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Mappa I, Marra MC, Pietrolucci ME, Lu JLA, D'Antonio F, Rizzo G. Midline structures and cortical development in late-onset fetal growth restriction according to Doppler status: prospective study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 64:228-235. [PMID: 38279964 DOI: 10.1002/uog.27598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVES Fetuses with late-onset growth restriction (FGR) have a higher risk of suboptimal 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 structure growth and cortical development in fetuses with late-onset FGR 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 This was a prospective observational study that included fetuses with late-onset FGR (defined according to the Delphi FGR criteria) undergoing neurosonography between 32 and 34 weeks' gestation. Midline structure (corpus callosum (CC) and cerebellar vermis (CV)) length and cortical development, including the depth of the Sylvian (SF), parieto-occipital (POF) and calcarine (CF) fissures, were compared between late-onset FGR, small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) fetuses. Subgroup analysis according to the severity of FGR (normal vs abnormal fetal Doppler) was also performed. Univariate analysis was used to analyze the data. RESULTS A total of 52 late-onset FGR fetuses with normal Doppler findings, 60 late-onset FGR fetuses with abnormal Doppler findings, 64 SGA fetuses and 100 AGA fetuses were included in the analysis. When comparing AGA controls with SGA fetuses, late-onset FGR fetuses with normal Doppler findings and late-onset FGR fetuses with abnormal Doppler findings, there was a progressive and significant reduction in the absolute values of the following parameters: CC length (median (interquartile range (IQR)), 43.5 (28.9-56.1) mm vs 41.9 (27.8-51.8) mm vs 38.5 (29.1-50.5) mm vs 31.7 (23.8-40.2) mm; K = 26.68; P < 0.0001), SF depth (median (IQR), 14.5 (10.7-16.8) mm vs 12.7 (9.8-15.1) mm vs 11.9 (9.1-13.4) mm vs 8.3 (6.7-10.3) mm; K = 75.82; P < 0.0001), POF depth (median (IQR), 8.6 (6.3-11.1) mm vs 8.1 (5.6-10.4) mm vs 7.8 (6.1-9.3) mm vs 6.6 (4.2-8.0) mm; K = 45.06; P < 0.0001) and CF depth (median (IQR), 9.3 (6.7-11.5) mm vs 8.2 (5.7-10.7) mm vs 7.7 (5.2-9.4) mm vs 6.3 (4.5-7.2) mm; K = 46.14; P < 0.0001). Absolute CV length was significantly higher in AGA fetuses compared with all other groups, although the same progressive pattern was not noted (median (IQR), 24.9 (17.6-29.2) mm vs 21.6 (15.2-26.1) mm vs 19.1 (13.8-25.9) mm vs 21.0 (13.5-25.8) mm; K = 16.72; P = 0.0008). When the neurosonographic variables were corrected for fetal head circumference, a significant difference in the CC length and SF, POF and CF depths, but not CV length, was observed only in late-onset FGR fetuses with abnormal Doppler findings when compared with AGA and SGA fetuses. CONCLUSIONS Fetuses with late-onset FGR had shorter CC length and delayed cortical development when compared with AGA fetuses. After controlling for fetal head circumference, these differences remained significant only in late-onset FGR fetuses with abnormal Doppler. These findings support the existence of a link between brain development and impaired placental function. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- I Mappa
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - M C Marra
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - M E Pietrolucci
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - J L A Lu
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - F D'Antonio
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - G Rizzo
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
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Mappa I, Marra MC, Pietrolucci ME, Angela Lu JL, D'Antonio F, Rizzo G. Effects of umbilical vein flow on midbrain growth and cortical development in late onset fetal growth restricted fetuses: a prospective cross-sectional study. J Perinat Med 2024; 52:423-428. [PMID: 38296222 DOI: 10.1515/jpm-2023-0487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 12/23/2023] [Indexed: 05/04/2024]
Abstract
OBJECTIVES To investigate midbrain growth, including corpus callusum (CC) and cerebellar vermis (CV) and cortical development in late fetal growth restricted (FGR) subclassified according to the umbilical vein blood flow (UVBF) values. METHODS This was a prospective study on singleton fetuses late FGR with abnormal placental cerebral ratio (PCR). FGR fetuses were further subdivided into normal (≥fifth centile) and abnormal ( RESULTS The study cohort included 60 late FGR, 31 with normal UVBF/AC and 29 with abnormal UVBF/AC values. The latter group showed significant differences in CC (median (interquartile range (IQR) normal 0.96 (0.73-1.16) vs. abnormal UVBF/AC 0.60 (0.47-0.87); p<0.0001)), CV (normal 1.04 (0.75-1.26) vs. abnormal UVBF (AC 0.76 (0.62-1.18)); p=0.0319), SF (normal 0.83 (0.74-0.93) vs. abnormal UVBF/AC 0.56 (0.46-0.68); p<0.0001), POF (normal 0.80 (0.71-0.90) vs. abnormal UVBF/AC l 0.49 (0.39-0.90); p≤0.0072) and CF (normal 0.83 (0.56-1.01) vs. abnormal UVBF/AC 0.72 (0.53-0.80); p<0.029). CONCLUSIONS Late onset FGR fetuses with of reduced umbilical vein flow showed shorter CC and CV length and a delayed cortical development when compared to those with normal umbilical vein hemodynamics. These findings support the existence of a link between abnormal brain development and changes in umbilical vein circulation.
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Affiliation(s)
- Ilenia Mappa
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Maria Chiara Marra
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Maria Elena Pietrolucci
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Jia Li Angela Lu
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Francesco D'Antonio
- Department of Obstetrics and Gynecology, Università di Chieti, Chieti, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology, Università di Chieti, Chieti, Italy
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Murillo C, Eixarch E, Rueda C, Larroya M, Boada D, Grau L, Ponce J, Aldecoa V, Monterde E, Ferrero S, Andreu-Fernández V, Arca G, Oleaga L, Ros O, Hernández MP, Gratacós E, Palacio M, Cobo T. Evidence of brain injury in fetuses of mothers with preterm labor with intact membranes and preterm premature rupture of membranes. Am J Obstet Gynecol 2024:S0002-9378(24)00531-3. [PMID: 38685550 DOI: 10.1016/j.ajog.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/10/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Brain injury and poor neurodevelopment have been consistently reported in infants and adults born before term. These changes occur, at least in part, prenatally and are associated with intra-amniotic inflammation. The pattern of brain changes has been partially documented by magnetic resonance imaging but not by neurosonography along with amniotic fluid brain injury biomarkers. OBJECTIVE This study aimed to evaluate the prenatal features of brain remodeling and injury in fetuses from patients with preterm labor with intact membranes or preterm premature rupture of membranes and to investigate the potential influence of intra-amniotic inflammation as a risk mediator. STUDY DESIGN In this prospective cohort study, fetal brain remodeling and injury were evaluated using neurosonography and amniocentesis in singleton pregnant patients with preterm labor with intact membranes or preterm premature rupture of membranes between 24.0 and 34.0 weeks of gestation, with (n=41) and without (n=54) intra-amniotic inflammation. The controls for neurosonography were outpatient pregnant patients without preterm labor or preterm premature rupture of membranes matched 2:1 by gestational age at ultrasound. Amniotic fluid controls were patients with an amniocentesis performed for indications other than preterm labor or preterm premature rupture of membranes without brain or genetic defects whose amniotic fluid was collected in our biobank for research purposes matched by gestational age at amniocentesis. The group with intra-amniotic inflammation included those with intra-amniotic infection (microbial invasion of the amniotic cavity and intra-amniotic inflammation) and those with sterile inflammation. Microbial invasion of the amniotic cavity was defined as a positive amniotic fluid culture and/or positive 16S ribosomal RNA gene. Inflammation was defined by amniotic fluid interleukin 6 concentrations of >13.4 ng/mL in preterm labor and >1.43 ng/mL in preterm premature rupture of membranes. Neurosonography included the evaluation of brain structure biometric parameters and cortical development. Neuron-specific enolase, protein S100B, and glial fibrillary acidic protein were selected as amniotic fluid brain injury biomarkers. Data were adjusted for cephalic biometrics, fetal growth percentile, fetal sex, noncephalic presentation, and preterm premature rupture of membranes at admission. RESULTS Fetuses from mothers with preterm labor with intact membranes or preterm premature rupture of membranes showed signs of brain remodeling and injury. First, they had a smaller cerebellum. Thus, in the intra-amniotic inflammation, non-intra-amniotic inflammation, and control groups, the transcerebellar diameter measurements were 32.7 mm (interquartile range, 29.8-37.6), 35.3 mm (interquartile range, 31.2-39.6), and 35.0 mm (interquartile range, 31.3-38.3), respectively (P=.019), and the vermian height measurements were 16.9 mm (interquartile range, 15.5-19.6), 17.2 mm (interquartile range, 16.0-18.9), and 17.1 mm (interquartile range, 15.7-19.0), respectively (P=.041). Second, they presented a lower corpus callosum area (0.72 mm2 [interquartile range, 0.59-0.81], 0.71 mm2 [interquartile range, 0.63-0.82], and 0.78 mm2 [interquartile range, 0.71-0.91], respectively; P=.006). Third, they showed delayed cortical maturation (the Sylvian fissure depth-to-biparietal diameter ratios were 0.14 [interquartile range, 0.12-0.16], 0.14 [interquartile range, 0.13-0.16], and 0.16 [interquartile range, 0.15-0.17], respectively [P<.001], and the right parieto-occipital sulci depth ratios were 0.09 [interquartile range, 0.07-0.12], 0.11 [interquartile range, 0.09-0.14], and 0.11 [interquartile range, 0.09-0.14], respectively [P=.012]). Finally, regarding amniotic fluid brain injury biomarkers, fetuses from mothers with preterm labor with intact membranes or preterm premature rupture of membranes had higher concentrations of neuron-specific enolase (11,804.6 pg/mL [interquartile range, 6213.4-21,098.8], 8397.7 pg/mL [interquartile range, 3682.1-17,398.3], and 2393.7 pg/mL [interquartile range, 1717.1-3209.3], respectively; P<.001), protein S100B (2030.6 pg/mL [interquartile range, 993.0-4883.5], 1070.3 pg/mL [interquartile range, 365.1-1463.2], and 74.8 pg/mL [interquartile range, 44.7-93.7], respectively; P<.001), and glial fibrillary acidic protein (1.01 ng/mL [interquartile range, 0.54-3.88], 0.965 ng/mL [interquartile range, 0.59-2.07], and 0.24 mg/mL [interquartile range, 0.20-0.28], respectively; P=.002). CONCLUSION Fetuses with preterm labor with intact membranes or preterm premature rupture of membranes had prenatal signs of brain remodeling and injury at the time of clinical presentation. These changes were more pronounced in fetuses with intra-amniotic inflammation.
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Affiliation(s)
- Clara Murillo
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Elisenda Eixarch
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain; Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Madrid, Spain
| | - Claudia Rueda
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Marta Larroya
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - David Boada
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain
| | - Laia Grau
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain
| | - Júlia Ponce
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain
| | - Victoria Aldecoa
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain
| | - Elena Monterde
- Biosanitary Research Institute, Valencian International University (VIU), Valencia, Spain. Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer (IIS-FRCB-IDIBAPS), Universitat de Barcelona. Barcelona, Spain
| | - Silvia Ferrero
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain
| | - Vicente Andreu-Fernández
- Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain; Biosanitary Research Institute, Valencian International University, Valencia, Spain
| | - Gemma Arca
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Laura Oleaga
- Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain; Department of Radiology, Clinical Diagnostic Imaging Centre, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Olga Ros
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain
| | - Maria Pilar Hernández
- Department of Radiology, Clinical Diagnostic Imaging Centre, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Eduard Gratacós
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain; Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Madrid, Spain.
| | - Montse Palacio
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain; Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Madrid, Spain
| | - Teresa Cobo
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain; Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Madrid, Spain
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Marra MC, Mappa I, Pietrolucci ME, Lu JLA, D' Antonio F, Rizzo G. Fetal brain development in pregnancies complicated by gestational diabetes mellitus. J Perinat Med 2024; 52:310-316. [PMID: 38231478 DOI: 10.1515/jpm-2023-0456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/23/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVES Gestational diabetes mellitus (GDM) carries an increased risk of neurocognitive impairment in offsprings. However, the contribution of maternal hyperglycemia in affecting fetal brain development is not fully elucidated yet. The aim of this study was to evaluate fetal brain and sulci development in pregnancies complicated by GDM. METHODS Prospective observational study including 100 singleton pregnancies complicated by GDM and 100 matched controls. All fetuses underwent neurosonography at 29-34 weeks of gestation, including the assessment of the length of the corpus callosum (CC), cerebellar vermis (CV), Sylvian (SF), parieto-occipital (POF) and calcarine fissures (CF). Sub-group analysis according to the specific treatment regimen adopted (n 67 diet vs. 33 insulin therapy) was also performed. RESULTS Fetuses from mothers with GDM under insulin therapy had a smaller CC (35.54 mm) compared to both controls (40 mm; p<0.001) and women with GDM under diet (39.26 mm; p=0.022) while there was no difference in the HC between the groups. Likewise, when corrected for HC, CV depth was smaller in fetuses with GDM both under insulin therapy (7.03 mm) and diet (7.05 mm,) compared to controls (7.36 mm; p=0.013). Finally, when assessing the sulci development of the brain SF (p≤0.0001), POF (p≤0.0001) and CF (p≤0.0001) were significantly smaller in fetuses with maternal GDM. Post-hoc analysis showed that fetuses of GDM mothers requiring insulin therapy had significantly lower values of SF (p=0.032), POF (p=0.016) and CF (p=0.001). CONCLUSIONS Pregnancies complicated by GDM showed a peculiar pattern of fetal brain growth and cortical development and these changes, which are more evident in those requiring insulin supplementation.
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Affiliation(s)
- Maria Chiara Marra
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Maria Elena Pietrolucci
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Jia Li Angela Lu
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | | | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
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Putra M, Peek E, Hobbins JC. Fetal insular measurements in pregnancy with estimated fetal weight <10th centile and childhood neurodevelopmental outcomes. Am J Obstet Gynecol 2024; 230:85.e1-85.e15. [PMID: 37442246 DOI: 10.1016/j.ajog.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND A growing body of evidence suggests that fetal growth restriction is associated with changes in brain structures as a result of chronic hypoxia. However, less is known about the effects of growth restriction on the fetal insula, particularly in less severely affected late-onset growth-restricted fetuses. OBJECTIVE This study aimed to (1) compare sonographic insular measurements between fetal-growth restricted, small-for-gestational-age, and appropriate-for-gestational-age control fetuses; and (2) evaluate the association of sonographic insular measurements with perinatal and neurodevelopmental outcomes in fetuses categorized as fetal-growth restricted or small-for-gestational-age. STUDY DESIGN This was a cohort study of singleton nonanomalous pregnancies with an estimated fetal weight <10th centile. Using data from the last examination before delivery, fetal insular depth, Sylvian fissure depth, hypoechoic insular zone thickness, circumference, and area were measured. All measurements were adjusted for by head circumference. Neurodevelopmental outcomes were evaluated at 2 to 3 years of age using the Bayley-III scales. Kruskal-Wallis H tests were performed to compare insular measurements between groups. Paired t tests were used to compare insular measurements between appropriate-for-gestational-age fetuses and gestational age-matched growth-restricted fetuses. Insular measurements for patients with and without an adverse perinatal outcome were compared using independent-samples t-tests. Spearman correlations were performed to evaluate the relationship of insular measurements to the percentile scores for each of the 5 Bayley-III subscales and to a summative percentile of these subscales. RESULTS A total of 89 pregnancies were included in the study; 68 of these pregnancies had an estimated fetal weight <10th percentile (fetal-growth restricted: n=39; small-for-gestational-age: n=29). The appropriate-for-gestational-age cohort consisted of 21 pregnancies. The gestational age at measurement was similar between fetal-growth restricted and small-for-gestational-age groups, but lower in the appropriate-for-gestational-age group. Differences between groups were noted in normalized insular depth, Sylvian fissure depth, and hypoechoic insular zone (P<.01). Normalized insular depth and hypoechoic insular zone circumference were larger in the growth-restricted cohort (P<.01). Normalized Sylvian fissure depth was smaller in the growth-restricted cohort (P<.01). There were no significant differences in insular measurements between pregnancies with and without an adverse perinatal outcome. Bayley-III results were available in 32 of the growth-restricted cases. Of all insular measurements, hypoechoic insular zone circumference was inversely correlated with the adaptive behavior Bayley-III score. CONCLUSION In our cohort, fetuses with estimated fetal weight <10th percentile had smaller Sylvian fissure depths and larger insular depths and hypoechoic insular zone circumferences than normally grown controls. A larger hypoechoic insular zone circumference was substantially correlated with worse neurodevelopmental outcomes in early childhood. We speculate that enlargement of this region may be an indication of accelerated neuronal maturation in growth-restricted fetuses with mild hypoxia.
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Affiliation(s)
- Manesha Putra
- University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Emma Peek
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | - John C Hobbins
- University of Colorado Anschutz Medical Campus, Aurora, CO
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Nakaki A, Crovetto F, Urru A, Piella G, Borras R, Comte V, Vellvé K, Paules C, Segalés L, Dacal M, Gomez Y, Youssef L, Casas R, Castro-Barquero S, Martín-Asuero A, Oller Guzmán T, Morilla I, Martínez-Àran A, Camacho A, Pascual Tutusaus M, Arranz A, Rebollo-Polo M, Gomez-Chiari M, Bargallo N, Pozo ÓJ, Gomez-Gomez A, Izquierdo Renau M, Eixarch E, Vieta E, Estruch R, Crispi F, Gonzalez-Ballester MA, Gratacós E. Effects of Mediterranean diet or mindfulness-based stress reduction on fetal and neonatal brain development: a secondary analysis of a randomized clinical trial. Am J Obstet Gynecol MFM 2023; 5:101188. [PMID: 37839546 DOI: 10.1016/j.ajogmf.2023.101188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/13/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Maternal suboptimal nutrition and high stress levels are associated with adverse fetal and infant neurodevelopment. OBJECTIVE This study aimed to investigate if structured lifestyle interventions involving a Mediterranean diet or mindfulness-based stress reduction during pregnancy are associated with differences in fetal and neonatal brain development. STUDY DESIGN This was a secondary analysis of the randomized clinical trial Improving Mothers for a Better Prenatal Care Trial Barcelona that was conducted in Barcelona, Spain, from 2017 to 2020. Participants with singleton pregnancies were randomly allocated into 3 groups, namely Mediterranean diet intervention, stress reduction program, or usual care. Participants in the Mediterranean diet group received monthly individual sessions and free provision of extra-virgin olive oil and walnuts. Pregnant women in the stress reduction group underwent an 8-week mindfulness-based stress reduction program adapted for pregnancy. Magnetic resonance imaging of 90 fetal brains was performed at 36 to 39 weeks of gestation and the Neonatal Neurobehavioral Assessment Scale was completed for 692 newborns at 1 to 3 months. Fetal outcomes were the total brain volume and lobular or regional volumes obtained from a 3-dimensional reconstruction and semiautomatic segmentation of magnetic resonance images. Neonatal outcomes were the 6 clusters scores of the Neonatal Neurobehavioral Assessment Scale. Multiple regression analyses were conducted to assess the association between the interventions and the fetal and neonatal outcomes. RESULTS When compared with the usual care group, the offspring exposed to a maternal Mediterranean diet had a larger total fetal brain volume (mean, 284.11 cm3; standard deviation, 23.92 cm3 vs 294.01 cm3; standard deviation, 26.29 cm3; P=.04), corpus callosum (mean, 1.16 cm3; standard deviation, 0.19 cm3 vs 1.26 cm3; standard deviation, 0.22 cm3; P=.03), and right frontal lobe (44.20; standard deviation, 4.09 cm3 vs 46.60; standard deviation, 4.69 cm3; P=.02) volumes based on magnetic resonance imaging measures and higher scores in the Neonatal Neurobehavioral Assessment Scale clusters of autonomic stability (mean, 7.4; standard deviation, 0.9 vs 7.6; standard deviation, 0.7; P=.04), social interaction (mean, 7.5; standard deviation, 1.5 vs 7.8; standard deviation, 1.3; P=.03), and range of state (mean, 4.3; standard deviation, 1.3 vs 4.5; standard deviation, 1.0; P=.04). When compared with the usual care group, offspring from the stress reduction group had larger fetal left anterior cingulate gyri volume (1.63; standard deviation, 0.32 m3 vs 1.79; standard deviation, 0.30 cm3; P=.03) based on magnetic resonance imaging and higher scores in the Neonatal Neurobehavioral Assessment Scale for regulation of state (mean, 6.0; standard deviation, 1.8 vs 6.5; standard deviation, 1.5; P<.01). CONCLUSION Maternal structured lifestyle interventions involving the promotion of a Mediterranean diet or stress reduction during pregnancy were associated with changes in fetal and neonatal brain development.
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Affiliation(s)
- Ayako Nakaki
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (Drs Nakaki, Bargallo, Eixarch, Crispi and Gratacos); Department of Surgery and Surgical specializations, Faculty of Medicine and Helath Sciences, University of Barcelona, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Castro-Barquero, Arranz, Eixarch, Crispi and Gratacos)
| | - Francesca Crovetto
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos); Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain (Drs Crovetto, Izquierdo Renau, and Gratacos)
| | - Andrea Urru
- BCN MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (Drs Urru and Piella, Mr Comte, and Dr Gonzalez-Ballester)
| | - Gemma Piella
- BCN MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (Drs Urru and Piella, Mr Comte, and Dr Gonzalez-Ballester)
| | - Roger Borras
- Cardiovascular Institute, Hospital Clínic, IDIBAPS, Universitat Autònoma de Barcelona, Barcelona, Spain (Mr Borras); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain (Mr Borras and Dr Bargallo)
| | - Valentin Comte
- BCN MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (Drs Urru and Piella, Mr Comte, and Dr Gonzalez-Ballester)
| | - Kilian Vellvé
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos)
| | - Cristina Paules
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos)
| | - Laura Segalés
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos)
| | - Marta Dacal
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos)
| | - Yvan Gomez
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos)
| | - Lina Youssef
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos); Josep Carreras Leukaemia Research Institute, Hospital Clinic, University of Barcelona Campus, Barcelona, Spain (Dr Youssef)
| | - Rosa Casas
- Department of Internal Medicine Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain (Drs Casas, Castro-Barquero, and Estruch); Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERON), Madrid, Spain (Drs Casas, Castro-Barquero, and Estruch)
| | - Sara Castro-Barquero
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos); Department of Internal Medicine Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain (Drs Casas, Castro-Barquero, and Estruch); Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERON), Madrid, Spain (Drs Casas, Castro-Barquero, and Estruch)
| | - Andrés Martín-Asuero
- Instituto esMindfulness, Barcelona, Spain (Dr Martín-Asuero and Ms Oller Guzmán)
| | - Teresa Oller Guzmán
- Instituto esMindfulness, Barcelona, Spain (Dr Martín-Asuero and Ms Oller Guzmán)
| | - Ivette Morilla
- Department of Psychiatry and Psychology, Hospital Clinic, Neuroscience Institute, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Spain (Drs Morilla, Martínez-Àran, and Vieta)
| | - Anabel Martínez-Àran
- Department of Psychiatry and Psychology, Hospital Clinic, Neuroscience Institute, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Spain (Drs Morilla, Martínez-Àran, and Vieta)
| | - Alba Camacho
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos)
| | - Mireia Pascual Tutusaus
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos)
| | - Angela Arranz
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos)
| | - Monica Rebollo-Polo
- Diagnostic Imaging and Image Guided Therapy, Institut de Recerca Sant Joan de Dèu, Esplugues de Llobregat, Spain (Drs Rebollo-Polo and Gomez-Chiari); Radiology Department, Hôpitaux Universitaires de Genève, Geneva, Switzerland (Dr Rebollo-Polo)
| | - Marta Gomez-Chiari
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos); Diagnostic Imaging and Image Guided Therapy, Institut de Recerca Sant Joan de Dèu, Esplugues de Llobregat, Spain (Drs Rebollo-Polo and Gomez-Chiari); Diagnostic Imaging Department, Hospital Sant Joan de Dèu, Esplugues de Llobregat, Spain (Dr Gomez-Chiari)
| | - Nuria Bargallo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (Drs Nakaki, Bargallo, Eixarch, Crispi and Gratacos); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain (Mr Borras and Dr Bargallo); Radiology Department, Center of Image Diagnostic, Hospital Clínic. Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain (Dr Bargallo)
| | - Óscar J Pozo
- Applied Metabolomics Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (Drs Pozo and Gomez-Gomez)
| | - Alex Gomez-Gomez
- Applied Metabolomics Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (Drs Pozo and Gomez-Gomez)
| | - Montserrat Izquierdo Renau
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain (Drs Crovetto, Izquierdo Renau, and Gratacos); Neonatology Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain (Dr Izquierdo Renau)
| | - Elisenda Eixarch
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (Drs Nakaki, Bargallo, Eixarch, Crispi and Gratacos); Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain (Drs Eixarch, Crispi, and Gratacos)
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Hospital Clinic, Neuroscience Institute, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Spain (Drs Morilla, Martínez-Àran, and Vieta)
| | - Ramon Estruch
- Department of Internal Medicine Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain (Drs Casas, Castro-Barquero, and Estruch); Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERON), Madrid, Spain (Drs Casas, Castro-Barquero, and Estruch)
| | - Fàtima Crispi
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (Drs Nakaki, Bargallo, Eixarch, Crispi and Gratacos); Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain (Drs Eixarch, Crispi, and Gratacos).
| | - Miguel Angel Gonzalez-Ballester
- BCN MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (Drs Urru and Piella, Mr Comte, and Dr Gonzalez-Ballester); ICREA, Barcelona, Spain (Dr Gonzalez-Ballester)
| | - Eduard Gratacós
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (Drs Nakaki, Bargallo, Eixarch, Crispi and Gratacos); Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain (Drs Crovetto, Izquierdo Renau, and Gratacos); Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain (Drs Eixarch, Crispi, and Gratacos)
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7
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De Asis-Cruz J, Kim JH, Krishnamurthy D, Lopez C, Kapse K, Andescavage N, Vezina G, Limperopoulos C. Examining the relationship between fetal cortical thickness, gestational age, and maternal psychological distress. Dev Cogn Neurosci 2023; 63:101282. [PMID: 37515833 PMCID: PMC10407290 DOI: 10.1016/j.dcn.2023.101282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023] Open
Abstract
In utero exposure to maternal stress, anxiety, and depression has been associated with reduced cortical thickness (CT), and CT changes, in turn, to adverse neuropsychiatric outcomes. Here, we investigated global and regional (G/RCT) changes associated with fetal exposure to maternal psychological distress in 265 brain MRI studies from 177 healthy fetuses of low-risk pregnant women. GCT was measured from cortical gray matter (CGM) voxels; RCT was estimated from 82 cortical regions. GCT and RCT in 87% of regions strongly correlated with GA. Fetal exposure was most strongly associated with RCT in the parahippocampal region, ventromedial prefrontal cortex, and supramarginal gyrus suggesting that cortical alterations commonly associated with prenatal exposure could emerge in-utero. However, we note that while regional fetal brain involvement conformed to patterns observed in newborns and children exposed to prenatal maternal psychological distress, the reported associations did not survive multiple comparisons correction. This could be because the effects are more subtle in this early developmental window or because majority of the pregnant women in our study did not experience high levels of maternal distress. It is our hope that the current findings will spur future hypothesis-driven studies that include a full spectrum of maternal mental health scores.
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Affiliation(s)
| | - Jung-Hoon Kim
- Developing Brain Institute, Children's National, Washington, DC, USA
| | | | - Catherine Lopez
- Developing Brain Institute, Children's National, Washington, DC, USA
| | - Kushal Kapse
- Developing Brain Institute, Children's National, Washington, DC, USA
| | - Nickie Andescavage
- Developing Brain Institute, Children's National, Washington, DC, USA; Division of Neonatology, Children's National Medical Center, Washington, DC, USA
| | - Gilbert Vezina
- Division of Diagnostic Imaging and Radiology, Children's National, Washington, DC, USA
| | - Catherine Limperopoulos
- Developing Brain Institute, Children's National, Washington, DC, USA; Division of Diagnostic Imaging and Radiology, Children's National, Washington, DC, USA.
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8
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Andescavage N, Bullen T, Liggett M, Barnett SD, Kapse A, Kapse K, Ahmadzia H, Vezina G, Quistorff J, Lopez C, duPlessis A, Limperopoulos C. Impaired in vivo feto-placental development is associated with neonatal neurobehavioral outcomes. Pediatr Res 2023; 93:1276-1284. [PMID: 36335267 PMCID: PMC10147575 DOI: 10.1038/s41390-022-02340-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Fetal growth restriction (FGR) is a risk factor for neurodevelopmental problems, yet remains poorly understood. We sought to examine the relationship between intrauterine development and neonatal neurobehavior in pregnancies diagnosed with antenatal FGR. METHODS We recruited women with singleton pregnancies diagnosed with FGR and measured placental and fetal brain volumes using MRI. NICU Network Neurobehavioral Scale (NNNS) assessments were performed at term equivalent age. Associations between intrauterine volumes and neurobehavioral outcomes were assessed using generalized estimating equation models. RESULTS We enrolled 44 women diagnosed with FGR who underwent fetal MRI and 28 infants underwent NNNS assessments. Placental volumes were associated with increased self-regulation and decreased excitability; total brain, brainstem, cortical and subcortical gray matter (SCGM) volumes were positively associated with higher self-regulation; SCGM also was positively associated with higher quality of movement; increasing cerebellar volumes were positively associated with attention, decreased lethargy, non-optimal reflexes and need for special handling; brainstem volumes also were associated with decreased lethargy and non-optimal reflexes; cerebral and cortical white matter volumes were positively associated with hypotonicity. CONCLUSION Disrupted intrauterine growth in pregnancies complicated by antenatally diagnosed FGR is associated with altered neonatal neurobehavior. Further work to determine long-term neurodevelopmental impacts is warranted. IMPACT Fetal growth restriction is a risk factor for adverse neurodevelopment, but remains difficult to accurately identify. Intrauterine brain volumes are associated with infant neurobehavior. The antenatal diagnosis of fetal growth restriction is a risk factor for abnormal infant neurobehavior.
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Affiliation(s)
- Nickie Andescavage
- Division of Neonatology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
- Prenatal Pediatric Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Theresa Bullen
- School of Medicine, George Washington University, Washington, DC, USA
| | - Melissa Liggett
- Division of Psychology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Scott D Barnett
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Anushree Kapse
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Kushal Kapse
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Homa Ahmadzia
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, George Washington University, 2300 Eye St. NW, Washington, DC, 20037, USA
| | - Gilbert Vezina
- Division of Radiology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
- Department of Radiology, George Washington University, 2300 Eye St. NW, Washington, DC, 20037, USA
| | - Jessica Quistorff
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Catherine Lopez
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Adre duPlessis
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
- Prenatal Pediatric Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
- Department of Pediatrics, George Washington University, 2300 Eye St. NW, Washington, DC, 20037, USA
| | - Catherine Limperopoulos
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA.
- Department of Radiology, George Washington University, 2300 Eye St. NW, Washington, DC, 20037, USA.
- Department of Pediatrics, George Washington University, 2300 Eye St. NW, Washington, DC, 20037, USA.
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9
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De Asis-Cruz J, Limperopoulos C. Harnessing the Power of Advanced Fetal Neuroimaging to Understand In Utero Footprints for Later Neuropsychiatric Disorders. Biol Psychiatry 2022; 93:867-879. [PMID: 36804195 DOI: 10.1016/j.biopsych.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/03/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
Adverse intrauterine events may profoundly impact fetal risk for future adult diseases. The mechanisms underlying this increased vulnerability are complex and remain poorly understood. Contemporary advances in fetal magnetic resonance imaging (MRI) have provided clinicians and scientists with unprecedented access to in vivo human fetal brain development to begin to identify emerging endophenotypes of neuropsychiatric disorders such as autism spectrum disorder, attention-deficit/hyperactivity disorder, and schizophrenia. In this review, we discuss salient findings of normal fetal neurodevelopment from studies using advanced, multimodal MRI that have provided unparalleled characterization of in utero prenatal brain morphology, metabolism, microstructure, and functional connectivity. We appraise the clinical utility of these normative data in identifying high-risk fetuses before birth. We highlight available studies that have investigated the predictive validity of advanced prenatal brain MRI findings and long-term neurodevelopmental outcomes. We then discuss how ex utero quantitative MRI findings can inform in utero investigations toward the pursuit of early biomarkers of risk. Lastly, we explore future opportunities to advance our understanding of the prenatal origins of neuropsychiatric disorders using precision fetal imaging.
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10
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Zheng W, Zhang X, Feng Y, Liu B, Zhu J, Zou Y, Qin J, Li B. Association of Corpus Callosum Development With Fetal Growth Restriction and Maternal Preeclampsia or Gestational Hypertension. JAMA Netw Open 2022; 5:e2226696. [PMID: 35969398 PMCID: PMC9379741 DOI: 10.1001/jamanetworkopen.2022.26696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE It remains unknown whether neurodevelopmental impairments are directly associated with the structural development of the brain in offspring with fetal growth restriction (FGR) and mothers with preeclampsia (PE) or gestational hypertension (GH). OBJECTIVES To assess whether fetal corpus callosum (CC) development differed among pregnancies with PE or GH with FGR, pregnancies with PE or GH without FGR, and normotensive pregnancies, particularly the severity of maternal disease and FGR, and to identify the association between adverse perinatal outcomes and structural development of the CC in fetuses with FGR in pregnancies with PE or GH. DESIGN, SETTING, AND PARTICIPANTS This retrospective matched case-control study was conducted between January 1, 2014, and January 31, 2021, at Women's Hospital, Zhejiang University School of Medicine in Hangzhou, China. The participant group included cases of singleton pregnancies with PE or GH with FGR; the control groups included cases with PG or GH without FGR and cases with paired normotensive pregnancy. EXPOSURES Maternal PE or GH and FGR. MAIN OUTCOMES AND MEASURES The length, thickness, total area, subdivision areas, and apparent diffusion coefficient (ADC) values of fetal CC were measured on magnetic resonance imaging (MRI) and analyzed. The association between adverse perinatal outcomes and structural development of CC was further investigated. RESULTS A total of 56 pregnant individuals with singleton pregnancies and PE or GH and fetuses with FGR were enrolled (maternal median [IQR] age, 29.0 [26.0-34.0] years; mean [SD] gestational age at MRI, 33.6 [2.5] weeks). Significant patterns of decreased median (IQR) fetal CC length (0.4284 [0.4079-0.4470] mm vs 0.4614 [0.4461-0.4944] mm, P < .001, vs 0.4591 [0.4310-0.4927] mm, P < .001) and mean (SD) CC total area (1.0779 [0.1931] mm2 vs 1.1896 [0.1803] mm2, P = .001, vs 1.1438 [0.1935] mm2, P = .02), adjusted for the cephalic index, was observed in cases of PE or GH with FGR compared with cases without FGR and cases with normotensive pregnancy. The splenium region of fetal CC also exhibited the distinct alterations in macrostructural development (with FGR: 0.3149 [0.0697] mm2 vs without FGR: 0.3727 [0.0698] mm2, P < .001, vs normotensive pregnancies: 0.3565 [0.0763] mm2, P < .001) and microstructural development (median [IQR] ADC values: 1.47 [1.38-1.57] × 10-3 mm2/s vs 1.57 [1.53-1.63] × 10-3 mm2/s, P = .009, vs 1.63 [1.50-1.70] × 10-3 mm2/s, P < .001) in all groups. Furthermore, significant associations were found between structural abnormality of the splenium region and adverse perinatal outcomes in the PE or GH with FGR group (mean [SD] ADC value: 1.40 [0.07] × 10-3 mm2/s; P = .04). CONCLUSIONS AND RELEVANCE Results of this study suggest that, in fetuses with FGR in pregnancies with PE or GH, decreased structural development of the CC, predominantly the splenium region, may be significantly associated with a higher risk of adverse perinatal outcomes and may be regarded as an MRI-based biomarker for better prenatal counseling and early management decisions.
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Affiliation(s)
- Weizeng Zheng
- Department of Radiology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaodan Zhang
- Department of Radiology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Feng
- Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bingqing Liu
- Department of Women’s Health, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiajun Zhu
- Department of Neonatology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yu Zou
- Department of Radiology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiale Qin
- Department of Ultrasound, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Women’s Reproductive Health Key Laboratory of Zhejiang Province, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Baohua Li
- Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Women’s Reproductive Health Key Laboratory of Zhejiang Province, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
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11
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Parikh AN, Triplett RL, Wu TJ, Arora J, Lukas K, Smyser TA, Miller JP, Luby JL, Rogers CE, Barch DM, Warner BB, Smyser CD. Neonatal Intensive Care Unit Network Neurobehavioral Scale Profiles in Full-Term Infants: Associations with Maternal Adversity, Medical Risk, and Neonatal Outcomes. J Pediatr 2022; 246:71-79.e3. [PMID: 35430247 PMCID: PMC10030163 DOI: 10.1016/j.jpeds.2022.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 03/01/2022] [Accepted: 04/08/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To examine healthy, full-term neonatal behavior using the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) in relation to measures of maternal adversity, maternal medical risk, and infant brain volumes. STUDY DESIGN This was a prospective, longitudinal, observational cohort study of pregnant mothers followed from the first trimester and their healthy, full-term infants. Infants underwent an NNNS assessment and high-quality magnetic resonance imaging 2-5 weeks after birth. A latent profile analysis of NNNS scores categorized infants into neurobehavioral profiles. Univariate and multivariate analyses compared differences in maternal factors (social advantage, psychosocial stress, and medical risk) and neonatal characteristics between profiles. RESULTS The latent profile analysis of NNNS summary scales of 296 infants generated 3 profiles: regulated (46.6%), hypotonic (16.6%), and fussy (36.8%). Infants with a hypotonic profile were more likely to be male (χ2 = 8.601; P = .014). Fussy infants had smaller head circumferences (F = 3.871; P = .022) and smaller total brain (F = 3.522; P = .031) and cerebral white matter (F = 3.986; P = .020) volumes compared with infants with a hypotonic profile. There were no differences between profiles in prenatal maternal health, social advantage, or psychosocial stress. CONCLUSIONS Three distinct neurobehavioral profiles were identified in healthy, full-term infants with hypotonic and fussy neurobehavioral features related to neonatal brain volumes and head circumference, but not prenatal exposure to socioeconomic or psychosocial adversity. Follow-up beyond the neonatal period will determine if identified profiles at birth are associated with subsequent clinical or developmental outcomes.
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Affiliation(s)
- Amisha N Parikh
- School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Regina L Triplett
- Department of Neurology, Washington University in St. Louis, St. Louis, MO.
| | - Tiffany J Wu
- School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Jyoti Arora
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO
| | - Karen Lukas
- Department of Neurology, Washington University in St. Louis, St. Louis, MO
| | - Tara A Smyser
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO
| | - J Philip Miller
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO
| | - Joan L Luby
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO
| | - Cynthia E Rogers
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO; Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Deanna M Barch
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO; Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO; Department of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Barbara B Warner
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Christopher D Smyser
- Department of Neurology, Washington University in St. Louis, St. Louis, MO; Department of Pediatrics, Washington University in St. Louis, St. Louis, MO; Department of Radiology, Washington University in St. Louis, St. Louis, MO
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12
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Basso A, Youssef L, Nakaki A, Paules C, Miranda J, Casu G, Salazar L, Gratacos E, Eixarch E, Crispi F, Crovetto F. Fetal neurosonography at 31-35 weeks reveals altered cortical development in pre-eclampsia with and without small-for-gestational-age fetus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:737-746. [PMID: 35015926 DOI: 10.1002/uog.24853] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore the pattern of fetal cortical development in pregnancies complicated by pre-eclampsia (PE), with and without a small-for-gestational-age (SGA) fetus, compared to uncomplicated pregnancies. METHODS This was a prospective observational study including singleton pregnancies complicated by normotensive SGA (birth weight < 10th centile) (n = 77), PE with an appropriate-for-gestational-age (AGA) fetus (n = 76) or PE with a SGA fetus (n = 67), and 128 uncomplicated pregnancies (normotensive AGA) matched by gestational age at ultrasound. All pregnancies underwent detailed neurosonography, using a transabdominal and transvaginal approach, at 31-35 weeks' gestation to assess the depth of the insula, Sylvian fissure, parieto-occipital sulcus, cingulate sulcus and calcarine sulcus. All measurements were adjusted for biparietal diameter (BPD). In addition, a grading score of cortical development was assigned to each brain structure, ranging from Grade 0 (no development) to Grade 5 (maximum development). Univariate and multiple regression analyses were conducted. RESULTS Similar to findings in previous studies, normotensive pregnancies with a SGA fetus showed significant differences in cortical development compared with controls, with reduced Sylvian fissure depth adjusted for BPD (14.5 ± 2.4 vs 16.6 ± 2.3; P < 0.001) and increased insula depth adjusted for BPD (33.2 ± 2.0 vs 31.8 ± 2.0; P < 0.001). Interestingly, a similar cortical development pattern was observed in PE pregnancies with a SGA fetus and in PE pregnancies with an AGA fetus, manifested by reduced Sylvian fissure depth adjusted for BPD (14.2 ± 2.3 and 14.3 ± 2.3 vs 16.6 ± 2.3; P < 0.001 for both) and greater insula depth adjusted for BPD (33.2 ± 2.1 and 32.8 ± 1.7 vs 31.8 ± 2.0; P < 0.001 for both) compared with controls. No significant differences were observed in parieto-occipital, cingulate sulcus or calcarine sulcus depth across the study groups. The Sylvian fissure was scored as Grade 4 in significantly more (93.2% vs 59.5%) and as Grade 5 in significantly fewer (2.7% vs 37.3%) PE pregnancies with an AGA fetus compared with controls (P < 0.05 for both). These differences remained significant even after statistical adjustment for potential confounders, including ethnicity, low socioeconomic status, nulliparity, chronic hypertension, pregestational diabetes, assisted reproductive technologies, smoking and fetal gender, with the application of Benjamini-Hochberg procedure for multiple comparisons. CONCLUSIONS PE with or without SGA is associated with a differential fetal cortical development pattern which is similar to that described previously in small fetuses. Future research is warranted to elucidate better the mechanism(s) underlying these changes. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Basso
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - L Youssef
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - A Nakaki
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - C Paules
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - J Miranda
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - G Casu
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - L Salazar
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - E Gratacos
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - E Eixarch
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - F Crispi
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - F Crovetto
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
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13
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Ribas-Prats T, Arenillas-Alcón S, Lip-Sosa DL, Costa-Faidella J, Mazarico E, Gómez-Roig MD, Escera C. Deficient neural encoding of speech sounds in term neonates born after fetal growth restriction. Dev Sci 2021; 25:e13189. [PMID: 34758093 DOI: 10.1111/desc.13189] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 11/29/2022]
Abstract
Infants born after fetal growth restriction (FGR)-an obstetric condition defined as the failure to achieve the genetic growth potential-are prone to neurodevelopmental delays, with language being one of the major affected areas. Yet, while verbal comprehension and expressive language impairments have been observed in FGR infants, children and even adults, specific related impairments at birth, such as in the ability to encode the sounds of speech, necessary for language acquisition, remain to be disclosed. Here, we used the frequency-following response (FFR), a brain potential correlate of the neural phase locking to complex auditory stimuli, to explore the encoding of speech sounds in FGR neonates. Fifty-three neonates born with FGR and 48 controls born with weight adequate-for-gestational age (AGA) were recruited. The FFR was recorded to the consonant-vowel stimulus (/da/) during sleep and quantified as the spectral amplitude to the fundamental frequency of the syllable and its signal-to-noise ratio (SNR). The outcome was available in 45 AGA and 51 FGR neonates, yielding no differences for spectral amplitudes. However, SNR was strongly attenuated in the FGR group compared to the AGA group at the vowel region of the stimulus. These findings suggest that FGR population present a deficit in the neural pitch tracking of speech sounds already present at birth. Our results pave the way for future research on the potential clinical use of the FFR in this population, so that if confirmed, a disrupted FFR recorded at birth may help deriving FGR neonates at risk for postnatal follow-ups.
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Affiliation(s)
- Teresa Ribas-Prats
- Brainlab - Cognitive Neuroscience Research Group, Department of Clinical Psychology and Psychobiology, University of Barcelona, Catalonia, Spain.,Institute of Neurosciences, University of Barcelona, Catalonia, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain
| | - Sonia Arenillas-Alcón
- Brainlab - Cognitive Neuroscience Research Group, Department of Clinical Psychology and Psychobiology, University of Barcelona, Catalonia, Spain.,Institute of Neurosciences, University of Barcelona, Catalonia, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain
| | - Diana Lucia Lip-Sosa
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain.,BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic), University of Barcelona, Barcelona, Catalonia, Spain
| | - Jordi Costa-Faidella
- Brainlab - Cognitive Neuroscience Research Group, Department of Clinical Psychology and Psychobiology, University of Barcelona, Catalonia, Spain.,Institute of Neurosciences, University of Barcelona, Catalonia, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain
| | - Edurne Mazarico
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain.,BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic), University of Barcelona, Barcelona, Catalonia, Spain
| | - María Dolores Gómez-Roig
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain.,BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic), University of Barcelona, Barcelona, Catalonia, Spain
| | - Carles Escera
- Brainlab - Cognitive Neuroscience Research Group, Department of Clinical Psychology and Psychobiology, University of Barcelona, Catalonia, Spain.,Institute of Neurosciences, University of Barcelona, Catalonia, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain
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14
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Everwijn SM, van Bohemen JF, van Geloven N, Jansen FA, Teunissen AK, Rozendaal L, Blom N, van Lith JM, Haak MC. Serial neurosonography in fetuses with congenital heart defects shows mild delays in cortical development. Prenat Diagn 2021; 41:1649-1657. [PMID: 34474501 PMCID: PMC9293037 DOI: 10.1002/pd.6038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 07/28/2021] [Accepted: 08/23/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Neurodevelopmental delay is more common in children born with congenital heart defects (CHD), even with optimal perinatal and peri-operative care. It is hypothesized that fetuses with CHD are prone to neurological impairment in utero due to their cardiac defect, possibly leading to delayed cortical development. METHODS Cerebral cortical maturation was assessed with advanced neurosonographic examinations every 4 weeks in fetuses with CHD and compared to control fetuses. Five different primary fissures and four areas were scored (ranging 0-5) by blinded examiners using a cortical maturation scheme. RESULTS Cortical staging was assessed in 574 ultrasound examinations in 85 CHD fetuses and 61 controls. Small differences in grading were seen in Sylvian and cingulate fissures. (Sylvian fissure: -0.12 grade, 95% CI (-0.23; -0.01) p = 0.05, cingulate fissure: -0.24 grade, 95% CI (-0.38; -0.10) p = <0.001. Other cortical areas showed normal maturation as compared to control fetuses. CONCLUSION Small differences were seen in three of the nine analyzed cortical areas in CHD fetuses, in contrast to previous reports on progressive third-trimester delay. The clinical implications of the small differences however, remain unknown.
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Affiliation(s)
- Sheila M Everwijn
- Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Jiska F van Bohemen
- Department of Obstetrics and Gynecology, HAGA Hospital, The Hague, The Netherlands
| | - Nan van Geloven
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Fenna A Jansen
- Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Aalbertine K Teunissen
- Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Lieke Rozendaal
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nico Blom
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan M van Lith
- Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique C Haak
- Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
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15
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Lerman-Sagie T, Pogledic I, Leibovitz Z, Malinger G. A practical approach to prenatal diagnosis of malformations of cortical development. Eur J Paediatr Neurol 2021; 34:50-61. [PMID: 34390998 DOI: 10.1016/j.ejpn.2021.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/27/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
Malformations of cortical development (MCD) can frequently be diagnosed at multi-disciplinary Fetal Neurology clinics with the aid of multiplanar neurosonography and MRI. The patients are usually referred following prenatal sonographic screening that raises the suspicion of a possible underlying MCD. These indirect findings include, but are not limited to, ventriculomegaly (lateral ventricles larger than 10 mm), asymmetric ventricles, commissural anomalies, absent cavum septum pellucidum, cerebellar vermian and/or hemispheric anomalies, abnormal head circumference (microcephaly or macrocephaly), multiple CNS malformations, and associated systemic defects. The aim of this paper is to suggest a practical approach to prenatal diagnosis of malformations of cortical development utilizing dedicated neurosonography and MRI, based on the current literature and our own experience. We suggest that an MCD should be suspected in utero when the following intracranial imaging signs are present: abnormal development of the Sylvian fissure; delayed achievement of cortical milestones, premature appearance of sulcation; irregular ventricular borders, abnormal cortical thickness (thick, thin); abnormal shape and orientation of the sulci and gyri; irregular, abnormal, asymmetric, and enlarged hemisphere; simplified cortex; non continuous cortex or cleft; and intraparenchymal echogenic nodules. Following the putative diagnosis of fetal MCD by neurosonography and MRI, when appropriate and possible (depending on gestational age), the imaging diagnosis is supplemented by genetic studies (CMA and trio whole exome sequencing). In some instances, no further studies are required during pregnancy due to the clear dire prognosis and then the genetic evaluation can be deferred after delivery or termination of pregnancy (in countries where allowed).
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Affiliation(s)
- Tally Lerman-Sagie
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel; Pediatric Neurology Unit, Center for Rare Diseases-Magen, Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Ivana Pogledic
- Department of Biomedical Imaging and Image-guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Zvi Leibovitz
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel; Ultrasound in Obstetrics and Gynecology Unit, Bnai-Zion Medical Center, Haifa, Israel; Technion Faculty of Medicine, Haifa, Israel
| | - Gustavo Malinger
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Fetal Neurology Multidisciplinary Clinic, Division of Ultrasound in Obstetrics & Gynecology, Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
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16
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Paules C, Miranda J, Policiano C, Crovetto F, Youssef L, Hahner N, Nakaki A, Crispi F, Gratacós E, Eixarch E. Fetal neurosonography detects differences in cortical development and corpus callosum in late-onset small fetuses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:42-47. [PMID: 33438307 DOI: 10.1002/uog.23592] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/17/2020] [Accepted: 12/24/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore whether neurosonography can detect differences in cortical development and corpus callosal length in late-onset small fetuses subclassified into small-for-gestational age (SGA) or growth restricted (FGR). METHODS This was a prospective cohort study in singleton pregnancies, including normally grown fetuses (birth weight between the 10th and 90th centiles) and late-onset small fetuses (estimated fetal weight < 10th centile, diagnosed after 32 weeks of gestation and confirmed by birth weight < 10th centile). Small fetuses were subclassified into SGA (birth weight between the 3rd and 9th centiles and normal fetoplacental Doppler) and FGR (birth weight < 3rd centile and/or abnormal cerebroplacental ratio and/or abnormal uterine artery Doppler). Neurosonography was performed at 33 ± 1 weeks of gestation to assess the depth of the insula, Sylvian fissure and parieto-occipital sulcus in the axial views and corpus callosal length in the midsagittal plane. Measurements were performed offline using Alma Workstation software and were adjusted by biparietal diameter or cephalic index. Linear regression analysis was used to assess the association between the neurosonographic variables and study group, adjusting for confounding factors such as gender, gestational age at neurosonography, nulliparity and pre-eclampsia. RESULTS In total, 318 fetuses were included, of which 97 were normally grown and 221 were late-onset small fetuses that were further subdivided into late-onset SGA (n = 67) or late-onset FGR (n = 154). Compared to controls, both SGA and FGR cases showed significantly increased insular depth adjusted for biparietal diameter (median (interquartile range), controls 0.329 (0.312-0.342) vs SGA 0.339 (0.321-0.347) vs FGR 0.336 (0.325-0.349); P = 0.006). A linear tendency to reduced Sylvian fissure depth adjusted for biparietal diameter was also observed across the study groups (mean ± SD, controls 0.148 ± 0.021 vs SGA 0.142 ± 0.025 vs FGR 0.139 ± 0.022; P = 0.003). However, differences were significant only between the FGR and control groups. Corpus callosal length adjusted for cephalic index was significantly reduced in FGR cases compared with both controls and SGA cases, while there was no difference between SGA cases and controls (median (interquartile range), controls 0.500 (0.478-0.531) vs SGA 0.502 (0.487-0.526) vs FGR 0.475 (0.447-0.508); P = 0.005). No differences were found in parieto-occipital sulcus depth between the three study groups. CONCLUSION Neurosonography seems to be a sensitive tool to detect subtle structural differences in brain development in late-onset small fetuses. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C Paules
- BCNatal - Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Instituto de Investigación Sanitaria Aragón (IISAragon), Red de Salud Materno Infantil y del Desarrollo (SAMID), RETICS, Instituto de Salud Carlos III (ISCIII), Subdirección General de Evaluación y Fomento de la Investigación y Fondo Europeo de Desarrollo Regional (FEDER), Zaragoza, Spain
| | - J Miranda
- BCNatal - Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
| | - C Policiano
- BCNatal - Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Departamento de Obstetrícia, Ginecologia e Medicina da Reproduçao, Hospital Universitário de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - F Crovetto
- BCNatal - Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - L Youssef
- BCNatal - Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - N Hahner
- BCNatal - Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - A Nakaki
- BCNatal - Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - F Crispi
- BCNatal - Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - E Gratacós
- BCNatal - Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - E Eixarch
- BCNatal - Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
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17
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Stampalija T, Ciardo C, Barbieri M, Risso FM, Travan L. Neurodevelopment of infant with late fetal growth restriction. Minerva Obstet Gynecol 2021; 73:482-489. [PMID: 33949822 DOI: 10.23736/s2724-606x.21.04807-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Late fetal growth restriction has increasingly gain interest. Differently from early fetal growth restriction, the severity of this condition and the impact on perinatal mortality and morbidity is less severe. Nevertheless, there is some evidence to suggest that fetuses exposed to growth restriction late in pregnancy are at increased risk of neurological dysfunction and behavioral impairment. The aim of our review was to discuss the available evidence on the neurodevelopmental outcome in fetuses exposed to growth restriction late in pregnancy. Cerebral blood flow redistribution, a Doppler hallmark of late fetal growth restriction, has been associated with this increased risk, although there are still some controversies. Currently, most of the available studies are heterogeneous and do not distinguish between early and late fetal growth restriction when evaluating the long-term outcome, thus, making the correlation between late fetal growth restriction and neurological dysfunction difficult to interpret. The available evidence suggests that fetuses exposed to late growth restriction are at increased risk of neurological dysfunction and behavioral impairment. The presence of the cerebral blood flow redistribution seems to be associated with adverse neurodevelopmental outcome, however, from the present literature the causality cannot be ascertained.
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Affiliation(s)
- Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy - .,Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy -
| | - Claudia Ciardo
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Moira Barbieri
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Francesco M Risso
- Division of Neonatology, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Laura Travan
- Division of Neonatology, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
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18
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Hahner N, Benkarim OM, Aertsen M, Perez-Cruz M, Piella G, Sanroma G, Bargallo N, Deprest J, Gonzalez Ballester MA, Gratacos E, Eixarch E. Global and Regional Changes in Cortical Development Assessed by MRI in Fetuses with Isolated Nonsevere Ventriculomegaly Correlate with Neonatal Neurobehavior. AJNR Am J Neuroradiol 2020; 40:1567-1574. [PMID: 31467239 DOI: 10.3174/ajnr.a6165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 06/28/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Fetuses with isolated nonsevere ventriculomegaly (INSVM) are at risk of presenting neurodevelopmental delay. However, the currently used clinical parameters are insufficient to select cases with high risk and determine whether subtle changes in brain development are present and might be a risk factor. The aim of this study was to perform a comprehensive evaluation of cortical development in INSVM by magnetic resonance (MR) imaging and assess its association with neonatal neurobehavior. MATERIALS AND METHODS Thirty-two INSVM fetuses and 29 healthy controls between 26-28 weeks of gestation were evaluated using MR imaging. We compared sulci and fissure depth, cortical maturation grading of specific areas and sulci and volumes of different brain regions obtained from 3D brain reconstruction of cases and controls. Neonatal outcome was assessed by using the Neonatal Behavioral Assessment Scale at a mean of 4 ± 2 weeks after birth. RESULTS Fetuses with INSVM showed less profound and underdeveloped sulcation, including the Sylvian fissure (mean depth: controls 16.8 ± 1.9 mm, versus INSVM 16.0 ± 1.6 mm; P = .01), and reduced global cortical grading (mean score: controls 42.9 ± 10.2 mm, versus INSVM: 37.8 ± 9.9 mm; P = .01). Fetuses with isolated nonsevere ventriculomegaly showed a mean global increase of gray matter volume (controls, 276.8 ± 46.0 ×10 mm3, versus INSVM 277.5 ± 49.3 ×10 mm3, P = .01), but decreased mean cortical volume in the frontal lobe (left: controls, 53.2 ± 8.8 ×10 mm3, versus INSVM 52.4 ± 5.4 ×10 mm3; P = < .01). Sulcal depth and brain volumes were significantly associated with the Neonatal Behavioral Assessment Scale severity (P = .005, Nagelkerke R2 = 0.732). CONCLUSIONS INSVM fetuses showed differences in cortical development, including regions far from the lateral ventricles, that are associated with neonatal neurobehavior. These results suggest the possible use of these parameters to identify cases at higher risk of altered neurodevelopment.
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Affiliation(s)
- N Hahner
- From the Fetal i+D Fetal Medicine Research Center (N.H., M.P.-C., E.G., E.E.), BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - O M Benkarim
- BCN MedTech (O.M.B., G.P., G.S., M.A.G.B.), Universitat Pompeu Fabra, Barcelona, Spain
| | | | - M Perez-Cruz
- From the Fetal i+D Fetal Medicine Research Center (N.H., M.P.-C., E.G., E.E.), BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - G Piella
- BCN MedTech (O.M.B., G.P., G.S., M.A.G.B.), Universitat Pompeu Fabra, Barcelona, Spain
| | - G Sanroma
- BCN MedTech (O.M.B., G.P., G.S., M.A.G.B.), Universitat Pompeu Fabra, Barcelona, Spain
| | - N Bargallo
- Magnetic Resonance Image Core Facility (N.B.), Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain.,Department of Radiology (N.B.), Centre de Diagnòstic per la Imatge, Hospital Clínic, Barcelona, Spain
| | - J Deprest
- Obstetrics (J.D.), UZ Leuven, Leuven, Belgium.,Institute for Women's Health (J.D.), University College London, London, UK
| | - M A Gonzalez Ballester
- BCN MedTech (O.M.B., G.P., G.S., M.A.G.B.), Universitat Pompeu Fabra, Barcelona, Spain.,ICREA (M.A.G.B.), Barcelona, Spain
| | - E Gratacos
- From the Fetal i+D Fetal Medicine Research Center (N.H., M.P.-C., E.G., E.E.), BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain .,Centre for Biomedical Research on Rare Diseases (E.G., E.E.), Barcelona, Spain
| | - E Eixarch
- From the Fetal i+D Fetal Medicine Research Center (N.H., M.P.-C., E.G., E.E.), BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.,Centre for Biomedical Research on Rare Diseases (E.G., E.E.), Barcelona, Spain
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19
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Sanz Cortes M, Torres P, Yepez M, Guimaraes C, Zarutskie A, Shetty A, Hsiao A, Pyarali M, Davila I, Espinoza J, Shamshirsaz AA, Nassr A, Whitehead W, Lee W, Belfort MA. Comparison of brain microstructure after prenatal spina bifida repair by either laparotomy-assisted fetoscopic or open approach. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:87-95. [PMID: 31219638 DOI: 10.1002/uog.20373] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To compare prenatal and postnatal brain microstructure between infants that underwent fetoscopic myelomeningocele (MMC) repair and those that had open-hysterotomy repair. METHODS This was a longitudinal retrospective cohort study of 57 fetuses that met the Management of Myelomeningocele Study (MOMS) trial criteria and underwent prenatal MMC repair, by a fetoscopic (n = 27) or open-hysterotomy (n = 30) approach, at 21.4-25.9 weeks' gestation. Fetoscopic repair was performed under CO2 insufflation, according to our protocol. Diffusion-weighted magnetic resonance imaging (MRI) was performed before surgery in 30 cases (14 fetoscopic and 16 open), at 6 weeks postsurgery in 48 cases (24 fetoscopic and 24 open) and within the first year after birth in 23 infants (five fetoscopic and 18 open). Apparent diffusion coefficient (ADC) values from the basal ganglia, frontal, occipital and parietal lobes, mesencephalon and genu as well as splenium of the corpus callosum were calculated. ADC values at each of the three timepoints (presurgery, 6 weeks postsurgery and postnatally) and the percentage change in the ADC values between the timepoints were compared between the fetoscopic-repair and open-repair groups. ADC values at 6 weeks after surgery in the two prenatally repaired groups were compared with those in a control group of eight healthy fetuses that underwent MRI at a similar gestational age (GA). Comparison of ADC values was performed using the Student's t-test for independent samples (or Mann-Whitney U-test if non-normally distributed) and multivariate general linear model analysis, adjusting for GA or age at MRI and mean ventricular width. RESULTS There were no differences in GA at surgery or GA/postnatal age at MRI between the groups. No significant differences were observed in ADC values in any of the brain areas assessed between the open-repair and fetoscopic-repair groups at 6 weeks after surgery and in the first year after birth. No differences were detected in the ADC values of the studied areas between the control and prenatally repaired groups, except for significantly increased ADC values in the genu of the corpus callosum in the open-hysterotomy and fetoscopic-repair groups. Additionally, there were no differences between the two prenatally repaired groups in the percentage change in ADC values at any of the time intervals analyzed. CONCLUSIONS Fetoscopic MMC repair has no detectable effect on brain microstructure when compared to babies repaired using an open-hysterotomy technique. CO2 insufflation of the uterine cavity during fetoscopy does not seem to have any isolated deleterious effects on fetal brain microstructure. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Sanz Cortes
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - P Torres
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - M Yepez
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - C Guimaraes
- Department of Radiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - A Zarutskie
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - A Shetty
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - A Hsiao
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - M Pyarali
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - I Davila
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - J Espinoza
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - A A Shamshirsaz
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - A Nassr
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - W Whitehead
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - W Lee
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - M A Belfort
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
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20
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Husen SC, Koning IV, Go ATJI, van Graafeiland AW, Willemsen SP, Groenenberg IAL, Steegers-Theunissen RPM. Three-dimensional ultrasound imaging of fetal brain fissures in the growth restricted fetus. PLoS One 2019; 14:e0217538. [PMID: 31120993 PMCID: PMC6532926 DOI: 10.1371/journal.pone.0217538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 05/14/2019] [Indexed: 11/18/2022] Open
Abstract
Objectives To examine differences in growth trajectories of fetal brain fissures in the growth restricted fetus (FGR) compared to controls. Methods We selected a subgroup of 227 women with a singleton pregnancy from the Rotterdam Periconceptional Cohort. Participants received three-dimensional ultrasound (3D-US) examinations of the fetal brain at 22, 26 and 32 weeks of gestational age (GA). The left and right Sylvian, insula and parieto-occipital fissures (POF) were measured in standardized planes. Linear mixed models with adjustment for potential confounders were applied to estimate differences between the trajectories of brain fissure depth measurements of FGR and controls. Results 22 FGR and 172 controls provided 31 and 504 3D-US respectively for longitudinal brain fissure depth measurements. Success rates for the Sylvian and insula depth measurements were over 80% and for POF over 62% at all GA. In FGR compared to controls, the trajectory of the right Sylvian fissure depth was significantly decreased (ß = -4.30, 95%CI = -8.03;-0.56, p = 0.024) while its growth rate was slightly increased (ß = 0.02, 95%CI = 0.00;0.04, p = 0.04), after adjustment for GA, head circumference, gender, educational level and parity. Conclusions The small differences in brain fissure measurements between 22 and 32 weeks GA in FGR warrant further investigation in larger cohorts with postnatal follow-up.
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Affiliation(s)
- Sofie C. Husen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Irene V. Koning
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Attie T. J. I. Go
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Anne W. van Graafeiland
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Sten P. Willemsen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
- Department of Biostatistics, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Irene A. L. Groenenberg
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Régine P. M. Steegers-Theunissen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
- Department of Paediatrics, Division of Neonatology, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands
- * E-mail:
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21
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Álvarez-Bueno C, Cavero-Redondo I, Díez-Fernández A, Pardo-Guijarro MJ, Sánchez-López M, Martínez-Vizcaíno V. Cardiorespiratory fitness as a mediator of the relationship between birth weight and cognition in school children. Psychol Res Behav Manag 2019; 12:255-262. [PMID: 31114408 PMCID: PMC6497506 DOI: 10.2147/prbm.s197945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/21/2019] [Indexed: 01/03/2023] Open
Abstract
Objectives: To examine differences in cognition parameters by birth weight categories and to analyze whether the relationships between birth weight and cognitive functions are mediated by cardiorespiratory fitness (CRF) in schoolchildren. Methods: A cross-sectional study using a sample of 664 school children from the MOVI-Kids study. Variables: i) cognitive function measured by the Battery of General and Differential Aptitudes (BADyG); ii) birth weight, reported by parents; and iii) CRF (20-m shuttle run test). ANCOVA models were estimated to assess differences in cognitive function categories across birth weight and CRF categories. Mediation analysis was conducted with Hayes' PROCESS macro. Results: CRF is a full mediator of the association between birth weight with the verbal and numerical factors, and general intelligence; and is a partial mediator when logical reasoning and the spatial factor were the dependent variables. The available data suggest that, in schoolchildren, the influence of birth weight on cognitive function is mediated by CRF. Conclusions: These findings highlight that children with lower birth weight values and lower fitness levels should be target subgroups to improve children's cognition, in which long-life physical activity interventions at early ages are a priority.
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Affiliation(s)
- Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Castilla-La Mancha, Spain
| | - Iván Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Castilla-La Mancha, Spain
| | - Ana Díez-Fernández
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Castilla-La Mancha, Spain
| | - Maria Jesús Pardo-Guijarro
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Castilla-La Mancha, Spain.,School of Education, Universidad de Castilla-La Mancha, Cuenca, Castilla-La Mancha, Spain
| | - Mairena Sánchez-López
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Castilla-La Mancha, Spain.,School of Education, Universidad de Castilla-La Mancha, Ciudad Real, Castilla-La Mancha, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Castilla-La Mancha, Spain.,Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
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22
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Tchirikov M, Saling E, Bapayeva G, Bucher M, Thews O, Seliger G. Hyperbaric oxygenation and glucose/amino acids substitution in human severe placental insufficiency. Physiol Rep 2019. [PMID: 29536649 PMCID: PMC5849598 DOI: 10.14814/phy2.13589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In the first case, the AA and glucose were infused through a perinatal port system into the umbilical vein at 30 weeks' gestation due to severe IUGR. The patient received daily hyperbaric oxygenation (HBO, 100% O2) with 1.4 atmospheres absolute for 50 min for 7 days. At 31+4 weeks' gestation, the patient gave birth spontaneously to a newborn weighing 1378 g, pH 7.33, APGAR score 4/6/intubation. In follow‐up examinations at 5 years of age, the boy was doing well without any neurological disturbance or developmental delay. In the second case, the patient presented at 25/5 weeks' gestation suffering from severe IUGR received HBO and maternal AA infusions. The cardiotocography was monitored continuously during HBO treatment. The short‐time variations improved during HBO from 2.9 to 9 msec. The patient developed pathologic CTG and uterine contractions 1 day later and gave birth to a hypotrophic newborn weighing 420 g. After initial adequate stabilization, the extremely preterm newborn unfortunately died 6 days later. Fetal nutrition combined with HBO is technically possible and may allow the prolongation of the pregnancy. Fetal‐specific amino‐acid composition would facilitate the treatment options of IUGR fetuses and extremely preterm newborn.
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Affiliation(s)
- Michael Tchirikov
- Center of Fetal Surgery, University Clinic of Obstetrics and Fetal Medicine, University Medical Center Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Erich Saling
- Saling Institute of Perinatal Medicine, Berlin, Germany
| | - Gauri Bapayeva
- National Research Center for Mother and Child Health, Nazarbayev University, Astana, Republic of Kazakhstan
| | - Michael Bucher
- Center of HBO, University Clinic of Anesthesiology, University Medical Center Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Oliver Thews
- Institute of Physiology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Gregor Seliger
- Center of Fetal Surgery, University Clinic of Obstetrics and Fetal Medicine, University Medical Center Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany
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23
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Baud O, Berkane N. Hormonal Changes Associated With Intra-Uterine Growth Restriction: Impact on the Developing Brain and Future Neurodevelopment. Front Endocrinol (Lausanne) 2019; 10:179. [PMID: 30972026 PMCID: PMC6443724 DOI: 10.3389/fendo.2019.00179] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/04/2019] [Indexed: 12/14/2022] Open
Abstract
The environment in which a fetus develops is not only important for its growth and maturation but also for its long-term postnatal health and neurodevelopment. Several hormones including glucocorticosteroids, estrogens and progesterone, insulin growth factor and thyroid hormones, carefully regulate the growth of the fetus and its metabolism during pregnancy by controlling the supply of nutrients crossing the placenta. In addition to fetal synthesis, hormones regulating fetal growth are also expressed and regulated in the placenta, and they play a key role in the vulnerability of the developing brain and its maturation. This review summarizes the current understanding and evidence regarding the involvement of hormonal dysregulation associated with intra-uterine growth restriction and its consequences on brain development.
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Affiliation(s)
- Olivier Baud
- Division of Neonatology and Pediatric Intensive Care, Department of Women-Children-Teenagers, University Hospitals Geneva, Geneva, Switzerland
- Inserm U1141, Sorbonne, Paris Diderot University, Paris, France
- *Correspondence: Olivier Baud
| | - Nadia Berkane
- Division of Obstetrics and Gynecology, Department of Women-Children-Teenagers, University Hospitals Geneva, Geneva, Switzerland
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24
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Quezada S, Castillo-Melendez M, Walker DW, Tolcos M. Development of the cerebral cortex and the effect of the intrauterine environment. J Physiol 2018; 596:5665-5674. [PMID: 30325048 DOI: 10.1113/jp277151] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 10/02/2018] [Indexed: 12/31/2022] Open
Abstract
The human brain is one of the most complex structures currently under study. Its external shape is highly convoluted, with folds and valleys over the entire surface of the cortex. Disruption of the normal pattern of folding is associated with a number of abnormal neurological outcomes, some serious for the individual. Most of our knowledge of the normal development and folding of the cerebral cortex (gyrification) focuses on the internal, biological (i.e. genetically driven) mechanisms of the brain that drive gyrification. However, the impact of an adverse intrauterine and maternal physiological environment on cortical folding during fetal development has been understudied. Accumulating evidence suggests that the state of the intrauterine and maternal environment can have a significant impact on gyrification of the fetal cerebral cortex. This review summarises our current knowledge of how development in a suboptimal intrauterine and maternal environment can affect the normal development of the folded cerebral cortex.
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Affiliation(s)
- Sebastian Quezada
- Monash University, Wellington Rd, Clayton, Melbourne, Australia, 3168.,The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, Melbourne, Australia, 3168
| | - Margie Castillo-Melendez
- Monash University, Wellington Rd, Clayton, Melbourne, Australia, 3168.,The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, Melbourne, Australia, 3168
| | - David W Walker
- School of Health & Biomedical Sciences, RMIT University, Plenty Rd., Bundoora, Melbourne, Australia, 3083
| | - Mary Tolcos
- School of Health & Biomedical Sciences, RMIT University, Plenty Rd., Bundoora, Melbourne, Australia, 3083
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25
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Miranda J, Simões RV, Paules C, Cañueto D, Pardo-Cea MA, García-Martín ML, Crovetto F, Fuertes-Martin R, Domenech M, Gómez-Roig MD, Eixarch E, Estruch R, Hansson SR, Amigó N, Cañellas N, Crispi F, Gratacós E. Metabolic profiling and targeted lipidomics reveals a disturbed lipid profile in mothers and fetuses with intrauterine growth restriction. Sci Rep 2018; 8:13614. [PMID: 30206284 PMCID: PMC6134091 DOI: 10.1038/s41598-018-31832-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/13/2018] [Indexed: 12/11/2022] Open
Abstract
Fetal growth may be impaired by poor placental function or maternal conditions, each of which can influence the transfer of nutrients and oxygen from the mother to the developing fetus. Large-scale studies of metabolites (metabolomics) are key to understand cellular metabolism and pathophysiology of human conditions. Herein, maternal and cord blood plasma samples were used for NMR-based metabolic fingerprinting and profiling, including analysis of the enrichment of circulating lipid classes and subclasses, as well as the number of sub-fraction particles and their size. Changes in phosphatidylcholines and glycoproteins were prominent in growth-restricted fetuses indicating significant alterations in their abundance and biophysical properties. Lipoprotein profiles showed significantly lower plasma concentrations of cholesterol-intermediate density lipoprotein (IDL), triglycerides-IDL and high-density lipoprotein (HDL) in mothers of growth-restricted fetuses compared to controls (p < 0.05). In contrast, growth-restricted fetuses had significantly higher plasma concentrations of cholesterol and triglycerides transporting lipoproteins [LDL, IDL, and VLDL, (p < 0.005; all)], as well as increased VLDL particle types (large, medium and small). Significant changes in plasma concentrations of formate, histidine, isoleucine and citrate in growth-restricted fetuses were also observed. Comprehensive metabolic profiling reveals that both, mother and fetuses of pregnancies complicated with fetal growth restriction have a substantial disruption in lipid metabolism.
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Affiliation(s)
- Jezid Miranda
- Fetal i+D Fetal Medicine Research, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Rui V Simões
- Fetal i+D Fetal Medicine Research, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Cristina Paules
- Fetal i+D Fetal Medicine Research, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Daniel Cañueto
- Metabolomics Platform, IISPV, DEEiA, Universidad Rovira i Virgili, Tarragona, Spain
| | | | - María L García-Martín
- BIONAND, Andalusian Centre for Nanomedicine and Biotechnology, Junta de Andalucía, Universidad de Málaga, Málaga, Spain
| | - Francesca Crovetto
- Fetal i+D Fetal Medicine Research, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Rocio Fuertes-Martin
- Metabolomics Platform, IISPV, DEEiA, Universidad Rovira i Virgili, Tarragona, Spain
- Biosfer Teslab, Reus, Spain
| | - Monica Domenech
- Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - María D Gómez-Roig
- Fetal i+D Fetal Medicine Research, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Elisenda Eixarch
- Fetal i+D Fetal Medicine Research, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Ramon Estruch
- Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Stefan R Hansson
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Lund University, Sweden; Skåne University Hospital, Lund, Sweden
| | | | - Nicolau Cañellas
- Metabolomics Platform, IISPV, DEEiA, Universidad Rovira i Virgili, Tarragona, Spain
- CIBERDEM, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Madrid, Spain
| | - Fatima Crispi
- Fetal i+D Fetal Medicine Research, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
| | - Eduard Gratacós
- Fetal i+D Fetal Medicine Research, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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26
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Zinni M, Colella M, Batista Novais AR, Baud O, Mairesse J. Modulating the Oxytocin System During the Perinatal Period: A New Strategy for Neuroprotection of the Immature Brain? Front Neurol 2018; 9:229. [PMID: 29706926 PMCID: PMC5908892 DOI: 10.3389/fneur.2018.00229] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/23/2018] [Indexed: 11/13/2022] Open
Abstract
Oxytocin is a neurohypophysal hormone known for its activity during labor and its role in lactation. However, the function of oxytocin (OTX) goes far beyond the peripheral regulation of reproduction, and the central effects of OTX have been extensively investigated, since it has been recognized to influence the learning and memory processes. OTX has also prominent effects on social behavior, anxiety, and autism. Interaction between glucocorticoids, OTX, and maternal behavior may have long-term effects on the developmental program of the developing brain subjected to adverse events during pre and perinatal periods. OTX treatment in humans improves many aspects of social cognition and behavior. Its effects on the hypothalamic–pituitary–adrenal axis and inflammation appear to be of interest in neonates because these properties may confer benefits when the perinatal brain has been subjected to injury. Indeed, early life inflammation and abnormal adrenal response to stress have been associated with an abnormal white matter development. Recent investigations demonstrated that OTX is involved in the modulation of microglial reactivity in the developing brain. This review recapitulates state-of-the art data supporting the hypothesis that the OTX system could be considered as an innovative candidate for neuroprotection, especially in the immature brain.
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Affiliation(s)
- Manuela Zinni
- INSERM U1141 Protect, Paris-Diderot University, Paris, France
| | - Marina Colella
- INSERM U1141 Protect, Paris-Diderot University, Paris, France
| | - Aline Rideau Batista Novais
- INSERM U1141 Protect, Paris-Diderot University, Paris, France.,Neonatal Intensive Care Unit, Robert Debré Children's Hospital, Paris, France
| | - Olivier Baud
- INSERM U1141 Protect, Paris-Diderot University, Paris, France.,University of Geneva, Geneva, Switzerland.,Division of Neonatology, Geneva Children's Hospital, Geneva, Switzerland
| | - Jérôme Mairesse
- INSERM U1141 Protect, Paris-Diderot University, Paris, France.,University of Geneva, Geneva, Switzerland
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27
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Bouyssi-Kobar M, Murnick J, Brossard-Racine M, Chang T, Mahdi E, Jacobs M, Limperopoulos C. Altered Cerebral Perfusion in Infants Born Preterm Compared with Infants Born Full Term. J Pediatr 2018; 193:54-61.e2. [PMID: 29212618 PMCID: PMC5794508 DOI: 10.1016/j.jpeds.2017.09.083] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 08/18/2017] [Accepted: 09/29/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To compare regional cerebral cortical blood flow (CBF) in infants born very preterm at term-equivalent age (TEA) and healthy newborns born full term and to examine the impact of clinical risk factors on CBF in the cohort born preterm. STUDY DESIGN This prospective, cross-sectional study included infants born very preterm (gestational age at birth <32 weeks; birth weight <1500 g) and healthy infants born full term. Using noninvasive 3T arterial spin labeling magnetic resonance imaging, we quantified regional CBF in the cerebral cortex: sensorimotor/auditory/visual cortex, superior medial/dorsolateral prefrontal cortex, anterior cingulate cortex (ACC)/posterior cingulate cortex, insula, and lateral posterior parietal cortex, as well as in the brainstem, and deep gray matter. Analyses were performed controlling for sex, gestational age, and age at magnetic resonance imaging. RESULTS We studied 202 infants: 98 born preterm and 104 born full term at TEA. Infants born preterm demonstrated greater global CBF (β = 9.03; P < .0001) and greater absolute regional CBF in all brain regions except the insula. Relative CBF in the insula, ACC and auditory cortex were decreased significantly in infants born preterm compared with their peers born at full term (P < .0001; P = .026; P = .036, respectively). In addition, the presence of parenchymal brain injury correlated with lower global and regional CBF (insula, ACC, sensorimotor, auditory, and visual cortices) whereas the need for cardiac vasopressor support correlated with lower regional CBF in the insula and visual cortex. CONCLUSIONS Altered regional cortical CBF in infants born very preterm at TEA may reflect early brain dysmaturation despite the absence of cerebral cortical injury. Furthermore, specific cerebral cortical areas may be vulnerable to early hemodynamic instability and parenchymal brain injury.
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Affiliation(s)
- Marine Bouyssi-Kobar
- The Developing Brain Research Laboratory, Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC; Institute for Biomedical Sciences, George Washington University, Washington, DC
| | - Jonathan Murnick
- The Developing Brain Research Laboratory, Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC
| | - Marie Brossard-Racine
- Department of Pediatrics Neurology, Montreal Children's Hospital-McGill University Health Center, Montreal, Québec, Canada
| | - Taeun Chang
- Department of Neurology, Children's National Health System, Washington, DC
| | - Eman Mahdi
- The Developing Brain Research Laboratory, Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC
| | - Marni Jacobs
- Department of Epidemiology and Biostatistics, Children's Research Institute, Children's National Health System, Washington, DC
| | - Catherine Limperopoulos
- The Developing Brain Research Laboratory, Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC.
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28
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Andescavage N, duPlessis A, Metzler M, Bulas D, Vezina G, Jacobs M, Iqbal SN, Baschat A, Limperopoulos C. In vivo assessment of placental and brain volumes in growth-restricted fetuses with and without fetal Doppler changes using quantitative 3D MRI. J Perinatol 2017; 37:1278-1284. [PMID: 28837138 PMCID: PMC5711581 DOI: 10.1038/jp.2017.129] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/01/2017] [Accepted: 06/23/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The relationship between placental and fetal brain growth is poorly understood and difficult to assess. The objective of this study was to interrogate placental and fetal brain growth in healthy pregnancies and those complicated by fetal growth restriction (FGR). STUDY DESIGN In a prospective, observational study, pregnant women with normal pregnancies or pregnancies complicated by FGR underwent fetal magnetic resonance imaging (MRI). Placental, global and regional brain volumes were calculated. RESULTS A total of 114 women (79 controls and 35 FGR) underwent MRI (median gestational age (GA) 30 weeks, range 18 to 39). All measured volumes increased exponentially with advancing GA. Placental, total brain, cerebral and cerebellar volumes were smaller in FGR compared with controls (P<0.05). Increasing placental volume was associated with increasing cerebral and cerebellar volumes (P<0.05). CONCLUSION Quantitative fetal MRI can accurately detect decreased placental and brain volumes in pregnancies with FGR and may provide insight into the timing and mechanisms of brain injury in FGR.
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Affiliation(s)
- Nickie Andescavage
- Division of Neonatology, Children’s National Health System, 111 Michigan Ave. NW, Washington, DC 20010,Department of Pediatrics, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037
| | - Adre duPlessis
- Division of Fetal & Transitional Medicine, Children’s National Health System, 111 Michigan Ave. NW, Washington, DC 20010,Department of Pediatrics, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037
| | - Marina Metzler
- Division of Fetal & Transitional Medicine, Children’s National Health System, 111 Michigan Ave. NW, Washington, DC 20010
| | - Dorothy Bulas
- Division of Diagnostic Imaging & Radiology, Children’s National Health System, 111 Michigan Ave. NW, Washington, DC 20010,Department of Radiology, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037
| | - Gilbert Vezina
- Division of Diagnostic Imaging & Radiology, Children’s National Health System, 111 Michigan Ave. NW, Washington, DC 20010,Department of Radiology, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037
| | - Marni Jacobs
- Division of Biostatistics & Study Methodology, Children’s National Health System, 111 Michigan Ave. NW, Washington, DC 20010
| | - Sara N Iqbal
- Division of Maternal Fetal-Medicine, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, 110 Irving St. NW, Washington, DC 20010
| | - Ahmet Baschat
- Department of Gynecology and Obstetrics, Johns Hopkins Center for Fetal Therapy, 600 North Wolfe Street, Nelson 228, Baltimore, MD 21287
| | - Catherine Limperopoulos
- Division of Fetal & Transitional Medicine, Children’s National Health System, 111 Michigan Ave. NW, Washington, DC 20010,Division of Diagnostic Imaging & Radiology, Children’s National Health System, 111 Michigan Ave. NW, Washington, DC 20010,Department of Pediatrics, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037,Department of Radiology, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037
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29
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Arichi T, Whitehead K, Barone G, Pressler R, Padormo F, Edwards AD, Fabrizi L. Localization of spontaneous bursting neuronal activity in the preterm human brain with simultaneous EEG-fMRI. eLife 2017; 6. [PMID: 28893378 PMCID: PMC5595428 DOI: 10.7554/elife.27814] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 08/03/2017] [Indexed: 12/21/2022] Open
Abstract
Electroencephalographic recordings from the developing human brain are characterized by spontaneous neuronal bursts, the most common of which is the delta brush. Although similar events in animal models are known to occur in areas of immature cortex and drive their development, their origin in humans has not yet been identified. Here, we use simultaneous EEG-fMRI to localise the source of delta brush events in 10 preterm infants aged 32–36 postmenstrual weeks. The most frequent patterns were left and right posterior-temporal delta brushes which were associated in the left hemisphere with ipsilateral BOLD activation in the insula only; and in the right hemisphere in both the insular and temporal cortices. This direct measure of neural and hemodynamic activity shows that the insula, one of the most densely connected hubs in the developing cortex, is a major source of the transient bursting events that are critical for brain maturation.
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Affiliation(s)
- Tomoki Arichi
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.,Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Kimberley Whitehead
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Giovanni Barone
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.,Department of Pediatrics, Catholic University of Sacred Heart, Rome, Italy
| | - Ronit Pressler
- Clinical Neurosciences, UCL-Institute of Child Health, London, United Kingdom
| | - Francesco Padormo
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.,Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, United States
| | - A David Edwards
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.,Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Lorenzo Fabrizi
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
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30
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Denison FC, Macnaught G, Semple SIK, Terris G, Walker J, Anblagan D, Serag A, Reynolds RM, Boardman JP. Brain Development in Fetuses of Mothers with Diabetes: A Case-Control MR Imaging Study. AJNR Am J Neuroradiol 2017; 38:1037-1044. [PMID: 28302607 PMCID: PMC7960386 DOI: 10.3174/ajnr.a5118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 12/20/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Offspring exposed to maternal diabetes are at increased risk of neurocognitive impairment, but its origins are unknown. With MR imaging, we investigated the feasibility of comprehensive assessment of brain metabolism (1H-MRS), microstructure (DWI), and macrostructure (structural MRI) in third-trimester fetuses in women with diabetes and determined normal ranges for the MR imaging parameters measured. MATERIALS AND METHODS Women with singleton pregnancies with diabetes (n = 26) and healthy controls (n = 26) were recruited prospectively for MR imaging studies between 34 and 38 weeks' gestation. RESULTS Data suitable for postprocessing were obtained from 79%, 71%, and 46% of women for 1H-MRS, DWI, and structural MRI, respectively. There was no difference in the NAA/Cho and NAA/Cr ratios (mean [SD]) in the fetal brain in women with diabetes compared with controls (1.74 [0.79] versus 1.79 [0.64], P = .81; and 0.78 [0.28] versus 0.94 [0.36], P = .12, respectively), but the Cho/Cr ratio was marginally lower (0.46 [0.11] versus 0.53 [0.10], P = .04). There was no difference in mean [SD] anterior white, posterior white, and deep gray matter ADC between patients and controls (1.16 [0.12] versus 1.16 [0.08], P = .96; 1.54 [0.16] versus 1.59 [0.20], P = .56; and 1.49 [0.23] versus 1.52 [0.23], P = .89, respectively) or volume of the cerebrum (243.0 mL [22.7 mL] versus 253.8 mL [31.6 mL], P = .38). CONCLUSIONS Acquiring multimodal MR imaging of the fetal brain at 3T from pregnant women with diabetes is feasible. Further study of fetal brain metabolism in maternal diabetes is warranted.
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Affiliation(s)
- F C Denison
- From the Medical Research Council Centre for Reproductive Health (F.C.D., D.A., A.S., J.P.B.), University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - G Macnaught
- Clinical Research Imaging Centre (G.M., S.I.K.S.)
| | - S I K Semple
- Clinical Research Imaging Centre (G.M., S.I.K.S.)
- University/British Heart Foundation Centre for Cardiovascular Science (S.I.K.S., R.M.R.)
| | - G Terris
- Simpson Centre for Reproductive Health (G.T., J.W.), Royal Infirmary, Edinburgh, UK
| | - J Walker
- Simpson Centre for Reproductive Health (G.T., J.W.), Royal Infirmary, Edinburgh, UK
| | - D Anblagan
- From the Medical Research Council Centre for Reproductive Health (F.C.D., D.A., A.S., J.P.B.), University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
- Centre for Clinical Brain Sciences (D.A., J.P.B.), University of Edinburgh, Edinburgh, UK
| | - A Serag
- From the Medical Research Council Centre for Reproductive Health (F.C.D., D.A., A.S., J.P.B.), University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - R M Reynolds
- University/British Heart Foundation Centre for Cardiovascular Science (S.I.K.S., R.M.R.)
| | - J P Boardman
- From the Medical Research Council Centre for Reproductive Health (F.C.D., D.A., A.S., J.P.B.), University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
- Centre for Clinical Brain Sciences (D.A., J.P.B.), University of Edinburgh, Edinburgh, UK
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31
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Muñoz-Moreno E, Fischi-Gomez E, Batalle D, Borradori-Tolsa C, Eixarch E, Thiran JP, Gratacós E, Hüppi PS. Structural Brain Network Reorganization and Social Cognition Related to Adverse Perinatal Condition from Infancy to Early Adolescence. Front Neurosci 2016; 10:560. [PMID: 28008304 PMCID: PMC5143343 DOI: 10.3389/fnins.2016.00560] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 11/21/2016] [Indexed: 11/13/2022] Open
Abstract
Adverse conditions during fetal life have been associated to both structural and functional changes in neurodevelopment from the neonatal period to adolescence. In this study, connectomics was used to assess the evolution of brain networks from infancy to early adolescence. Brain network reorganization over time in subjects who had suffered adverse perinatal conditions is characterized and related to neurodevelopment and cognition. Three cohorts of prematurely born infants and children (between 28 and 35 weeks of gestational age), including individuals with a birth weight appropriated for gestational age and with intrauterine growth restriction (IUGR), were evaluated at 1, 6, and 10 years of age, respectively. A common developmental trajectory of brain networks was identified in both control and IUGR groups: network efficiencies of the fractional anisotropy (FA)-weighted and normalized connectomes increase with age, which can be related to maturation and myelination of fiber connections while the number of connections decreases, which can be associated to an axonal pruning process and reorganization. Comparing subjects with or without IUGR, a similar pattern of network differences between groups was observed in the three developmental stages, mainly characterized by IUGR group having reduced brain network efficiencies in binary and FA-weighted connectomes and increased efficiencies in the connectome normalized by its total connection strength (FA). Associations between brain networks and neurobehavioral impairments were also evaluated showing a relationship between different network metrics and specific social cognition-related scores, as well as a higher risk of inattention/hyperactivity and/or executive functional disorders in IUGR children.
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Affiliation(s)
- Emma Muñoz-Moreno
- Fetal i+D, Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of BarcelonaBarcelona, Spain; Experimental 7T MRI Unit, Institut d'Investigacions Biomèdiques August Pi I SunyerBarcelona, Spain
| | - Elda Fischi-Gomez
- Signal Processing Laboratory 5, École Polytechnique Fédérale de LausanneLausanne, Switzerland; Division of Development and Growth. Department of Pediatrics, University Hospital of GenevaGeneva, Switzerland
| | - Dafnis Batalle
- Fetal i+D, Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of BarcelonaBarcelona, Spain; Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College LondonLondon, UK
| | - Cristina Borradori-Tolsa
- Division of Development and Growth. Department of Pediatrics, University Hospital of Geneva Geneva, Switzerland
| | - Elisenda Eixarch
- Fetal i+D, Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of BarcelonaBarcelona, Spain; Centre for Biomedical Research on Rare DiseasesBarcelona, Spain
| | - Jean-Philippe Thiran
- Signal Processing Laboratory 5, École Polytechnique Fédérale de LausanneLausanne, Switzerland; Department of Radiology, University Hospital Center and University of LausanneLausanne, Switzerland
| | - Eduard Gratacós
- Fetal i+D, Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of BarcelonaBarcelona, Spain; Centre for Biomedical Research on Rare DiseasesBarcelona, Spain
| | - Petra S Hüppi
- Division of Development and Growth. Department of Pediatrics, University Hospital of Geneva Geneva, Switzerland
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32
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Hunter DS, Hazel SJ, Kind KL, Liu H, Marini D, Giles LC, De Blasio MJ, Owens JA, Pitcher JB, Gatford KL. Effects of induced placental and fetal growth restriction, size at birth and early neonatal growth on behavioural and brain structural lateralization in sheep. Laterality 2016; 22:560-589. [PMID: 27759494 DOI: 10.1080/1357650x.2016.1243552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Poor perinatal growth in humans results in asymmetrical grey matter loss in fetuses and infants and increased functional and behavioural asymmetry, but specific contributions of pre- and postnatal growth are unclear. We therefore compared strength and direction of lateralization in obstacle avoidance and maze exit preference tasks in offspring of placentally restricted (PR: 10M, 13F) and control (CON: 23M, 17F) sheep pregnancies at 18 and 40 weeks of age, and examined gross brain structure of the prefrontal cortex at 52 weeks of age (PR: 14M, 18F; CON: 23M, 25F). PR did not affect lateralization direction, but 40-week-old PR females had greater lateralization strength than CON (P = .021). Behavioural lateralization measures were not correlated with perinatal growth. PR did not alter brain morphology. In males, cross-sectional areas of the prefrontal cortex and left hemisphere correlated positively with skull width at birth, and white matter area correlated positively with neonatal growth rate of the skull (all P < .05). These studies reinforce the need to include progeny of both sexes in future studies of neurodevelopmental programming, and suggest that restricting in utero growth has relatively mild effects on gross brain structural or behavioural lateralization in sheep.
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Affiliation(s)
- Damien Seth Hunter
- a Robinson Research Institute , North Adelaide , Australia.,b Discipline of Obstetrics and Gynaecology, Adelaide Medical School , Adelaide , Australia.,c School of Animal and Veterinary Sciences , Adelaide , South Australia , Australia
| | - Susan J Hazel
- c School of Animal and Veterinary Sciences , Adelaide , South Australia , Australia
| | - Karen L Kind
- a Robinson Research Institute , North Adelaide , Australia.,c School of Animal and Veterinary Sciences , Adelaide , South Australia , Australia
| | - Hong Liu
- a Robinson Research Institute , North Adelaide , Australia.,b Discipline of Obstetrics and Gynaecology, Adelaide Medical School , Adelaide , Australia
| | - Danila Marini
- c School of Animal and Veterinary Sciences , Adelaide , South Australia , Australia
| | - Lynne C Giles
- a Robinson Research Institute , North Adelaide , Australia.,d School of Population Health , University of Adelaide , Adelaide , South Australia , Australia
| | - Miles J De Blasio
- a Robinson Research Institute , North Adelaide , Australia.,b Discipline of Obstetrics and Gynaecology, Adelaide Medical School , Adelaide , Australia
| | - Julie A Owens
- a Robinson Research Institute , North Adelaide , Australia.,b Discipline of Obstetrics and Gynaecology, Adelaide Medical School , Adelaide , Australia
| | - Julia B Pitcher
- a Robinson Research Institute , North Adelaide , Australia.,b Discipline of Obstetrics and Gynaecology, Adelaide Medical School , Adelaide , Australia
| | - Kathryn L Gatford
- a Robinson Research Institute , North Adelaide , Australia.,b Discipline of Obstetrics and Gynaecology, Adelaide Medical School , Adelaide , Australia
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33
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Polat A, Barlow S, Ber R, Achiron R, Katorza E. Volumetric MRI study of the intrauterine growth restriction fetal brain. Eur Radiol 2016; 27:2110-2118. [PMID: 27491875 DOI: 10.1007/s00330-016-4502-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/25/2016] [Accepted: 06/30/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Intrauterine growth restriction (IUGR) is a pathologic fetal condition known to affect the fetal brain regionally and associated with future neurodevelopmental abnormalities. This study employed MRI to assess in utero regional brain volume changes in IUGR fetuses compared to controls. METHODS Retrospectively, using MRI images of fetuses at 30-34 weeks gestational age, a total of 8 brain regions-supratentorial brain and cavity, cerebral hemispheres, temporal lobes and cerebellum-were measured for volume in 13 fetuses with IUGR due to placental insufficiency and in 21 controls. Volumes and their ratios were assessed for difference using regression models. Reliability was assessed by intraclass correlation coefficients (ICC) between two observers. RESULTS In both groups, all structures increase in absolute volume during that gestation period, and the rate of cerebellar growth is higher compared to that of supratentorial structures. All structures' absolute volumes were significantly smaller for the IUGR group. Cerebellar to supratentorial ratios were found to be significantly smaller (P < 0.05) for IUGR compared to controls. No other significant ratio differences were found. ICC showed excellent agreement. CONCLUSIONS The cerebellar to supratentorial volume ratio is affected in IUGR fetuses. Additional research is needed to assess this as a radiologic marker in relation to long-term outcome. KEY POINTS • IUGR is a pathologic fetal condition affecting the brain • IUGR is associated with long-term neurodevelopmental abnormalities; fetal characterization is needed • This study aimed to evaluate regional brain volume differences in IUGR • Cerebellar to supratentorial volume ratios were smaller in IUGR fetuses • This finding may play a role in long-term development of IUGR fetuses.
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Affiliation(s)
- A Polat
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Tel Hashomer, Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - S Barlow
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Tel Hashomer, Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Ber
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Tel Hashomer, Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Achiron
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Tel Hashomer, Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Katorza
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Tel Hashomer, Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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34
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Eixarch E, Muñoz-Moreno E, Bargallo N, Batalle D, Gratacos E. Motor and cortico-striatal-thalamic connectivity alterations in intrauterine growth restriction. Am J Obstet Gynecol 2016; 214:725.e1-9. [PMID: 26719213 DOI: 10.1016/j.ajog.2015.12.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 12/02/2015] [Accepted: 12/16/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Intrauterine growth restriction is associated with short- and long-term neurodevelopmental problems. Structural brain changes underlying these alterations have been described with the use of different magnetic resonance-based methods that include changes in whole structural brain networks. However, evaluation of specific brain circuits and its correlation with related functions has not been investigated in intrauterine growth restriction. OBJECTIVES In this study, we aimed to investigate differences in tractography-related metrics in cortico-striatal-thalamic and motor networks in intrauterine growth restricted children and whether these parameters were related with their specific function in order to explore its potential use as an imaging biomarker of altered neurodevelopment. METHODS We included a group of 24 intrauterine growth restriction subjects and 27 control subjects that were scanned at 1 year old; we acquired T1-weighted and 30 directions diffusion magnetic resonance images. Each subject brain was segmented in 93 regions with the use of anatomical automatic labeling atlas, and deterministic tractography was performed. Brain regions included in motor and cortico-striatal-thalamic networks were defined based in functional and anatomic criteria. Within the streamlines that resulted from the whole brain tractography, those belonging to each specific circuit were selected and tractography-related metrics that included number of streamlines, fractional anisotropy, and integrity were calculated for each network. We evaluated differences between both groups and further explored the correlation of these parameters with the results of socioemotional, cognitive, and motor scales from Bayley Scale at 2 years of age. RESULTS Reduced fractional anisotropy (cortico-striatal-thalamic, 0.319 ± 0.018 vs 0.315 ± 0.015; P = .010; motor, 0.322 ± 0.019 vs 0.319 ± 0.020; P = .019) and integrity cortico-striatal-thalamic (0.407 ± 0.040 vs 0.399 ± 0.034; P = .018; motor, 0.417 ± 0.044 vs 0.409 ± 0.046; P = .016) in both networks were observed in the intrauterine growth restriction group, with no differences in number of streamlines. More importantly, strong specific correlation was found between tractography-related metrics and its relative function in both networks in intrauterine growth restricted children. Motor network metrics were correlated specifically with motor scale results (fractional anisotropy: rho = 0.857; integrity: rho = 0.740); cortico-striatal-thalamic network metrics were correlated with cognitive (fractional anisotropy: rho = 0.793; integrity, rho = 0.762) and socioemotional scale (fractional anisotropy: rho = 0.850; integrity: rho = 0.877). CONCLUSIONS These results support the existence of altered brain connectivity in intrauterine growth restriction demonstrated by altered connectivity in motor and cortico-striatal-thalamic networks, with reduced fractional anisotropy and integrity. The specific correlation between tractography-related metrics and neurodevelopmental outcomes in intrauterine growth restriction shows the potential to use this approach to develop imaging biomarkers to predict specific neurodevelopmental outcome in infants who are at risk because of intrauterine growth restriction and other prenatal diseases.
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Affiliation(s)
- Elisenda Eixarch
- Fetal i+D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Barcelona, Spain; Centre for Biomedical Research on Rare Diseases, Barcelona, Spain.
| | - Emma Muñoz-Moreno
- Fetal i+D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Nuria Bargallo
- Department of Radiology, Centre de Diagnòstic per la Imatge Clínic, Hospital Clínic, and the Magnetic Resonance core facility, Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
| | - Dafnis Batalle
- Fetal i+D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Barcelona, Spain; Centre for the Developing Brain, Division of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom
| | - Eduard Gratacos
- Fetal i+D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Barcelona, Spain; Centre for Biomedical Research on Rare Diseases, Barcelona, Spain
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Simões RV, Cruz-Lemini M, Bargalló N, Gratacós E, Sanz-Cortés M. Brain metabolite differences in one-year-old infants born small at term and association with neurodevelopmental outcome. Am J Obstet Gynecol 2015; 213:210.e1-210.e11. [PMID: 25891998 DOI: 10.1016/j.ajog.2015.04.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 02/06/2015] [Accepted: 04/14/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We assessed brain metabolite levels by magnetic resonance spectroscopy (MRS) in 1-year-old infants born small at term, as compared with infants born appropriate for gestational age (AGA), and their association with neurodevelopment at 2 years of age. STUDY DESIGN A total of 40 infants born small (birthweight <10th centile for gestational age) and 30 AGA infants underwent brain MRS at age 1 year on a 3-T scanner. Small-born infants were subclassified as late intrauterine growth restriction or as small for gestational age, based on the presence or absence of prenatal Doppler and birthweight predictors of an adverse perinatal outcome, respectively. Single-voxel proton magnetic resonance spectroscopy ((1)H-MRS) data were acquired from the frontal lobe at short echo time. Neurodevelopment was evaluated at 2 years of age using the Bayley Scales of Infant and Toddler Development, Third Edition, assessing cognitive, language, motor, social-emotional, and adaptive behavior scales. RESULTS As compared with AGA controls, infants born small showed significantly higher levels of glutamate and total N-acetylaspartate (NAAt) to creatine (Cr) ratio at age 1 year, and lower Bayley Scales of Infant and Toddler Development, Third Edition scores at 2 years. The subgroup with late intrauterine growth restriction further showed lower estimated glutathione levels at age 1 year. Significant correlations were observed for estimated glutathione levels with adaptive scores, and for myo-inositol with language scores. Significant associations were also noticed for NAA/Cr with cognitive scores, and for glutamate/Cr with motor scores. CONCLUSION Infants born small show brain metabolite differences at 1 year of age, which are correlated with later neurodevelopment. These results support further research on MRS to develop imaging biomarkers of abnormal neurodevelopment.
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de Bie HMA, de Ruiter MB, Ouwendijk M, Oostrom KJ, Wilke M, Boersma M, Veltman DJ, Delemarre-van de Waal HA. Using fMRI to Investigate Memory in Young Children Born Small for Gestational Age. PLoS One 2015; 10:e0129721. [PMID: 26132815 PMCID: PMC4488594 DOI: 10.1371/journal.pone.0129721] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 05/12/2015] [Indexed: 12/13/2022] Open
Abstract
Objectives Intrauterine growth restriction (IUGR) can lead to infants being born small for gestational age (SGA). SGA is associated with differences in brain anatomy and impaired cognition. We investigated learning and memory in children born SGA using neuropsychological testing and functional Magnetic Resonance Imaging (fMRI). Study Design 18 children born appropriate for gestational age (AGA) and 34 SGA born children (18 with and 16 without postnatal catch-up growth) participated in this study. All children were between 4 and 7 years old. Cognitive functioning was assessed by IQ and memory testing (Digit/Word Span and Location Learning). A newly developed fMRI picture encoding task was completed by all children in order to assess brain regions involved in memory processes. Results Neuropsychological testing demonstrated that SGA children had IQ’s within the normal range but lower than in AGA and poorer performances across measures of memory. Using fMRI, we observed memory related activity in posterior parahippocampal gyrus as well as the hippocampus proper. Additionally, activation was seen bilaterally in the prefrontal gyrus. Children born SGA showed less activation in the left parahippocampal region compared to AGA. Conclusions This is the first fMRI study demonstrating different brain activation patterns in 4-7 year old children born SGA, suggesting that intrauterine growth restriction continues to affect neural functioning in children later-on.
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Affiliation(s)
- Henrica M. A. de Bie
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - Michiel B. de Ruiter
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Mieke Ouwendijk
- Department of Pediatric Psychology, VU University Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - Kim J. Oostrom
- Department of Pediatric Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - Marko Wilke
- Department of Pediatric Neurology and Developmental Medicine and Experimental Pediatric Neuroimaging Neuroimaging Group, Children’s Hospital, University of Tübingen, Tübingen, Germany
| | - Maria Boersma
- Department of Clinical Neurophysiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Dick J. Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Henriette A. Delemarre-van de Waal
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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Association of brain metabolism with sulcation and corpus callosum development assessed by MRI in late-onset small fetuses. Am J Obstet Gynecol 2015; 212:804.e1-8. [PMID: 25640049 DOI: 10.1016/j.ajog.2015.01.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 12/12/2014] [Accepted: 01/27/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We sought to determine the relationship between fetal brain metabolism and microstructure expressed by brain sulcation, and corpus callosum (CC) development assessed by fetal brain magnetic resonance (MR) imaging and proton MR spectroscopy ((1)H-MRS). STUDY DESIGN A total of 119 fetuses, 64 that were small for gestational age (estimated fetal weight <10th centile and normal umbilical artery Doppler) and 55 controls underwent a 3T MR imaging/(1)H-MRS exam at 37 weeks. Anatomical T2-weighted images were obtained in the 3 orthogonal planes and long echo time (TE) (1)H-MRS acquired from the frontal lobe. Head biometrics, cortical fissure depths (insula, Sylvian, parietooccipital, cingulate, and calcarine), and CC area and biometries were blindly performed by manual and semiautomated delineation using Analyze software and corrected creating ratios for biparietal diameter and frontooccipital diameter, respectively, for group comparison. Spectroscopic data were processed using LCModel software and analyzed as metabolic ratios of N-acetylaspartate (NAA) to choline (Cho), Cho to creatine (Cr), and myo-inositol (Ino) to Cho. Differences between cases and controls were assessed. To test for the association between metabolic ratios and microstructural parameters, bivariate correlation analyses were performed. RESULTS Spectroscopic findings showed decreased NAA/Cho and increased Cho/Cr ratios in small fetuses. They also presented smaller head biometrics, shorter and smaller CC, and greater insular and cingulate depths. Frontal lobe NAA/Cho significantly correlated with biparietal diameter (r = 0.268; P = .021), head circumference (r = 0.259; P = .026), CC length (r = 0.265; P = .026), CC area (r = 0.317; P = .007), and the area of 6 from the 7 CC subdivisions. It did not correlate with any of the cortical sulcation parameters evaluated. None of the other metabolic ratios presented significant correlations with cortical development or CC parameters. CONCLUSION Frontal lobe NAA/Cho levels-which are considered a surrogate marker of neuronal activity-show a strong association with CC development. These results suggest that both metabolic and callosal alterations may be part of the same process of impaired brain development associated with intrauterine growth restriction.
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Maliszewski-Hall AM, Alexander M, Tkáč I, Öz G, Rao R. Differential Effects of Intrauterine Growth Restriction on the Regional Neurochemical Profile of the Developing Rat Brain. Neurochem Res 2015; 42:133-140. [PMID: 25972040 DOI: 10.1007/s11064-015-1609-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 05/05/2015] [Accepted: 05/07/2015] [Indexed: 11/24/2022]
Abstract
Intrauterine growth restricted (IUGR) infants are at increased risk for neurodevelopmental deficits that suggest the hippocampus and cerebral cortex may be particularly vulnerable. Evaluate regional neurochemical profiles in IUGR and normally grown (NG) 7-day old rat pups using in vivo 1H magnetic resonance (MR) spectroscopy at 9.4 T. IUGR was induced via bilateral uterine artery ligation at gestational day 19 in pregnant Sprague-Dawley dams. MR spectra were obtained from the cerebral cortex, hippocampus and striatum at P7 in IUGR (N = 12) and NG (N = 13) rats. In the cortex, IUGR resulted in lower concentrations of phosphocreatine, glutathione, taurine, total choline, total creatine (P < 0.01) and [glutamate]/[glutamine] ratio (P < 0.05). Lower taurine concentrations were observed in the hippocampus (P < 0.01) and striatum (P < 0.05). IUGR differentially affects the neurochemical profile of the P7 rat brain regions. Persistent neurochemical changes may lead to cortex-based long-term neurodevelopmental deficits in human IUGR infants.
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Affiliation(s)
- Anne M Maliszewski-Hall
- Division of Neonatology, Department of Pediatrics, University of Minnesota, 420 Delaware Street SE, Suite 13-227, MMC 391, Minneapolis, MN, 55455, USA.
| | - Michelle Alexander
- Division of Neonatology, Department of Pediatrics, University of Minnesota, 420 Delaware Street SE, Suite 13-227, MMC 391, Minneapolis, MN, 55455, USA
| | - Ivan Tkáč
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
| | - Gülin Öz
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
| | - Raghavendra Rao
- Division of Neonatology, Department of Pediatrics, University of Minnesota, 420 Delaware Street SE, Suite 13-227, MMC 391, Minneapolis, MN, 55455, USA
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Abstract
Magnetic resonance imaging of the human fetal brain has been a clinical tool for many years and provides valuable additional information to compliment more common ultrasound studies. Advances in both MRI acquisition and post processing over the last 10 years have enabled full 3D imaging and the accurate combination of data acquired in different head positions to create improved geometric integrity, tissue contrast, and resolution. This research is now motivating the development of new quantitative MRI-based techniques for clinical imaging that can more accurately characterize brain development and detect abnormalities. In this article, we will review some of the key areas that are driving changes in our understanding of fetal brain growth using quantitative measures derived from in utero MRI and the possible directions for its increased use in improving the evaluation of pregnancies and the accurate characterization of abnormal brain growth.
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Affiliation(s)
- Colin Studholme
- Biomedical Image Computing Group, Departments of Pediatrics, Bioengineering and Radiology, University of Washington, Seattle, WA.
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Sanz-Cortes M, Simoes RV, Bargallo N, Masoller N, Figueras F, Gratacos E. Proton Magnetic Resonance Spectroscopy Assessment of Fetal Brain Metabolism in Late-Onset ‘Small for Gestational Age' versus ‘Intrauterine Growth Restriction' Fetuses. Fetal Diagn Ther 2014; 37:108-16. [DOI: 10.1159/000365102] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/22/2014] [Indexed: 11/19/2022]
Abstract
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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