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Published on: January 7, 2018
Differential effect of intrauterine growth restriction on childhood neurodevelopment: a systematic review
E Murray1, M Fernandes2, M Fazel1
1Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
Insights
Intrauterine growth restriction (IUGR) is linked to childhood neurodevelopmental delays. Children born preterm or with altered fetal circulation due to IUGR face more severe impairments.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Obstetrics
Background:
- Neurodevelopmental disorders are increasingly linked to intrauterine growth restriction (IUGR).
- Existing reviews often rely on birth weight, an insufficient indicator of IUGR's neurodevelopmental impact.
Purpose of the Study:
- To investigate the association between in utero documented IUGR and childhood neurodevelopmental outcomes.
- To differentiate the impact of IUGR based on gestational age and evidence of fetal circulatory redistribution.
Main Methods:
- Searched Medline, CINAHL, PsycInfo, and Scopus for studies post-1970.
- Included studies with in utero IUGR diagnosis and follow-up from 1 month to 12 years.
- Extracted data on cognitive, behavioral, language, motor, sensory, and sleep outcomes, analyzed separately for preterm (<35 weeks) and term (≥35 weeks) infants.
Main Results:
- IUGR infants (≥35 weeks) scored 0.5 SD lower; preterm IUGR infants (<35 weeks) scored 0.7 SD lower on neurodevelopmental assessments.
- IUGR with fetal circulatory redistribution showed more severe neurodevelopmental impairments than IUGR alone.
- 38 studies were included from 28,876 identified titles.
Conclusions:
- IUGR elevates the risk of neurodevelopmental impairment in children across various domains.
- Preterm birth and fetal circulatory redistribution exacerbate neurodevelopmental deficits in IUGR infants.
- IUGR is a significant risk factor for neurodevelopmental delay.
Background:
Neurodevelopmental disorders are increasingly believed to originate from intrauterine growth restriction (IUGR). Current reviews exploring the neurodevelopmental effects of IUGR, however, are mostly based on birthweight, an inadequate proxy.
Objective:
We aimed to examine the association between IUGR documented in utero, and neurodevelopmental outcomes during childhood.
Search Strategy:
Medline, CINAHL, PsycInfo and Scopus were searched for relevant studies published after 1970.
Selection Criteria:
The analysis included studies that identified IUGR in utero, with follow-up assessments between 1 month and 12 years of age.
Data Collection And Analysis:
Data was extracted for cognitive, behavioural, language, motor, hearing, vision or sleep outcomes. Studies were summarised separately for children born at <35 and ≥35 weeks gestation.
Main Results:
Of 28 876 titles identified, 38 were suitable for inclusion. IUGR children born ≥35 weeks gestation scored on average 0.5 SD lower than non-IUGR children across all neurodevelopmental assessments. IUGR children born <35 weeks of gestation scored approximately 0.7 SD lower than non-IUGR children across all neurodevelopmental assessments. IUGR children with evidence of fetal circulatory redistribution (preferential perfusion of the brain) had more severe neurodevelopmental impairments than those born IUGR alone.
Conclusions:
IUGR increases the risk of neurodevelopmental impairment during childhood differentially across domains. IUGR children born preterm or with evidence of fetal circulatory redistribution are more severely affected.
Tweetable Abstract:
IUGR is associated with an overall risk for neurodevelopmental delay in a range of neurodevelopmental domains.
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