objective: fetuses with late growth restriction (FGR) have a higher risk of sub-optimal neurocognitive performance after birth. previous studies have reported that impaired brain and cortical development can start in utero. the primary aim of this study was to report midline structures and cortical development in fetuses with late growth restriction according to its severity; the secondary aim was to elucidate whether the severity of FGR, as defined by the presence of abnormal doppler findings, plays a role in affecting brain growth and maturation. methods: prospective cross-sectional study including fetuses with late FGR undergoing neurosonography between 32 and 34 weeks of gestation. midline structures (corpus callosum (CC) and cerebellar vermis (CV) length) and cortical development, including the depth of Sylvian (SF), parieto-occipital (POF) and calcarine (CF) were compared between FGR, small (SGA) and appropriate for gestational age (AGA) fetuses, defined upon the delphi criteria. sub-group analysis according to the severity of FGR (normal vs abnormal fetal dopplers) was also performed. univariate analysis was used to analyze the data. results: 52 FGR with normal, 60 with abnormal dopplers, 64 SGA and 100 AGA fetuses were included in the analysis. SGA and FGR fetuses showed significant differences in absolute values of CC (median (interquartile range) control 43.47 (28.9-56.05), vs SGA 41.85 (27.82-51.79), vs FGR ND 38.54 (29.12-50.53), vs FGR AD 31.72 (23.8-40.19) K= 26.68; p<0.0001), CV (control 24.85 (17.55-29.21), SGA K=16.71; p=0.0008), SF (control 14.52 (10.65-16.76) vs SGA 12.71 (9.8-15.10) vs FGR ND 11.93 (9.12-13.43) VS FGR A 8.30 (6.72-10.33) K=75.82; p<0.0001), POF (control 8.56 (6.31-11.09) vs SGA 8.11 (5.58-10.43) vs FGR ND 7.81 (6.14-9.29) vs FGR AD 6.56 (4.22-7.99), K=45.06; p<0.0001) and CF ( control 9.27 (6.70-11.45) vs SGA 8.23 (5.67-10.65) vs FGR ND 7.68 (5.22-9.41) vs FGR AD 6.26 (4.48-7.19) K=46.14; p<0.0001) when compared to AGA controls with a progressive reduction across groups. when neurosonographic variables were corrected for fetal HC values, significant difference in the length of CC, SF, POF and CF but CV were observed only in FGR fetuses with abnormal doppler when compared to AGA controls. conclusions: late onset small fetuses showed shorter CC length and a delayed cortical development when compared to control. after controlling for HC size these differences remain significant only in FGR fetuses with abnormal dopplers. these findings support the existence of a link between brain development and impaired placental function. this article is protected by copyright. all rights reserved.
Mappa, I., Marra, M.c., Pietrolucci, M.e., Lu, J., D'Antonio, F., Rizzo, G. (2024). Midline structures and cortical development in fetuses with late growth restriction according to Doppler status: prospective study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY [10.1002/uog.27598].
Midline structures and cortical development in fetuses with late growth restriction according to Doppler status: prospective study
Mappa, I.;Marra, M. C.;Pietrolucci, M. E.;Lu, J. L. A.;Rizzo, G.
2024-01-01
Abstract
objective: fetuses with late growth restriction (FGR) have a higher risk of sub-optimal neurocognitive performance after birth. previous studies have reported that impaired brain and cortical development can start in utero. the primary aim of this study was to report midline structures and cortical development in fetuses with late growth restriction according to its severity; the secondary aim was to elucidate whether the severity of FGR, as defined by the presence of abnormal doppler findings, plays a role in affecting brain growth and maturation. methods: prospective cross-sectional study including fetuses with late FGR undergoing neurosonography between 32 and 34 weeks of gestation. midline structures (corpus callosum (CC) and cerebellar vermis (CV) length) and cortical development, including the depth of Sylvian (SF), parieto-occipital (POF) and calcarine (CF) were compared between FGR, small (SGA) and appropriate for gestational age (AGA) fetuses, defined upon the delphi criteria. sub-group analysis according to the severity of FGR (normal vs abnormal fetal dopplers) was also performed. univariate analysis was used to analyze the data. results: 52 FGR with normal, 60 with abnormal dopplers, 64 SGA and 100 AGA fetuses were included in the analysis. SGA and FGR fetuses showed significant differences in absolute values of CC (median (interquartile range) control 43.47 (28.9-56.05), vs SGA 41.85 (27.82-51.79), vs FGR ND 38.54 (29.12-50.53), vs FGR AD 31.72 (23.8-40.19) K= 26.68; p<0.0001), CV (control 24.85 (17.55-29.21), SGA K=16.71; p=0.0008), SF (control 14.52 (10.65-16.76) vs SGA 12.71 (9.8-15.10) vs FGR ND 11.93 (9.12-13.43) VS FGR A 8.30 (6.72-10.33) K=75.82; p<0.0001), POF (control 8.56 (6.31-11.09) vs SGA 8.11 (5.58-10.43) vs FGR ND 7.81 (6.14-9.29) vs FGR AD 6.56 (4.22-7.99), K=45.06; p<0.0001) and CF ( control 9.27 (6.70-11.45) vs SGA 8.23 (5.67-10.65) vs FGR ND 7.68 (5.22-9.41) vs FGR AD 6.26 (4.48-7.19) K=46.14; p<0.0001) when compared to AGA controls with a progressive reduction across groups. when neurosonographic variables were corrected for fetal HC values, significant difference in the length of CC, SF, POF and CF but CV were observed only in FGR fetuses with abnormal doppler when compared to AGA controls. conclusions: late onset small fetuses showed shorter CC length and a delayed cortical development when compared to control. after controlling for HC size these differences remain significant only in FGR fetuses with abnormal dopplers. these findings support the existence of a link between brain development and impaired placental function. this article is protected by copyright. all rights reserved.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
