Risk Factors for Cerebral Palsy in Brazilian Children: A Case-Control Study





Cerebral Palsy; Epidemiology; Risk factors; Case-control studies; Disabled children.


Background: Cerebral palsy is the main cause of physical disability in childhood. Objectives: This study analyzed prenatal and perinatal risk factors that contribute to cerebral palsy in Brazilian children. Methods: A case-control study was conducted with 2- to 10-year-old children in the city of Aracaju, Sergipe, Brazil. The cases were population-based, selected from the Primary Health Care services. The controls were selected from the database of the Brazilian Live Births Information System. Controls were paired with cases by gender, year, and hospital of birth. Results: A total of 570 participants (114 cases and 456 controls) were studied. Most of the participants were male, with bilateral spastic cerebral palsy. Among the prenatal factors examined, the presence of congenital anomalies was significantly different between cases and controls (OR = 54.28, [95% CI 12.55, 234.86]). The analysis of perinatal factors revealed significant differences between cases and controls in low birth weight (OR = 3.8, [95% CI 2.34, 6.16]), preterm birth (OR = 2.31, [95% CI 1.41, 3.80]), and low Apgar scores (OR = 14.73, [95% CI 5.27, 41.15]). Conclusions: The main prenatal and perinatal factors associated with cerebral palsy in our population were congenital anomalies, low Apgar scores, low birth weight, and preterm birth. The perinatal period had more risk factors, demanding a deeper study of their causes and of possible preventive measures.


Ahlin, K., Himmelmann, K., Hagberg, G., Kacerovsky, M., Cobo, T., Wennerholm, U. B., & Jacobsson, B. (2013). Non-infectious risk factors for different types of cerebral palsy in term-born babies: A population-based, case-control study. BJOG: An International Journal of Obstetrics and Gynaecology, 120(6), 724–731. https://doi.org/10.1111/1471-0528.12164

Coelho, C. P., & Soares, R. G. (2020). Estudo de caso com intervenções Neuropsicopedagógicas: estímulos à possibilidades cognitivas. Research, Society and Development, 9(4), e173943065. 10.33448/rsd-v9i4.3065

Colver, A., Fairhurst, C., & Pharoah, P. O. D. (2014). Cerebral palsy. The Lancet, 383(9924), 1240–1249. https://doi.org/10.1016/S0140-6736(13)61835-8

Daher, S., & El-khairy, L. (2013). Risk factors for cerebral palsy in Palestinian children : a case-control study. The Lancet, 382, S8. 10.1016/S0140-6736(13)62580-5

Donald, K. A., Neuro, M. P., Samia, P., Neuro, M. P., Kakooza-mwesige, A., & Bearden, D. (2014). Pediatric Cerebral Palsy in Africa: A Systematic Review. Seminars in Pediatric Neurology, 21(1), 30–35. 10.1016/j.spen.2014.01.001

Gao, J., Zhao, B., He, L., Sun, M., Yu, X., & Wang, L. (2017). Risk of cerebral palsy in Chinese children: A N:M matched case control study. Journal of Paediatrics and Child Health, 53(5), 464–469. 10.1111/jpc.13479

Gladstone, M. (2010). A review of the incidence and prevalence, types and aetiology of childhood cerebral palsy in resource-poor settings. Annals of Tropical Paediatrics, 30(3), 181–196. 10.1179/146532810X12786388978481

Graham, H. K., Rosenbaum, P., Paneth, N., Dan, B., Lin, J.-P., Damiano, D. L., & Lieber, R. L. (2016). Cerebral palsy. Nature Reviews Disease Primers, 2(1), 15082. 10.1038/nrdp.2015.82

Gurbuz, A., Karateke, A., Yilmaz, U., & Kabaca, C. (2006). The role of perinatal and intrapartum risk factors in the etiology of cerebral palsy in term deliveries in a Turkish population. Journal of Maternal-Fetal and Neonatal Medicine, 19(3), 147–155. 10.1080/14767050500476212

Himmelmann, K., & Uvebrant, P. (2018). The panorama of cerebral palsy in Sweden part XII shows that patterns changed in the birth years 2007–2010. Acta Paediatrica, International Journal of Paediatrics, 107(3), 462–468. 10.1111/apa.14147

Himmelmann, K., Ahlin, K., Jacobsson, B., Cans, C., & Thorsen, P. (2011). Risk factors for cerebral palsy in children born at term. Acta Obstetricia et Gynecologica Scandinavica, 90(10), 1070–1081. 10.1111/j.1600-0412.2011.01217.x

Hirvonen, M., Ojala, R., Korhonen, P., Haataja, P., Eriksson, K., Gissler, M., & Tammela, O. (2014). Cerebral Palsy Among Children Born Moderately and Late Preterm. Pediatrics, 134(6), e1584–e1593. 10.1542/peds.2014-0945

Huley, S. B., Cummings, S. R., Browner, W. S., Grady, D. G., & Newman, T. B. (2013). Designing clinical research. Philadelphia, USA: Lippincott Williams & Wilkins.

Jacobsson, B., Hagberg, G., Hagberg, B., Ladfors, L., Niklasson, A., & Hagberg, H. (2002). Cerebral palsy in preterm infants: a population-based case-control study of antenatal and intrapartal risk factors. Acta Paediatrica, 91(8), 946–951. https://doi.org/10.1080/080352502760148685

Jystad, K. P., Strand, K. M., Bjellmo, S., Lydersen, S., Klungsöyr, K., Stoknes, M., & Vik, T. (2017). Congenital anomalies and the severity of impairments for cerebral palsy. Developmental Medicine & Child Neurology, 59(11), 1174–1180. https://doi.org/10.1111/dmcn.13552

Lie, K. K., Grøholt, E. K., & Eskild, A. (2010). Association of cerebral palsy with Apgar score in low and normal birthweight infants: Population based cohort study. BMJ, 341(7777), 817. 10.1136/bmj.c4990

Marcondes, C. B., & Ximenes, M. de F. F. de M. (2015). Zika virus in Brazil and the danger of infestation by Aedes (Stegomyia) mosquitoes. Revista Da Sociedade Brasileira de Medicina Tropical, 49(1), 4–10. 10.1590/0037-8682-0220-2015

Mcintyre, S., Taitz, D., Keogh, J., Goldsmith, S., Badawi, N., & Blair, E. (2013). A systematic review of risk factors for cerebral palsy in children born at term in developed countries. Developmental Medicine & Child Neurology, 55(6), 499–508. 10.1111/dmcn.12017

Moster, D., Wilcox, A. J., Vollset, S. E., Markestad, T., & Lie, R. T. (2010). Cerebral palsy among term and postterm births. JAMA, 304(9), 976–982. 10.1001/jama.2010.1271

Nelson, K. B., & Blair, E. (2015). Prenatal Factors in Singletons with Cerebral Palsy Born at or near Term. The New England Journal of Medicine, 373(10), 946–953. 10.1056/NEJMra1505261

Oliveira, M. R., Nascimento, L. E. C., Moraes, B. L. J., Souza, W. S., Pita, W. S., Melo, G. L. R., & Mazzoccante, R. P. (2021). Efeitos de práticas corporais no desenvolvimento motor em crianças e adolescentes com paralisia cerebral. Research, Society and Development, 10(2), e31710212627. 10.33448/rsd-v10i2.12627

Oskoui, M., Coutinho, F., Dykeman, J., Jetté, N., & Pringsheim, T. (2013). An update on the prevalence of cerebral palsy: A systematic review and meta-analysis. Developmental Medicine and Child Neurology, 55(6), 509–519. 10.1111/dmcn.12080

Oztürk, A., Demirci, F., Yavuz, T., Yildiz, S., Değirmenci, Y., Döşoğlu, M., & Avşar, Y. (2007). Antenatal and delivery risk factors and prevalence of cerebral palsy in Duzce (Turkey). Brain & Development, 29(1), 39–42. 10.1016/j.braindev.2006.05.011

OʼCallaghan, M. E., MacLennan, A. H., Gibson, C. S., McMichael, G. L., Haan, E. a., Broadbent, J. L., & Dekker, G. A. (2011). Epidemiologic Associations With Cerebral Palsy. Obstetrics & Gynecology, 118(3), 576–582. 10.1097/AOG.0b013e31822ad2dc

Pakula, A. T., Van Naarden Braun, K., & Yeargin-Allsopp, M. (2009). Cerebral Palsy: Classification and Epidemiology. Physical Medicine and Rehabilitation Clinics of North America, 20(3), 425–452. 10.1016/j.pmr.2009.06.001

Persson, M., Razaz, N., Tedroff, K., Joseph, K. S., & Cnattingius, S. (2018). Five- and 10-minute Apgar scores and risks of cerebral palsy and epilepsy: population based cohort study in Sweden. BMJ, 360, k207. 10.1136/bmj.k207

Petridou, E., Koussouri, M., Toupadaki, N., Papavassiliou, A., Youroukos, S., Katsarou, E., & Trichopoulos, D. (1996). Risk factors for cerebral palsy: A case-control study in Greece. Scandinavian Journal of Public Health, 24(1), 14–26. http://www.scopus.com/inward/record.url?eid=2-s2.0-26444532411&partnerID=40&md5=39ffb899cf06df2b75403c5492f4bab6

Rosenbaum, P., Paneth, N., Leviton, A., Goldstein, M., Bax, M., Damiano, D., & Jacobsson, B. (2007). A report: The definition and classification of cerebral palsy April 2006. Developmental Medicine and Child Neurology, 49(S.109), 8–14. 10.1111/j.1469-8749.2007.tb12610.x

Saadi, H. R., Sutan, R., Dhaher, A. M., & Alshaham, S. A. (2012). Maternal and foetal risk factors of cerebral palsy among Iraqi children. A case control study. Open Journal of Preventive Medicine, 2(3), 350–358. 10.4236/ojpm.2012.23051

Sellier, E., Platt, M. J. M. J., Andersen, G. L. G. L., Krägeloh-Mann, I., De La Cruz, J., Cans, C., & Mejaski-Bosnjak, V. (2016). Decreasing prevalence in cerebral palsy: A multi-site European population-based study, 1980 to 2003. Developmental Medicine and Child Neurology, 58(1), 85–92. 10.1111/dmcn.12865

Serdaroǧlu, A., Cansu, A., Özkan, S., & Tezcan, S. (2006). Prevalence of cerebral palsy in Turkish children between the ages of 2 and 16 years. Developmental Medicine and Child Neurology, 48(6), 413–416. 10.1017/S0012162206000910

Silva, A. K. R., Barata, M. F. O., Rabelo, A. R. M., Silva, L. P., & Marcelino, J. F. Q. (2020). Ações da Terapia Ocupacional durante visitas escolares a crianças e adolescentes com deficiência motora. Research, Society and Development, 9(8), e971986715. 10.33448/rsd-v9i8.6715

Stelmach, T., Pisarev, H., & Talvik, T. (2005). Ante- and Perinatal Factors for Cerebral Palsy: Case-Control Study in Estonia. Journal of Child Neurology, 20(8), 654–661. 10.1177/08830738050200080401

Victora, C. G., Aquino, E. M., Carmo Leal, M., Monteiro, C. A., Barros, F. C., & Szwarcwald, C. L. (2011). Maternal and child health in Brazil: Progress and challenges. The Lancet, 377(9780), 1863–1876. 10.1016/S0140-6736(11)60138-4

Walstab, J., Bell, R., Reddihough, D., Brennecke, S., Bessell, C., & Beischer, N. (2002). Antenatal and intrapartum antecedents of cerebral palsy: a case-control study. The Australian & New Zealand Journal of Obstetrics & Gynaecology, 42(2), 138–146. 10.1111/j.0004-8666.2002.00138.x

World Health Organization. (2016). International Statistical Classification of Diseases and Related Health Problems (10th ed.). Genebra: World Health Organization. Retrieved from: http://apps.who.int/classifications/icd10/browse/2016/en

Yeargin-Allsopp, M., Van Braun, K. N., Doernberg, N. S., Benedict, R. E., Kirby, R. S., & Durkin, M. S. (2008). Prevalence of cerebral palsy in 8-year-old children in three areas of the united states in 2002: A multisite collaboration. Pediatrics, 121(3), 547–554. 10.1542/peds.2007-1270




How to Cite

PEIXOTO, M. V. da S.; DUQUE, A. M. .; SANTOS, A. D. dos .; LIMA, S. V. M. A. .; RIBEIRO, C. J. N. .; VOCI, S. M. .; CARVALHO, S. de; NUNES, M. A. P. . Risk Factors for Cerebral Palsy in Brazilian Children: A Case-Control Study. Research, Society and Development, [S. l.], v. 10, n. 5, p. e35710515075, 2021. DOI: 10.33448/rsd-v10i5.15075. Disponível em: https://www.rsdjournal.org/index.php/rsd/article/view/15075. Acesso em: 22 jun. 2024.



Health Sciences