Chorioamnionitis in the development of cerebral palsy: A meta-analysis and systematic review

Zhongjie Shi, Lin Ma, Kehuan Luo, Monika Bajaj, Sanjay Chawla, Girija Natarajan, Henrik Hagberg, Sidhartha Tan

Research output: Contribution to journalReview articlepeer-review

72 Scopus citations


Context: Chorioamnionitis (CA) has often been linked etiologically to cerebral palsy (CP). ObjectiveS: To differentiate association from risk of CA in the development of CP. Data Sources: PubMed, Cochrane Library, Embase, and bibliographies of original studies were searched by using the keywords (chorioamnionitis) AND ((cerebral palsy) OR brain). Study Selection: Included studies had to have: (1) controls, (2) criteria for diagnoses, and (3) neurologic follow-up. Studies were categorized based on: (1) finding incidence of CP in a CA population, or risk of CP; and (2) incidence of CA in CP or association with CP. Data Extraction: Two reviewers independently verified study inclusion and extracted data. Results: Seventeen studies (125 256 CA patients and 5 994 722 controls) reported CP in CA. There was significantly increased CP inpreterm histologic chorioamnionitis (HCA; risk ratio [RR] = 1.34, P < .01), but not in clinical CA (CCA). Twenty-two studies (2513 CP patients and 8135 controls) reported CA in CP. There was increased CCA (RR = 1.43, P < .01), but no increase in HCA in preterm CP. Increased HCA was found (RR = 4.26, P < .05), as well as CCA in term/near-term CP (RR = 3.06, P < .01). Conclusions: The evidence for a causal or associative role of CA in CP is weak. Preterm HCA may be a risk factor for CP, whereas CCA is not. An association with term and preterm CP was found for CCA, but only with term CP for HCA.

Original languageEnglish
Article numbere20163781
Issue number6
StatePublished - Jun 2017


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