Comparative Aetiological Studies of Congenital Diplegia in Scotland

Abstract

A composite series of 229 diplegic patients, all of whom were the result of legitimate singleton births, is compared in respect of social factors, maternal reproductive history and perinatal history with groups of prematurely and maturely born children derived from approximately the same Scottish population. The diplegic patients were divided into 2 groups, the 1 comprising children weighing more than 5 1/2 lb. (2.4 kg.) at birth, the 2d weighing 4 1/2 lb. (2.0 kg.) or less. Whereas the fathers of mature diplegic patients were more often in social classes I and II and less often in social class III than fathers of all live births in the Scottish population, premature diplegic patients more often had fathers in social classes IV and V and less often fathers in social class III than all live births in the general population. Mothers of mature diplegic patients married later than women in the general population, whereas mothers of premature diplegic patients married earlier. One-third of all first-born premature diplegic patients were conceived before marriage compared to 12.1% of mature diplegic patients and 17.6% of all live births in Scotland.Whereas the average age of mothers by parity of mature diplegic patients was found to be significantly higher than mothers in the general population, the average age of mothers of premature diplegic patients was little different Mothers of mature diplegic patients were relatively infertile immediately before the birth of the diplegic patient compared to other times. They were subfertile compared to mothers of all Edinburgh births in 1959 and mothers of premature diplegic patients. Rather arbitrary criteria of subfertility were devised, and it was found that there was a significant excess of subfertility among the mothers of mature diplegic patients compared to the mothers of normal mature controls and of premature diplegic patients. Other conceptions were more often abnormal in the premature diplegic group than in the mature diplegic group or among all live births in the Edinburgh population 1959. There was an excess of complications of pregnancy in the mature diplegic group as compared to the mature control group and a greater excess of abnormalities of labor and delivery in mature diplegic patients compared to mature controls. Premature diplegic and premature control groups showed comparable figures for the prevalence of disorders of pregnancy, but there was a significant excess of disorders of labour and delivery in the diplegic group. There was a marked excess of complications of the neonatal period in the mature diplegic patients compared to mature controls, and this difference was accentuated when there had been previous abnormalities of labour or delivery. A higher proportion of premature diplegic patients had complications in the neonatal period than premature controls, and in both groups the neonatal period was more often abnormal if there had been disorders of labour or delivery. It is suggested that the differences in clinical findings between premature and mature patients recently reported are accompanied by differences in aetiological findings. While perinatal injury may be the etiological factor of major importance in some patients suffering from diplegia, in others multiple contributory etiological factors are operating (Freud, 1893, 1897). They may cause the child to be abnormal before birth and predispose him to injury at the time of birth. Their nature and mode of operation require further study, but they differ in maturely and prematurely born patients.