Cerebral palsy (CP) is the most common childhood motor disability worldwide. Two large, prospective pregnancy cohorts, the Danish National Birth Cohort (DNBC) and the Norwegian Mother and Child Cohort (MoBa), have been harmonized to create The MOthers and BAbies of Norway and Denmark- Cerebral Palsy Study (MOBAND-CP), which has facilitated novel research on prenatal risk factors for CP. Nevertheless, prenatal nutrition is an area of CP research that is still largely untouched and is also suited for analysis using MOBAND-CP data.Using a sample of singleton children born at 35 weeks gestation or later (i.e., term or near-term), the primary aim of this research is to evaluate the association between prenatal consumption of two poly-unsaturated fatty acids, docosahexaenoic acid (DHA) and arachidonic acid (ARA), and the risk of CP in term- or near-term children. Secondary aims are to: (a) calculate the ratio of DHA to ARA, (b) evaluate the association between the DHA to ARA ratio and CP, (c) estimate the risk of CP for children whose mothers reported an infection during pregnancy and (d) explore the effect modification of the association between infection and CP by docosahexaenoic quartile.We calculated the prevalence of CP for children born at or near-term by exposure to assess the suitability of combining the source cohorts' data for models. To estimate risk of CP, we used multiple imputation to retain observations missing covariate and infection data. We generated log-binomial models to estimate the risk of CP by exposure.Term- and near-term children with DHA exposure in the second quartile had a 1.85-fold increased risk of CP compared to children whose DHA exposure was in the first quartile. The risk of CP for children in the third and fourth quartile of DHA exposure was similar to the risk for children exposed in the first quartile. Risk of CP by ARA quartile differed between the two cohorts that comprise MOBAND-CP. For term- and near-term children from the Danish National Birth Cohort (DNBC), the risk of CP decreased as ARA quartile increased. In the Norwegian Mother and Child Cohort (MoBa), the risk of CP increased as ARA quartile increased. The ratio of DHA to ARA also differed by cohort. In the DNBC, the risk of CP increased as the ratio quartile increased. In the MoBa, the risk of CP decreased as ratio quartile increased.Risk of CP was similar for term- and near-term children whose mothers did and did not report an infection during pregnancy. The results of the effect modification analysis demonstrated that within children with prenatal DHA exposure in the third quartile, the risk of CP was 1.92 times higher for those whose mothers reported a prenatal infection compared to children whose mothers did not.Exposure to DHA in utero affects a child's risk of CP, and it may modify the relationship between infection and CP. The association between ARA and CP remains unclear, as does the association between the DHA to ARA ratio and CP. DHA intake in the second quartile was associated with the greatest risk of CP, though further research is needed to explain the underlying mechanisms. Further research is needed to clarify the association between ARA and CP, and the reasons that children in the third quartile of DHA exposure have significantly higher risk of CP if their mothers reported a prenatal infection compared to the children whose mothers did not.
Read
