Differences in cortical development assessed by fetal MRI in late-onset intrauterine growth restriction

Egaña-Ugrinovic, G.; Sanz‐Cortes, M.; Figueras, F.; Bargalló, Núria; Gratacós, E.

doi:10.1016/j.ajog.2013.04.008

Cited by 98 publications

(128 citation statements)

References 44 publications

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“…The metabolic changes detected in this study are also in line with other brain reorganizational differences reported in SGA fetuses, including microstructural changes in various brain areas, differences in brain sulcation and in cerebellar and brainstem size [12,13,14,39]. …”

Section: Discussionsupporting

confidence: 75%

“…The findings of the present study challenge the notion that SGA fetuses without signs of severity are merely constitutionally small. This notion goes in line with recent studies showing that SGA fetuses without high-risk factors present changes in their brain sulcation, umbilical blood metabolomic profile and cardiovascular profile [7,8,12]. However, our results do not contribute to clarify the pathogenesis of fetal smallness in this subgroup.…”

Section: Discussionsupporting

confidence: 69%

“…Thus, small fetuses with abnormal uterine artery Doppler ultrasound [4], birth weight below the 3rd centile [5] or signs of brain redistribution [3] are associated with poorer perinatal outcome. It has been speculated whether those SGA fetuses without signs of poor perinatal outcome showed merely milder forms of the same disease, were constitutionally small fetuses or represented another pathogenic pathway leading to abnormally low fetal growth [8,12,13]. The findings of the present study challenge the notion that SGA fetuses without signs of severity are merely constitutionally small.…”

Section: Discussioncontrasting

confidence: 55%

“…However, it is unclear whether these fetuses are ‘constitutional' SGA or represent other forms of growth restriction. For instance, despite normal perinatal outcomes, small fetuses with normal brain and uterine Doppler sonography still present long-term differences as compared with normally grown fetuses, such as cardiovascular and metabolic programming [7,8], neurological deficits [9,10,11] and neurostructural changes [12,13,14]. Therefore, there is a need to improve the characterization and understanding of the different phenotypes under the common diagnosis of ‘fetal smallness'.…”

Section: Introductionmentioning

confidence: 99%

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Proton Magnetic Resonance Spectroscopy Assessment of Fetal Brain Metabolism in Late-Onset ‘Small for Gestational Age' versus ‘Intrauterine Growth Restriction' Fetuses

et al. 2014

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Objectives: We used magnetic resonance spectroscopy (MRS) to evaluate brain metabolic differences in small fetuses near term as compared to appropriate for gestational age (AGA) fetuses. Study Design: 71 term small fetuses (estimated fetal weight <10th centile for gestational age with normal umbilical artery Doppler sonography) were subclassified as late intrauterine growth restriction (IUGR) (n = 50) or small for gestational age (SGA) (n = 21), and compared with 65 AGA fetuses. IUGR was defined by either abnormal middle cerebral artery, abnormal uterine artery Doppler sonography or estimated fetal weight <3rd centile. All participants underwent brain magnetic resonance imaging at 37 weeks of gestation, and single-voxel magnetic resonance spectra were obtained from the frontal lobe on a 3-tesla scanner. N-acetylaspartate (NAA)/choline (Cho), NAA/creatine (Cr) and Cho/Cr ratios were calculated and compared between cases and controls. The association of the metabolic ratios with the study groups was tested. Results: After MRS processing and applying quality control criteria, 31 spectra from late-onset IUGR, 11 from SGA and 30 from AGA fetuses were selected for further analysis. Both SGA and late-onset IUGR fetuses showed significantly reduced NAA/Cho levels when compared to AGA fetuses. This decrease followed a linear trend across the three clinical groups that were considered. Conclusions: Both SGA and late-onset IUGR fetuses showed differences in MRS brain metabolic ratios. The findings suggest that despite near-normal perinatal outcomes, SGA fetuses are not constitutionally small and may represent a form of growth disorder that needs to be clarified.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionsupporting

confidence: 69%

Section: Discussioncontrasting

confidence: 55%

Section: Introductionmentioning

confidence: 99%

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Proton Magnetic Resonance Spectroscopy Assessment of Fetal Brain Metabolism in Late-Onset ‘Small for Gestational Age' versus ‘Intrauterine Growth Restriction' Fetuses

et al. 2014

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“…In late-onset FGR, gestational age becomes a smaller contributor, and further studies are necessary to determine which fetal variables at the time of delivery are the main determinants of neurodevelopment [85]. …”

Section: Impact Of Delivery Timingmentioning

confidence: 99%

Neurodevelopment after Fetal Growth Restriction

2013

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Fetal growth restriction (FGR) can emerge as a complication of placental dysfunction and increases the risk for neurodevelopmental delay. Marked elevations of umbilical artery (UA) Doppler resistance that set the stage for cardiovascular and biophysical deterioration with subsequent preterm birth characterize early-onset FGR. Minimal, or absent UA Doppler abnormalities and isolated cerebral Doppler changes with subtle deterioration and a high risk for unanticipated term stillbirth are characteristic for late-onset FGR. Nutritional deficiency manifested in lagging head growth is the most powerful predictor of developmental delay in all forms of FGR. Extremes of blood flow resistance and cardiovascular deterioration, prematurity and intracranial hemorrhage increase the risks for psychomotor delay and cerebral palsy. In late-onset FGR, regional cerebral vascular redistribution correlates with abnormal behavioral domains. Irrespective of the phenotype of FGR, prenatal tests that provide precise and independent stratification of risks for adverse neurodevelopment have yet to be determined.

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Prenatal Diagnosis by Fetal Magnetic Resonance Imaging

Girard

Chaumoître

2015

Genetic Disorders and the Fetus

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Differences in cortical development assessed by fetal MRI in late-onset intrauterine growth restriction

Cited by 98 publications

References 44 publications

Proton Magnetic Resonance Spectroscopy Assessment of Fetal Brain Metabolism in Late-Onset ‘Small for Gestational Age' versus ‘Intrauterine Growth Restriction' Fetuses

Proton Magnetic Resonance Spectroscopy Assessment of Fetal Brain Metabolism in Late-Onset ‘Small for Gestational Age' versus ‘Intrauterine Growth Restriction' Fetuses

Neurodevelopment after Fetal Growth Restriction

Prenatal Diagnosis by Fetal Magnetic Resonance Imaging

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