Brain Development in Fetuses of Mothers with Diabetes: A Case-Control MR Imaging Study

Area of Science:

• Neuroscience
• Radiology
• Maternal-Fetal Medicine

Background:

• Offspring of mothers with diabetes mellitus face increased risks of neurocognitive impairment.
• The precise origins of these neurodevelopmental risks in the fetal brain remain largely unknown.
• Maternal diabetes can impact fetal development, necessitating advanced imaging techniques for assessment.

Purpose of the Study:

• To assess the feasibility of comprehensive multimodal magnetic resonance (MR) imaging in third-trimester fetuses of women with diabetes.
• To evaluate fetal brain metabolism using proton magnetic resonance spectroscopy (¹H-MRS).
• To examine fetal brain microstructure with diffusion-weighted imaging (DWI) and macrostructure with structural MRI.

Main Methods:

• Prospective recruitment of pregnant women with diabetes (n=26) and healthy controls (n=26) between 34-38 weeks' gestation.
• Acquisition of multimodal MR imaging data, including ¹H-MRS, DWI, and structural MRI, at 3 Tesla (3T).
• Analysis of key metabolites (NAA/Cho, NAA/Cr, Cho/Cr), apparent diffusion coefficients (ADC), and cerebral volume.

Main Results:

• Feasible data acquisition rates were achieved: 79% for ¹H-MRS, 71% for DWI, and 46% for structural MRI.
• No significant differences were observed in NAA/Cho and NAA/Cr ratios or ADC values in fetal brains between diabetic and control groups.
• A marginally lower Cho/Cr ratio was noted in the diabetic group (P=.04), with no significant difference in cerebral volume.

Conclusions:

• Multimodal MR imaging of the fetal brain at 3T is feasible in pregnant women with diabetes.
• Initial findings suggest no significant alterations in major brain metabolites or microstructure in fetuses exposed to maternal diabetes.
• Further research into fetal brain metabolism and development in the context of maternal diabetes is warranted.