OBJECTIVE: To identify the main prenatal risk factors for cerebral palsy in ve ry preterm singletons and twins. METHODS: The data were from the Epipage study, which included all very preterm children (< 33 weeks) born in 1997 in 9 regions of France. The analysis included 1,954 children for whom a medical questionnaire was completed at the age of 2 years (83%of the surviving children). The risk f actors studied were pregnancy complications and specific factors in twins (type of placenta and death of cotwin). Logistic regression analysis was carried out f or singletons and generalized estimating equation models used for twins. RESULTS : The proportion of cerebral palsy was 8%in singletons and 9%in twins. For sin gletons, spontaneous preterm labor (adjusted odds ratio [OR] 3.4, 95%confidence interval [CI] 1.7-6.7), preterm premature rupture of membranes (PPROM) with sh ort latency (adjusted OR 4.9, 95%CI 2.0-11.8), and prolonged PPROM (adjusted OR 2.7, 95%CI 1.4-5.3) were associated with a higher risk of cerebral palsy than was hypertension. No such link was found between these preg nancy complications and cerebral palsy in twins. For twins, a monochorionic plac enta (OR 1.9, 95%CI 1.0-3.6) increased the risk of cerebral palsy, but the OR became nonsignificant after adjustment (OR 1.7, 95%CI 0.8-3.4). CONCLUSION: In very preterm singletons, spontaneous preterm labor and PPROM increased the risk of cerebral palsy compared with hypertension.
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