Impaired in vivo feto-placental development is associated with neonatal neurobehavioral outcomes

Prenatal human brain development is not spared by IUGR: A systematic review

BACKGROUND

Intrauterine growth restriction (IUGR) is a severe condition in which the fetus fails to reach its genetically predetermined growth potential, impairing prenatal development and predisposing individuals to postnatal consequences that may persist into adulthood. Although fetal mechanisms such as the brain-sparing effect have been proposed to protect the brain against IUGR-related deficits, the extent of this protection remains unclear.

OBJECTIVE

To conduct a systematic review that demonstrates prenatal morphofunctional abnormalities in the brain of individuals with IUGR.

METHODS

A comprehensive literature search was performed in the MEDLINE/PubMed database using keywords and Boolean operators: IUGR AND newborn AND nervous system NOT review. Inclusion criteria used: free and full-text availability, publication date from January 1, 2013, to July 31, 2024, newborns (birth to 1 month), and both sexes. Exclusion criteria included studies of older infants, lack of focus on the central nervous system, multiple pregnancies, concurrent pathologies with IUGR, use of animal models, and review articles. The review protocol is registered with PROSPERO (ID: CRD42024542500).

RESULTS

Seventeen studies were identified, totaling 2085 individuals. Of these, 1203 had some form of IUGR (early- or late-onset, symmetrical or asymmetrical, with or without circulatory centralization), whereas 882 were appropriate for gestational age (AGA) and served as controls. Across all studies, individuals with IUGR showed biometric, morphological, and/or cerebral vascular abnormalities, even when biparietal diameter or head circumference measurements were similar to those of AGA individuals.

CONCLUSION

Prenatal human brain development is not spared by IUGR.

Long-Term Neurologic Consequences following Fetal Growth Restriction: The Impact on Brain Reserve

BACKGROUND

Fetal growth restriction (FGR) corresponds to the fetus's inability to achieve an adequate weight gain based on genetic potential and gestational age. It is an important cause of morbidity and mortality.

SUMMARY

In this review, we address the challenges of diagnosis and classification of FGR. We review how chronic fetal hypoxia impacts brain development. We describe recent advances on placental and fetal brain imaging using magnetic resonance imaging and how they offer new noninvasive means to study growth restriction in humans. We go on to review the impact of FGR on brain integrity in the neonatal period, later childhood, and adulthood and review available therapies.

KEY MESSAGES

FGR consequences are not limited to the perinatal period. We hypothesize that impaired brain reserve, as defined by structure and size, may predict some concerning epidemiological data of impaired cognitive outcomes and dementia with aging in this group of patients.

Born small-for-gestational age: not just smaller

Linked article: This Correspondence comments on Paz y Miño et al. Click here to view the article.