Figure cases 24 cases: neonatal or infant death

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Figure 1 365 cases 24 cases: neonatal or infant death Normal cord insertion (270 cases) Cerebral palsy 4.4 % (12) Developmental disorder 6.7 % (18) Marginal cord insertion (57 cases) Cerebral palsy 15.8 % (9) Developmental disorder 14.0 % (8) Velamentous cord insertion (14 cases) Cerebral palsy 28.6 % (4) Developmental disorder 28.6 % (4)

% Figure 2 Cerebral palsy * * ＊: p<0.05 28.6 % 15.8 % 4.4 % Normal Marginal (n=52) Velamentous (n=14)

Developmental disorder % Figure 3 Developmental disorder * * ＊: p<0.05 28.6 % 14.0 % 6.7 % Normal (n=270) Marginal (n=52) Velamentous (n=14)

Figure 4 % Impaired hearing ＊: p<0.05 * 7.1 % * 1.8 % 0 % Normal Marginal (n=52) Velamentous (n=14)

Small for gestational age short statue Figure 5 % Small for gestational age short statue 28.6 % 21.1 % 15.2 % Normal (n=270) Marginal (n=52) Velamentous (n=14)

Table 1: Demographics of the subjects stratified according to the type of umbilical/placental cord insertion Cord insertion Normal　(n=288) Marginal (n=63) Velamentous (n=14) Maternal Age at delivery (year) 33.1 ± 5.0 33.1 ± 5.6 33.8 ± 4.9 Height (cm) 157.4 ± 5.4 157.3 ± 5.6 158.9 ± 3.7 Gestational weeks at delivery 30 ± 3 31 Gravida 1 (0-7) 0 (0-6) 1 (0-6) Parity 0 (0-4) 0 (0-3) 0 (0-1) Multiparous 35.8% (103) 44.4 %　(28) 35.7 % (5) In vitro fertilization 16.0 (46) 15.9 % (10) 28.6 % (4) Pregnancyinduced hypertension 48.3% (139) 38.1 % (24) Cesarean section 99.3 % (286) * 93.7 % (59) * 100 % (14) Fetal Intrauterine growth arrest 27.1 % (78) 17.5 % (11) 21.4 % (3) Steroid 54.5 % (157) 46.0 % (29) 64.3 % (9) Neonatal Birth weight (g) 873 ± 297 897 ± 299 939 ± 227 Birth weight (z-score) -2.9 ± 0.7 -2.8 ± 0.6 -2.8 ± 0.7 Male 50.7% (146) 50.8% (32) 35.7% (5) Apgar score 1 min. 6 (0-9) 6 (1-9) Apgar score 5 min. 8 (1-10)* 7 (1-10)* 8 (3-9) Umbilical arterial pH 7.268 ± 0.110 7.286 ± 0.103 7.262 ± 0.140 Base excess -3.5 ± 4.5 -3.5 ± 4.4 -5.1 ± 6.2 Neonatal or infant death 6.3% (18) 9.5% (6) 0% (0) Placenta and umbilical cord Placental abruption 6.9% (20) 3.2 % (2) 7.1 % (1) Placenta previa 0.3 % (1) 0 % (0) Oligohydramnios 20.6 % (13) Single umbilical artery 3.5 % (10) * 11.1 % (7) * The data indicate the mean ± standard deviation, median (range) or frequency (n). Intrauterine growth arrest; estimated fetal body in ultrasound weight increased < 5% over two weeks. Steroid; use of antenatal corticosteroids. Oligohydramnios; largest vertical diameter of any pocket ≦ 2 cm by ultrasound. * Significant difference (p<0.05) between two groups.

Table 2. Perinatal risk factors for cerebral palsy by univariate analysis Cerebral palsy (n=25) non Cerebral palsy (n=317) Odds ratio (95% Confidence interval) Gestational weeks of delivery < 28weeks 16.0 % (4) 19.3 % (61) 0.80 (0.26-2.40) Birth weight < 1000 g 84.0 % (21) 61.8 % (196) 3.24 (1.09-9.67) Birth weight SD < -3 52.0 % (13) 32.5 % (103) 2.25 (0.99-5.11) Placental weight < 200g 68.0 % (17) 36.6 % (116) 3.68 (1.54-8.80) Velamentous cord insertion 3.2 % (10) 5.83 (1.69-20.16) Marginal cord insertion 36.0 % (9) 15.2 % (48) 3.14 (1.3-7.52) Single umbilical artery 4.0 % (1) 5.4 % (17) 0.77 (0.09-5.75) Oligohydramnios 45.8 % (11) 23.9 % (74) 2.69 (1.16-6.25) Cesarean section 100 % (25) 98.1 % (311) 0.98 (0.97-1.00) Apgar Score 1 min <4 21.5 % (68) 0.70 (0.23-2.10) Apgar Score 5 min <7 12.0 % (3) 17.4 % (55) 0.65 (0.19-2.25) Umbilical arterial pH <7.1 1.9 % (6) 2.16 (0.25-18.68) Umbilical arterial BE <-12 8.0 % (2) 6.3 % (20) 1.29 (0.28-5.87) The data indicate frequency (n) and odds ratios were calculated by univariate analysis.

Table 3. Perinatal risk factors for developmental disorder by univariate analysis developmental disorder (n=30) non-developmental disorder (n=311) Odds ratio (95% Confidence interval) Gestational weeks of delivery < 28weeks 40.0 % (12) 17.0 % (53) 3.25 (1.48-7.14) Birth weight < 1000 g 90.0 % (27) 60.9 % (190) 5.78 (1.72-19.46) Birth weight SD < -3 60.0 % (18) 31.4 % (98) 3.28 (1.52-7.06) Placental weight < 200g 70.0 % (21) 35.9 % (112) 4.17 (1.85-9.41) Velamentous cord insertion 13.3 % (4) 3.2 % (10) 4.63 (1.36-15.79) Marginal cord insertion 26.7 % (8) 15.8 % (49) 1.94 (0.82-4.62) Single umbilical artery 4.5 % (14) 3.26 (1.00-10.64) Oligohydramnios 34.5 % (10) 24.7 % (75) 1.61 (0.72-3.61) Cesarean section 93.3 % (28) 98.7 % (308) 0.18 (0.03-1.04) Apgar Score 1 min <4 30.0 % (9) 20.2 % (63) 1.69 (0.74-3.88) Apgar Score 5 min <7 16.0 % (50) 1.91 (0.80-4.52) Umbilical arterial pH <7.1 10.0 % (3) 6.1 % (19) 1.71 (0.48-6.16) Umbilical arterial BE <-12 The data indicate frequency (n) and odds ratios were calculated by univariate analysis.

Table 4: Results of the multivariate logistic regression analysis for neurological complications Cerebral palsy Adjusted odds ratio (95% confidence interval) p-value Velamentous cord insertion 10.13 (2.53, 40.66) 0.001 Marginal cord insertion 8.52 (1.61, 11.36) 0.004 Developmental disorder 7.25 (1.81, 29.08) 0.005 Single umbilical artery 3.97 (1.05, 14.95) 0.042 Birth weight < 1000g 5.70 (1.15, 28.26) 0.033 Placental weight < 200g 2.82 (1.08, 7.36) 0.034 Data was analyzed by logistic regression analysis.