576 A systematic review and meta-analysis of the evidence for association of potential risk factors with deformational plagiocephaly

BackgroundA number of potential risk factors may change the odds for developing deformational plagiocephaly. Understanding the evidence for the association of potential risk factors will improve the diagnosis and management of deformational plagiocephaly.ObjectivesThe aim of this study was to conduct a systematic review and meta-analysis to assess the evidence for association between potential risk factors and deformational plagiocephaly.MethodsThe study was conducted in accordance with PRISMA guidelines (PROSPERO identifier: CRD42020204979). PubMed and Web of Science were searched (21 August 2010 through to 21 August 2020) for observational studies which assessed risk factors for deformational plagiocephaly. Main outcomes were any risk factors which alter odds for the development of deformational plagiocephaly. When feasible, pooled meta-analytic estimates were provided using fixed- or random-effects models.ResultsA total of 17 studies met the inclusion criteria. Meta-analysis demonstrated evidence of association between specific risk factors and deformational plagiocephaly, including male gender (OR, 1.66; 95% confidence interval (CI) 1.13 to 2.43; I2, 63.25%; N=4), supine sleeping position (OR, 3.23; 95% CI 2.05 to 5.10; I2, 17.26%; N=2), head position preference (OR, 4.76; 95% CI 3.44 to 6.57; I2, 0.00%; N=3), vaginal mode of delivery (OR, 1.55; 95% CI 1.07 to 2.23; I2, 0.00%; N=3), and low maternal education level (OR, 1.66; 95% CI 1.17 to 2.37; I2, 0.00%; N=2). Evidence of no association was found for small for gestational age (SGA; OR, 1.74; 95% CI 0.91 to 3.31; I2, 37.08%; N=2), multiple pregnancy (OR, 1.97; 95% CI 0.30 to 13.15; I2, 87.04%; N=2), and cephalic presentation at delivery (OR, 0.53; 95% CI 0.10 to 2.86; I2, 88.61%; N=2).ConclusionsRisk factors associated with the development of deformational plagiocephaly include male gender, sleeping supine, head position preference, vaginal delivery, and lower maternal education. Risk factors with evidence of no association include SGA, multiple pregnancy, and cephalic presentation. These findings may assist in the development of guidelines for improving the diagnosis and management of deformational plagiocephaly.