{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:22:44Z","timestamp":1787008964819,"version":"build-2736575974"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2023,7,26]],"date-time":"2023-07-26T00:00:00Z","timestamp":1690329600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006636","name":"Swedish Research Council for Health, Working Life and Welfare","doi-asserted-by":"publisher","award":["4\u20132702\/2019"],"award-info":[{"award-number":["4\u20132702\/2019"]}],"id":[{"id":"10.13039\/501100006636","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004348","name":"Stockholm County Council","doi-asserted-by":"publisher","award":["501143"],"award-info":[{"award-number":["501143"]}],"id":[{"id":"10.13039\/501100004348","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cerebral palsy (CP) is the most common cause of childhood physical disability whose aetiology remains unclear in most cases. Maternal pre-existing and pregnancy complications are recognized risk factors of CP but the extent to which their effects are mediated by pre-term birth is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Population-based cohort study in Sweden including 2\u200a055\u200a378 singleton infants without congenital abnormalities, born between 1999 and 2019. Data on maternal and pregnancy characteristics and diagnoses of CP were obtained by individual record linkages of nationwide Swedish registries. Exposure was defined as maternal pre-pregnancy and pregnancy disorders. Inpatient and outpatient diagnoses were obtained for CP after 27\u2009days of age. Adjusted rate ratios (aRRs) were calculated, along with 95% CIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 515\u200a771 (25%) offspring were exposed to maternal pre-existing chronic disorders and 3472 children with CP were identified for a cumulative incidence of 1.7 per 1000 live births. After adjusting for potential confounders, maternal chronic cardiovascular or metabolic disorders, other chronic diseases, mental health disorders and early-pregnancy obesity were associated with 1.89-, 1.24-, 1.26- and 1.35-times higher risk (aRRs) of CP, respectively. Most notably, offspring exposed to maternal antepartum haemorrhage had a 6-fold elevated risk of CP (aRR 5.78, 95% CI, 5.00\u20136.68). Mediation analysis revealed that \u223c50% of the effect of these associations was mediated by pre-term delivery; however, increased risks were also observed among term infants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Exposure to pre-existing maternal chronic disorders and pregnancy-related complications increases the risk of CP in offspring. Although most infants with CP were born at term, pre-term delivery explained 50% of the overall effect of pre-pregnancy and pregnancy disorders on CP.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ije\/dyad106","type":"journal-article","created":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T17:57:19Z","timestamp":1689011839000},"page":"1766-1773","source":"Crossref","is-referenced-by-count":9,"title":["Pre-pregnancy and pregnancy disorders, pre-term birth and the risk of cerebral palsy: a population-based study"],"prefix":"10.1093","volume":"52","author":[{"given":"Neda","family":"Razaz","sequence":"first","affiliation":[{"name":"Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet , Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Cnattingius","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet , Stockholm, 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Pediatrics, Faculty of Medicine and Health Sciences, McGill University , Montreal, QC, Canada"},{"name":"Department of Neurology & Neurosurgery, Faculty of Medicine and Health Sciences, McGill University , Montreal, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2317-5607","authenticated-orcid":false,"given":"K S","family":"Joseph","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, University of British Columbia and the Children\u2019s\u00a0and Women\u2019s Hospital and Health Centre of British Columbia , Vancouver, BC, Canada"},{"name":"School of Population and Public Health, University of British Columbia , Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Kramer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, McGill University , Montreal, QC, Canada"},{"name":"Department of 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