Increased Fetal Brain Perfusion and Neonatal Neurobehavioral Performance in Normally Grown Fetuses

Abstract

Objective: To explore the association between fetal cerebroplacental ratio (CPR) and frontal brain perfusion at third trimester with neonatal neurobehavioral performance in normally grown fetuses. Methods: CPR and frontal brain perfusion measured by fractional moving blood volume (FMBV) were assessed in 258 consecutive healthy fetuses at routine third trimester scan (32-35.6 weeks). Neonates were evaluated with the Neonatal Behavioral Assessment Scale. The association between Doppler parameters and neurobehavior was analyzed by MANCOVA (multiple analysis of covariance) and logistic regression, with adjustment for smoking, socioeconomic class, mode of delivery, gestational age at birth, postnatal days at examination and gender. Results: Fetuses with increased FMBV (in the upper quartile) had lower neurobehavioral scores in all areas, reaching significance in motor (5.6 vs. 5.8; p = 0.049), social (6 vs. 6.4; p = 0.006) and attention (5.3 vs. 5.9; p = 0.032). Fetuses with increased FMBV had higher risk of abnormal (<10th centile) motor (OR 3.3; 95% CI 1.36-8.1), social (OR 2.9; 95 CI% 1.33-6.5) and attention (OR 2.5; 95% CI 1.1-5.8) scores. Fetuses with lower CPR (in the lower quartile) did not differ in their neurobehavioral scores from those with normal values. Conclusions: Normally grown fetuses with increased frontal brain perfusion have poorer neurobehavioral competences, suggesting a disrupted neurological maturation. The results support the existence of forms of placental insufficiency not detected by current definitions of growth restriction.

Towards an Integrated Third-Trimester Screening in Pregnancy

“…These results are in line with another very recent study from the United States [13]. Finally, another study published in this issue reports that blood flow centralization at 34 weeks predicts poorer neonatal neurobehavior in fetuses with apparently normal growth [14]. This evidence supports new research to find better definitions of ‘fetal growth restriction', which do not merely take into account estimated fetal weight.…”

Assisted Reproductive Technologies Are Associated With Cardiovascular Remodeling In Utero That Persists Postnatally

“…33 Consequently, one could argue that by the same token, we cannot exclude that the whole distribution of fetal weights in our population was shifted to the left, reflecting a more general effect on fetal growth in ART fetuses. If this were the case, there would be forms of true fetal growth restriction that have been missed because of the lack of sensitivity of currently used definitions; therefore, the impact of fetal growth restriction on our results would be greater than is now apparent because hidden forms of growth restriction not detected by conventional criteria 33 might have affected the cardiac outcome of the ART pregnancies. We fully acknowledge that prematurity and fetal growth restriction may have significantly contributed to the cardiac findings rather than ART via a mechanism of altered fetal programming.…”

Neonatal Acid-Base Status in Term Fetuses: Mathematical Models Investigating Cerebroplacental Ratio and Birth Weight

“…Although one study described an increased frontal perfusion in AGA fetuses [27] , studies have not investigated the interrelationship of fetal Doppler with BW and neonatal pH in term fetuses. Our study is novel in this regard, and in the sense that it applies a new approach to evaluate these associations constructing 2D and 3D representations.…”