Cerebral palsy finding as cause for change
Australian researchers have discovered that cerebral palsy has an even stronger genetic basis than previously thought.
The finding has led to a call for an end to unnecessary caesareans and arbitrary litigation against obstetric staff.
In an authoritative review published in the American Journal of Obstetrics & Gynecology, members of the Australian Cerebral Palsy Research Group, based at the University of Adelaide’s Robinson Research Institute, argue that up to 45 per cent of cerebral palsy cases can have genetic causes.
It builds on a previous finding that at least 14 per cent of cerebral palsy cases are likely to be caused by a genetic mutation, but the group expects that percentage to keep increasing as genetic sequencing techniques evolve.
Research leader Professor Alastair MacLennan says courts should realise that many cases of cerebral palsy cannot be prevented by differences in labour management.
This should reduce the adverse influence of obstetric litigation, he says.
“For many years it was assumed, without good evidence, cerebral palsy was caused by brain damage at birth through lack of oxygen. This belief along with the temptation to blame the insured, and the high cost of caring for children with cerebral palsy, has fuelled litigation against obstetric staff,” says Emeritus Professor MacLennan.
“Numerous recent studies have shown that despite an increase in caesarean deliveries over 50 years, which have risen from 5 per cent to 34 per cent in Australia, there has been no overall change in cerebral palsy rates.
“Some of the increase in caesareans appears to be due to defensive obstetrics and fear of litigation – there are lower rates of caesareans in countries with a “no-fault insurance scheme” like New Zealand, where rates are 23 per cent.
“It’s estimated that $300 million is paid on cerebral palsy settlements in Australia each year. I hope that our research will help end unfounded cerebral palsy related litigation,” he says.
Several more years of research are needed but the research group believes that eventually cerebral palsy genetic testing before, during and after pregnancy will be introduced.
“It is now becoming apparent that cerebral palsy is an umbrella diagnosis for children with non-progressive disorders of movement control and posture, and that there are many types and antenatal influences including genetic causes,” says the University of Adelaide’s Professor Jozef Gecz, Head of Neurogenetic Research.
“Cerebral is akin to many other neuro-developmental disorders such as intellectual disability, autism and epilepsy, co-morbidities that are often seen with cerebral palsy, and they too have many genetic causes,” he says.
“Many children who have received a diagnosis of cerebral palsy may have an inherited or spontaneous genetic cause and this is exciting because we can now focus research on the beginning of pregnancy and not so unfruitfully on the circumstances of birth,” says Dr Suzanna Thompson, co-author on the paper and paediatric neurologist at the Women’s and Children’s Hospital, Adelaide.