Neuroimaging and neurodevelopmental outcome after early fetal growth restriction: NEUROPROJECT—FGR

Abstract

BackgroundAdverse neurodevelopmental outcomes and MRI alterations are reported in infants born after fetal growth restriction (FGR). This study evaluates the additional role of FGR over prematurity in determining brain impairment. Methods Retrospective observational study comparing 48 FGR and 36 appropriate for gestational age infants born between 26 and 32 weeks' gestation who underwent a cerebral MRI at term equivalent age. Exclusion criteria were twins, congenital anomalies, and findings of overt brain lesions. Main outcomes were total maturation score (TMS) and cerebral areas independently measured by two neuro-radiologists and Griffiths or Bayley scale III scores at median age of 2 years. Results TMS was not significantly different between the groups. Inner calvarium and parenchyma's areas were significantly smaller in FGR cases. There were no significant differences in the average quotient scores. A positive correlation between parenchyma area and cognitive score was found (r = 0.372, p = 0.0078) and confirmed after adjusting for sex, gestational age, and birth weight (p = 0.0014). Among FGR, the subgroup with umbilical arterial Doppler velocimetry alterations had significantly worse gross motor scores (p = 0.005). Conclusions FGR plays additional role over prematurity in determining brain impairment. An early structural dimensional MRI evaluation may identify infants who are at higher risk. Impact  Fetal growth-restricted infants showed smaller cerebral parenchymal areas than preterm controls.  There is a positive correlation between the parenchyma area and the cognitive score.  These results highlight the already known link between structure and function and add importance to the role of a structural dimensional MRI evaluation even in the absence of overt brain lesions.

Impact of Maternal Environment and Inflammation on Fetal Neurodevelopment

“…Indeed, intrauterine chronic hypoxia is associated with a reduction in cortical grey and white matter [150], accompanied by a larger depth of the Sylvian fissure. Areas more sensitive to hypoxia include the hippocampus, amygdala, basal ganglia, thalamus, and cortical areas [151]. Moreover, FGR fetuses may undergo increased stress, resulting in higher cortisol levels that can impact gyrification [152].…”

“…Moreover, FGR fetuses may undergo increased stress, resulting in higher cortisol levels that can impact gyrification [152]. Following childbirth, a subsequent delay in both developmental and behavioral outcomes have been observed in the FGR offspring [149,151,152].…”

An externally validated normogram for predicting short-term pregnancy outcome of singleton pregnancies with fetal growth restriction (FGR)

“…FGR was described as the failure of the fetus to achieve its normal growth potential and is usually correlated to perinatal morbidity and mortality [2,3]. FGR infants have been reported to be correlated to increased risk of adverse perinatal outcomes (APOs) and almost half of stillbirths are proved to be associated with FGR in utero [4,5]. Gestational week (GW) has been discovered to be the strongest predictor of postnatal development [6,7].…”

Changes in structural brain development after selective fetal growth restriction in monochorionic twins

“…So far, in studies on the impact of FGR on brain structure and function, FGR singletons have been compared primarily to matched appropriate‐for‐gestational‐age singletons 4 , 7 . However, this study design is inherently biased by differences in genetic and maternal factors, which potentially influence outcomes and thereby limit comparability.…”