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COMMENTARY 

What Environmental Factors Increase the 

Risk of Cerebral Palsy in Unborn Children? 
 

Alexa Raquel Lopez1,2, Jayden Manzanares1,3, Amani Nguma1,4, Mahir Alam1,4, Victoria Anette 

Garcia1,4, Juan Gutierrez1,5, Savannah Rivera1,5, Alexis Blanco1,5, Sophia Mireles1,6, Saachi 

Grover1,7, Aolani Garza-Gonzalez1,8 

 
1 3rdAnnual Junior Clinical Research Internship, South Texas Academy for Education & Training in Research, DHR Health  

   Institute for Research and Development 
2 Achieve Early College High School, McAllen, TX 

3 Idea Tres Lagos, McAllen, TX 

4 McAllen Memorial High School, McAllen, TX 

5 Santa Maria High School, Santa Maria, TX 

6 South Texas ISD Science Academy, Mercedes, TX  

7 The Field School, Washington, DC 

8 Thelma R. Salinas STEM Early College High School, La Joya, TX 

 

Received: June 29, 2023 

Accepted for publication: September 1, 2023 

Published: November 16, 2023

Introduction 

Approximately 1 in 345 children are 

diagnosed with cerebral palsy and 85%-90% of these 

cases are congenital.1 Cerebral palsy is a complex and 

multifaceted neurological disorder that has significant 

implications for individuals and their families. There 

are a wide range of risk factors that can contribute to 

the development of cerebral palsy, including 

environmental factors that can increase the risk of 

cerebral palsy in the fetus. Some of these risk factors 

are modifiable and can reduce the risk of cerebral 

palsy.  By understanding the intricacies of cerebral 

palsy, we can contribute not only to medical 

advancements but also to improving the quality of life 

for those affected. 

What is Cerebral Palsy? 

Cerebral palsy is a motor disability that 

affects both brain development and muscle movement 

and is caused by brain damage which results from both 

physical complications and chemical impediment of 

the gestational process.2 Children affected by cerebral 

palsy are very limited in mobility. Compared to other 

kids’ abilities, children with cerebral palsy have an 

impairment of various physical and motor skills. 

Consequently, this can cause them to be prone to 

mental health conditions. Almost half (46%) of 

children with cerebral palsy have reported anxiety and 

depression, amongst other conditions.3 Symptoms of 

cerebral palsy can range from minor to severe. While 

cerebral palsy is not a progressive disorder, these 

symptoms have the potential to change over time, 

making child development strenuous and 

burdensome.2 

Maternal Diet and Medication Risk for 

Cerebral Palsy 

Being cautious of what a mother ingests 

during pregnancy is crucial to the health of her baby. 

Studies have shown that certain diets and medications 

can have a big impact on an infant's brain development 

and can increase the risk for cerebral palsy.4 

Medications such as opioids and antibiotics should be 

used with caution.5 An example of these mediations is 

betamethasone. Betamethasone is a drug given to 

pregnant mothers who are at risk of giving birth 

prematurely. However, administering more than one 

dose has been proven to cause damage to the white 

matter of the fetus’s brain.6 Another drug that many 

pregnant mothers take that could cause cerebral 



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damage in the fetus is Pitocin. Pitocin is a drug given 

to mothers in labor to cause uterine contractions and 

speed up the birthing process. However, if given an 

incorrect dose, the contractions can become too 

powerful and cut off oxygen for the fetus, leading to 

brain trauma-induced cerebral palsy.7 Diets and 

caloric intake have also been associated with 

gestational risk, with one study demonstrating how 

maternal obesity has an impact on infant health.8 

Alongside some drugs, certain vitamins and 

supplements have proven to increase the risk of a fetus 

developing cerebral palsy.9 Protective nutrients such 

as those found in fish and folate should be considered 

for infant health and to decrease the risk for cerebral 

palsy.9 Other nutrients, however, such as those found 

in meat, are considered a potential risk for cerebral 

palsy.10 A study in Norway and Denmark looking at 

maternal intake found that mothers who supplemented 

with folate had a lower association for cerebral 

palsy.8,9 Among births where the mother was 

diagnosed with obesity, her child had a higher risk of 

cerebral palsy. Studies show that out of 6.2 million 

births, 67,200 (1.1%) of recorded mothers had obesity 

and 8,798 (0.14%) of children born had cerebral 

palsy.11 Keeping good nutrition during pregnancy can 

lower a child’s risk of cerebral palsy. Physicians have 

recommended for pregnant women to avoid taking 

vitamin A during pregnancy, especially in the form of 

topical retinoids and other acne products. In fact, 

doctors always ask patients if they are pregnant before 

prescribing vitamin A based acne products to ensure 

that no harm is caused.12 Studies have shown that 

mothers who have used retinoids and other vitamin A 

products during pregnancy have birthed babies with 

fetal retinoid syndrome and other neurodevelopmental 

impairments leading to cerebral palsy. Adequate 

maternal nutrition and health status is important for the 

growing fetus. If good nutrition is not present during 

pregnancy, it can lead to long term effects for both the 

mother and the baby. 

Maternal Infection 

Infections can cause the mother’s immune 

system to increase the number of proteins called 

cytokines. Cytokines circulate in the blood and brain 

of the child, which can cause inflammation. Cytokines 

are signaled to repair and remodel tissue after certain 

cellular behavior.  When cytokines bind to the 

receptors, they introduce hundreds of interferon 

(IFNs) and stimulated genes (ISGs).13 These genes 

assist in the restriction of infections in the body. There 

are three types of IFNs, and they all have different 

functions and targets based on the expressions of the 

receptors. During pregnancy, the IFNs are employed 

and used in a defense against pathogens. The 

alterations that the IFNs induce can lead to pregnancy 

complications and congenital abnormalities. Since the 

influx of cytokines can cause congenital disorders, it 

can be concluded that IFNs pose a risk for cerebral 

palsy.14  

The most common congenital infection is 

cytomegalovirus (CMV), which is found in 1% of live 

births.15 CMV has been linked as a risk factor for the 

development of cerebral palsy. One study explored the 

relationship between the level of CMV infection and 

the developmental skills in children with cerebral 

palsy. Not only were a larger number of copies of 

CMV found in mothers of children with cerebral palsy 

compared to the control group, but decreased motor 

function and increased chance of spastic quadriplegia 

were also found throughout the group of cerebral palsy 

children with mothers of higher levels of CMV during 

pregnancy.16 Although no relation was found between 

abnormalities of brain tissues and the amount of CMV 

in mothers, this study still supports the idea that CMV 

is a risk factor for cerebral palsy and the level of motor 

development the child will have.  

Chorioamnionitis has also been linked to 

cerebral palsy. It is an infection of the placenta and 

amniotic fluid causing inflammation.17 A case study of 

231,582 infants with either spastic or dyskinetic 

cerebral palsy and a control group of children without 

cerebral palsy was conducted to determine if 

chorioamnionitis increases the risk of developing 

cerebral palsy. Fourteen percent of cases with cerebral 

palsy were diagnosed with chorioamnionitis, while 

only 4% of the control group were diagnosed with it. 

Other conditions found through logistic regression that 

may lead to cerebral palsy were intrauterine growth 

restriction and nulliparity.18 Another study examined 

the relationship between chorioamnionitis, extra-

amniotic infections, and the risk of cerebral palsy in 

children. Californian births between 1991 and 2001 

with maternal hospital diagnoses of intra and extra 

amniotic infections up to 12 months before birth were 

studied. It was determined that an infection diagnosis 

was more common in mothers of children with 

cerebral palsy. Out of the 8,473 children with cerebral 

palsy, 7.6% of their mothers had a chorioamnionitis 

diagnosis, compared to only 2.0% of mothers of 

children without cerebral palsy.19 The correlation 

between chorioamnionitis and cerebral palsy supports 

the claim that the amniotic inflammation from 

chorioamnionitis has an increased chance of damaging 

the fetal brain and leading to cerebral palsy. 



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In addition to CMV and chorioamnionitis, 

maternal urinary tract infections have also been found 

to be a potential risk factor in children developing 

cerebral palsy.20 A study done amongst 112 mothers 

of children with cerebral palsy and a control group of 

153 mothers of children without cerebral palsy found 

that 17.9% of mothers of children with cerebral palsy 

had a UTI, while only 5.2% of mothers in the control 

group had UTIs during pregnancy.21 At the time of the 

study, not much previous research had identified a 

relationship between maternal UTIs and the risk for 

cerebral palsy, making both this study and Polivka et 

al., 1993 one of the first to report detecting an 

association between UTIs and cerebral palsy. Another 

study found a similar relationship between mothers 

with UTIs and the birth of children with cerebral palsy. 

An analysis of 8,473 mothers of infants with cerebral 

palsy found that 5.2% had been diagnosed with a UTI, 

compared to 3.1% of 6,010,031 mothers of children 

without cerebral palsy.22 It is important that healthcare 

professionals aim to educate pregnant patients and 

improve patient care to prevent such a common 

infection like a UTI from occurring, thus preventing 

harm to fetal brain development and preventing 

cerebral palsy.  

Chemicals and Toxicity 

Interactions between environmental 

chemicals and fetal development may also increase the 

risk of cerebral palsy and create hormonal 

imbalances.23 

Methylmercury, a teratogen found in the 

bodies of fish and sea-dwelling consumers, can be 

spread through the biomagnification of food chains.24 

The concentration of methylmercury increases directly 

with the trophic level, meaning humans who consume 

seafood are exposed to the chemical. Methylmercury 

exposure would not be problematic unless consumed 

in large amounts to the average person, however, to 

the fetus, it is more susceptible to the effects of toxic 

chemicals and teratogens.25 Cerebral palsy is one of 

the various malformations caused by developmental 

impairment associated with methylmercury exposure. 

In areas like the Great Lakes, there have been higher 

incidences of cerebral palsy hospitalization, indicating 

a correlation between seafood consumption in an area 

known for high methylmercury levels and the 

occurrence of cerebral palsy.26 

Pesticides are one of the most acknowledged causes 

for endocrine disruption in humans.27 Of the various 

effects on the human body, disruptions in the fetus 

during gestation have been related to proximity of 

agricultural areas in which pesticides were used. In 

multiple studies with thousands of controls, mothers 

who resided near agricultural operations were reported 

to have higher incidence of cerebral palsy.28 

Although the knowledge of lead’s 

neurodegenerative effects is widely recognized (for 

example, it’s phasing out of gasoline as an engine 

stabilizer and as an ingredient in paint), industrial 

factors as well as the removal of lead-containing 

objects still allow lead to be a serious problem in the 

neurodevelopment of children.29 Through the removal 

of paint that was originally applied with lead as an 

ingredient, as well as the demolition of lead-

containing buildings, lead dust can be released into 

soils, recreational products, and water. Mothers near 

mining operations involving the harvesting of lead can 

also put children at risk for stunted neurodevelopment, 

as well as higher lead absorption.30 In areas of limited 

access to drinking water regulation, studies have 

shown that children with cerebral palsy have higher 

concentrations of lead.31 

Conclusion 

Research on the relationship between 

environmental factors and cerebral palsy has 

elucidated various factors that can contribute to the 

increased risk of cerebral palsy. These factors include 

being exposed to an illness while pregnant, taking 

certain medication, and being exposed to certain 

toxins. More importantly, some of these risk factors 

are modifiable and it is crucial for expecting mothers 

to limit their interaction with these risk factors. By 

taking action to lessen exposure to these 

environmental factors, we can contribute to the 

prevention of cerebral palsy. 

Acknowledgements 

Monica Betancourt-Garcia, MD, Program Director; 

Melissa Eddy, MS, Program Manager  

Funding 

Funded by DHR Health Institute for Research & 

Development; DHR Health; Region One ESC 

GEARUP College Ready, Career Set!; Region One 

ESC GEARUP College Now, Career Connected; 

Region One ESC PATHS; Region One ESC Upward 

Bound Math & Science; Benavides ISD; and Jubilee 

Academy-Brownsville  

 



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