Gestational diabetes mellitus (GDM) affects many women in pregnancy and is enhanced by epidemic conditions of obesity, increasing age at the time of the first pregnancy, stressful life conditions, a sedentary lifestyle with less physical activity and unhealthy nutrition with highly processed, high-calorie food intake. GDM does not affect the mother and offspring in pregnancy alone, as there is compelling evidence of the long-term effects of the hyperglycemic state in pregnancy postpartum. Type 2 diabetes mellitus, cardiovascular disease and metabolic syndrome are more common in GDM women, and even the offspring of GDM women are reported to have higher obesity rates and a higher risk for noncommunicable diseases. Early prevention of risk factors seems to be key to overcoming the vicious cycle of cardiometabolic disease onset.
BACKGROUND AND PURPOSE: Former preterm born males are at higher risk for neurodevelopmental disabilities compared with female infants born at the same gestational age. This retrospective study investigated sex-related differences in the maturity of early myelinating brain regions in infants born ,28 weeks' gestational age using diffusion tensor-and relaxometry-based MR imaging. MATERIALS AND METHODS:Quantitative MR imaging sequence acquisitions were analyzed in a sample of 35 extremely preterm neonates imaged at term-equivalent ages. Quantitative MR imaging metrics (fractional anisotropy; ADC [10 À3 mm 2 /s]; and T1-/T2relaxation times [ms]) of the medulla oblongata, pontine tegmentum, midbrain, and the right/left posterior limbs of the internal capsule were determined on diffusion tensor-and multidynamic, multiecho sequence-based imaging data. ANCOVA and a paired t test were used to compare female and male infants and to detect hemispheric developmental asymmetries. RESULTS:Seventeen female (mean gestational age at birth: 26 1 0 [SD, 1 1 4] weeks1days) and 18 male (mean gestational age at birth: 26 1 1 [SD, 1 1 3] weeks1days) infants were enrolled in this study. Significant differences were observed in the T2-relaxation time (P ¼ .014) of the pontine tegmentum, T1-relaxation time (P ¼ .011)/T2-relaxation time (P ¼ .024) of the midbrain, and T1-relaxation time (P ¼ .032) of the left posterior limb of the internal capsule. In both sexes, fractional anisotropy (P [$] , .001/P [#] , .001) and ADC (P [$] ¼ .017/P [#] ¼ .028) differed significantly between the right and left posterior limbs of the internal capsule. CONCLUSIONS:The combined use of various quantitative MR imaging metrics detects sex-related and interhemispheric differences of WM maturity. The brainstem and the left posterior limb of the internal capsule of male preterm neonates are more immature compared with those of female infants at term-equivalent ages. Sex differences in WM maturation need further attention for the personalization of neonatal brain imaging.
Objectives Corpus callosal agenesis (CCA) is one of the most common brain malformations and is generally associated with a good outcome when isolated. However, up to 25% of patients are at risk of neurodevelopmental delay, which currently available clinical and imaging parameters are inadequate to predict. The objectives of this study were to apply and validate a fetal magnetic resonance imaging (MRI) anatomical scoring system in a cohort of fetuses with isolated CCA and to evaluate the correlation with postnatal neurodevelopmental outcome. Methods This was a retrospective cohort study of cases of prenatally diagnosed isolated CCA (as determined on ultrasound and MRI), with normal karyotype and with known postnatal neurodevelopmental outcome assessed by standardized testing. A fetal brain MRI anatomical scoring system based on seven categories (gyration, opercularization, temporal lobe symmetry, lamination, hippocampal position, basal ganglia and ventricular size) was developed and applied to the cohort; a total score of 0–11 points could be given, with a score of 0 representing normal anatomy. Images were scored independently by two neuroradiologists blinded to the outcome. For the purpose of assessing the correlation between fetal MRI score and neurodevelopmental outcome, neurodevelopmental test results were scored as follows: 0, ‘below average’ (poor outcome); 1, ‘average’; and 2, ‘above average’ (good outcome). Spearman's rank coefficient was used to assess correlation, and inter‐rater agreement in the assessment of fetal MRI score was calculated. Results Twenty‐one children (nine females (42.9%)) fulfilled the inclusion criteria. Thirty‐seven fetal MRI examinations were evaluated. Mean gestational age was 28.3 ± 4.7 weeks (range, 20–38 weeks). All fetuses were delivered after 35 weeks' gestation with no perinatal complications. Fetal MRI scores ranged from 0 to 6 points, with a median of 3 points. Inter‐rater agreement in fetal MRI score assessment was excellent (intraclass correlation coefficient, 0.959 (95% CI, 0.921–0.979)). Neurodevelopmental evaluation was performed on average at 2.6 ± 1.46 years (range, 0.5–5.8 years). There was a significant negative correlation between fetal MRI score and neurodevelopmental outcome score in the three areas tested: cognitive (ρ = –0.559, P < 0.0001); motor (ρ = –0.414, P = 0.012) and language (ρ = –0.565, P < 0.0001) skills. Using fetal MRI score cut‐offs of ≤ 3 (good outcome) and ≥ 4 points (high risk for poor outcome), the correct prognosis could be determined in 20/21 (95.2% (95% CI, 77.3–99.2%)) cases. Conclusion By assessing structural features of the fetal brain on MRI, it may be possible to better stratify prenatally the risk of poor neurodevelopmental outcome in CCA patients. © 2020 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
BACKGROUND AND PURPOSE: Preterm birth interferes with regular brain development. The aim of this study was to investigate the impact of prematurity on the physical tissue properties of the neonatal brain stem using a quantitative MR imaging approach. MATERIALS AND METHODS:A total of 55 neonates (extremely preterm [n ¼ 30]: ,28 1 0 weeks gestational age; preterm [n ¼ 10]: 28 1 0-36 1 6 weeks gestational age; term [n ¼ 15]: $37 1 0 weeks gestational age) were included in this retrospective study. In most cases, imaging was performed at approximately term-equivalent age using a standard MR protocol. MR data postprocessing software SyMRI was used to perform multidynamic multiecho sequence (acquisition time: 5 minutes, 24 seconds)-based MR postprocessing to determine T1 relaxation time, T2 relaxation time, and proton density. Mixed-model ANCOVA (covariate: gestational age at MR imaging) and the post hoc Bonferroni test were used to compare the groups.RESULTS: There were significant differences between premature and term infants for T1 relaxation time (midbrain: P , .001; pons: P , .001; basis pontis: P ¼ .005; tegmentum pontis: P , .001; medulla oblongata: P , .001), T2 relaxation time (midbrain: P , .001; tegmentum pontis: P , .001), and proton density (tegmentum pontis: P ¼ .004). The post hoc Bonferroni test revealed that T1 relaxation time/T2 relaxation time in the midbrain differed significantly between extremely preterm and preterm (T1 relaxation time: P , .001/ T2 relaxation time: P ¼ .02), extremely preterm and term (T1 relaxation time/T2 relaxation time: P , .001), and preterm and term infants (T1 relaxation time: P , .001/T2 relaxation time: P ¼ .006). CONCLUSIONS:Quantitative MR parameters allow preterm and term neonates to be differentiated. T1 and T2 relaxation time metrics of the midbrain allow differentiation between the different stages of prematurity. SyMRI allows for a quantitative assessment of incomplete brain maturation by providing tissue-specific properties while not exceeding a clinically acceptable imaging time.
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