Deformational plagiocephaly at birth: an observational study on the role of assisted reproductive technologies

Background: Following the "back to sleep" recommendations, a striking rise in deformational plagiocephaly (DP) occurred. However, additional maternal, pregnancy and infant conditions may play a role. Objectives: We aimed to evaluate the prevalence of and risk factors for DP at birth. Additionally, given the association between assisted reproductive technologies (ART) use and unfavorable pregnancy events, we explored the association between ART and DP. Patients and Methods: A total of 413 neonates >33 weeks born at L. Sacco Hospital (Milan, Italy) from May 2011 through to January 2012 were enrolled. Data regarding parental, conceivement, pregnancy and delivery characteristics were recorded. Infants' skull measurements, including the oblique cranial length ratio (OCLR) were taken within 72 h after birth. Plagiocephaly was defined for OCLR > 105.9. Results: The prevalence of DP was 20.3%. It was associated with twinning (OR 5.0; 95% CI 2.22-11.1), pregnancy complications (OR 2.86; 95% CI 1.49-5.26), prematurity (OR 2.13; 95% CI 0.98-4.54), ART use (OR 2.00; 95% CI 0.90-4.35) and male gender (OR 1.79; 95% CI 0.94-2.50). Adjusting for multiple pregnancies however, the association between ART and DP disappeared. Conclusion: Results show that offspring of pregnancies conceived through ART do not have increased risk of DP. However, our numbers are small thus larger studies are needed for definitive conclusions.