena Georgiadis 0
Maija Harju 0
Mika Gissler 0
Leea Keski- 0
Nisula 0
Reetta Ka lvia inen 0
Seppo Heinonen 0
Devendra Amre, University of Montreal, Canada
0 1 Department of Obstetrics and Gynaecology, Kuopio University Hospital , Kuopio , Finland , 2 Department of Pediatric Neurology, Kuopio University Hospital , Kuopio , Finland , 3 University of Eastern Finland , Kuopio , Finland , 4 Information Department, Welfare and Health Data Resources Unit, National Institute for Health and Welfare , Helsinki , Finland , 5 Nordic School of Public Health , Gothenburg , Sweden , 6 Department of Neurology, Kuopio University Hospital , Kuopio , Finland
Background: Epilepsy is one of the most common neurologic disorders of childhood, affecting about 0.420.8% of all children up to the age of 20. Methodology: A population-based retrospective cohort study. Aim was to determine incidence and identify perinatal and reproductive risk factors of epilepsy in children born between 1989 and 2008 among women (n = 43,389) delivered in Kuopio University Hospital. Risk factors of childhood epilepsy were determined by using logistic regression analysis. Principal Findings: The incidence of childhood epilepsy was 0.7% (n = 302 of 43,389). Maternal epilepsy, major congenital anomalies and use of assisted reproductive technology (ART) were associated with 4.25-, 3.61-, and 1.67- fold increased incidence of childhood epilepsy. A 10 cm increase in umbilical cord length was associated with a 15% decrease in the incidence of epilepsy (adjusted OR 0.85, 95% CI 0.7820.94). However, the above reproductive factors accounted for less than 2% of total incidence, whereas maternal epilepsy proved to be the highest risk factor. Conclusions: Perinatal and reproductive factors were shown to be minor risk factors of childhood epilepsy, implying that little can be done in obstetric care to prevent childhood epilepsy. Infertility treatment and umbilical cord length, independent of gestational age and congenital malformations, may be novel markers of childhood epilepsy.
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. These authors contributed equally to this work.
Epilepsy is one of the most common neurologic disorders of
childhood, affecting about 0.420.8% of all children up to the age
of 20 [13]. The incidence of childhood epilepsy is highest in the
first year of life [1]. The etiology of epilepsy is poorly understood,
but central nervous system (CNS) infections and anomalies [1,4],
major non-CNS anomalies [1,4], metabolic conditions [4] and
head trauma [1,3] have been shown to be risk factors. Abnormal
development of the brain during prenatal life may be a causal
factor in some of these neurological disorders. Accordingly,
previous studies have identified several perinatal factors associated
with increased incidence of epilepsy. The risk profile of epilepsy
includes maternal preeclampsia [5,6], eclampsia [4,6], maternal
infections during pregnancy [4,7], intrauterine fetal growth
restriction [8], being small for gestational age [4], having a low
Apgar score at birth [9,10], and being either preterm [8] or
postterm at birth [8,11]. The risk of developing epilepsy is 4210% in
close relatives, especially siblings and offspring [1], implying that
genetic factors are clear risk factors for childhood epilepsy. On the
other hand, pregnancy and neonatal outcomes of women with
active epilepsy have been shown to be equivalent to the general
population when a predefined protocol was used for follow-up in
antenatal and neurologic care [12]. To date, there have been only
a limited number of population-based studies into events during
pregnancy and delivery and their possible association with the
subsequent incidence of childhood epilepsy among offspring.
Thus, we reviewed retrospective population-based register data to
identify perinatal and reproductive risk factors of childhood
epilepsy among the total population of women with singleton live
births in Kuopio University Hospital between 1989 and 2008.
Objectives
We analyzed data gathered from the Kuopio University
Hospital Birth Register for the period 1989 to 2008. The data
included information on maternal and neonatal birth
characteristics and perinatal outcomes (live- and still-born infants born after
the 22nd week of pregnancy or weighing 500 g or more). In
addition, information on background, such as previous surgeries,
illnesses, obstetric history, contraceptive use, smoking habits and
alcohol consumption was collected using a self-administered
written questionnaire. The information was complemented by
midwife interviews conducted during visits or at delivery in the
Kuopio University Hospital.
Congenital anomalies were unspecified and included only
major congenital anomalies, in (...truncated)