A little more than 10 years ago, I unexpectedly went into labor at just shy of 32 weeks with contractions every two minutes. Upon my admission to the labor and delivery ward at the local hospital, the doctors did everything they could to help stop, or at least slow, the contractions. Every extra 24 hours we could get before delivering my twin babies was so important for their development. Unfortunately, when it became clear that the twins needed to be born because they were both under distress, another worry unfolded itself. One of my doctors told me my babies would be at risk for cerebral palsy.
She told me that prematurity was a risk factor for cerebral palsy. The fact that my babies had made it to exactly 32 weeks due to the efforts of my care team was a small comfort to me because, as explained to me by my doctor, the risk for developing cerebral palsy was slightly lower at that point. Despite the lower risk, she offered me a medication called magnesium sulfate which is given to women delivering before 32 weeks as a possible preventative for the cerebral palsy at which my babies were at risk. However, since we had just made it to 32 weeks gestation (past the phase of highest risk), the recommendation was not cut and dry.
My husband and I were given the hefty task of weighing the pros and cons of having the treatment. We weighed the fact that the twins had made it (just barely) past the 32-week mark with the fact that there were side effects of the medication for the mother, including pulmonary edema, that I was especially wary of in my already distressed state. After having the facts clearly laid out for us, we decided the benefits did not outweigh the risks and opted against the medication.
What is Cerebral Palsy?
Cerebral palsy (CP) is a disorder that affects the brain and the ability to control certain muscles throughout the body. It is the most common movement disorder in childhood affecting one out of every 323 children according to the Centers for Disease Control and Prevention. Severity of the disorder varies widely from child to child, as do levels of disability. Mostly, cerebral palsy manifests as the spastic variety. That is to say, more children suffer from stiff muscles than flaccid muscles.
CP is considered overwhelmingly a congenital disorder that a child is born with. Risk factors for congenital CP include low birth weight, prematurity, multiple birth (being a twin or triplet), in vitro fertilization (IVF), other assisted reproductive technology (ART), or maternal infection during pregnancy. Untreated jaundice that leads to a condition that affects the brain called kernicterus has also been thought to cause CP. However, it is very difficult to pinpoint a specific cause for congenital CP.
Risk factors for congenital cerebral palsy include the following:
- Low birth weight
- Prematurity
- Multiple birth
- IVF or other assisted reproductive technology
- Maternal infection
Cerebral palsy (CP) is a disorder that affects the brain and the ability to control certain muscles throughout the body. It is the most common movement disorder in childhood affecting one out of every 323 children according to the Centers for Disease Control and Prevention.
Rarely, the disorder can be acquired 28 or more days after birth. Risk factors for acquired CP include head injury or an infection of the central nervous system like meningitis.
Cerebral palsy also brings with it a host of comorbidities. Many children who have CP will also exhibit symptoms of one or more of the following: developmental delay, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), epilepsy, vision impairment, or hearing impairment.
Comorbidities that often accompany cerebral palsy include the following:
- Developmental delay
- Attention-deficit/hyperactivity disorder (ADHD)
- Autism spectrum disorder (ASD)
- Epilepsy
- Vision impairment
- Hearing impairment
A word on magnesium sulfate
Magnesium sulfate has been used for many years in pregnant women to prevent seizures associated with severe preeclampsia and progression to eclampsia, though its effectiveness for this purpose has been questioned. Despite this, the World Health Organization strongly recommends its use for preventing complications from severe preeclampsia.
Additionally, and more relevant to the topic at hand, the World Health Organization strongly recommends the use of magnesium sulfate “for women at risk of imminent preterm birth before 32 weeks gestation for prevention of cerebral palsy in the infant and child.” However, the timing of administration of the medication is important. They are clear to advise that the treatment should only be used if a pregnant woman is likely to have a premature birth within 24 hours.
