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Fetal Growth Restriction with Brain Sparing: Neurocognitive and Behavioral Outcomes at 12 Years of Age
Fenny Beukers1, Cornelieke S H Aarnoudse-Moens1, Mirjam M van Weissenbruch2
1Department of Pediatrics, Academic Medical Center, Amsterdam, The Netherlands.
Insights
Children with fetal growth restriction (FGR) and brain sparing showed normal cognitive function at age 12. However, parents reported increased social and attention problems in these children.
Area of Science:
- Pediatric Neurology
- Developmental Psychology
- Maternal-Fetal Medicine
Background:
- Fetal growth restriction (FGR) affects neurodevelopment.
- Brain sparing in FGR indicates altered blood flow to the brain.
- Long-term neurocognitive and behavioral outcomes in FGR require further investigation.
Purpose of the Study:
- To assess neurocognitive functions and behavior in 12-year-old children with a history of FGR and brain sparing.
- To test the hypothesis that FGR with brain sparing leads to poorer neurocognitive and behavioral outcomes.
Main Methods:
- A prospective follow-up study compared 12-year-old children with FGR (n=96) to a control group (n=32).
- Neurocognitive outcomes included intelligence quotient, executive function, and attention.
- Parent-reported behavioral assessments covered social and attention problems.
Main Results:
- Neurocognitive outcomes were comparable between the FGR and control groups.
- Parents of children with FGR reported significantly more social problems (P<.001) and attention problems (P=.004).
- Severity of brain sparing (UC-ratio) was not associated with outcomes, but low parental education and birth weight ratio were.
Conclusions:
- Children with FGR and brain sparing exhibit normal neurocognitive function at age 12.
- Parent-reported social and attention difficulties are more prevalent in children with FGR history.
- Factors like parental education and birth weight ratio may influence outcomes in FGR.
Objective:
To study neurocognitive functions and behavior in children with a history of fetal growth restriction (FGR) with brain sparing. We hypothesized that children with FGR would have poorer outcomes on these domains.
Study Design:
Subjects were 12-year-old children with a history of FGR born to mothers with severe early-onset hypertensive pregnancy disorders (n = 96) compared with a normal functioning full term comparison group with a birth weight ≥2500 g (n = 32). Outcome measures were neurocognitive outcomes (ie, intelligence quotient, executive function, attention) and behavior.
Results:
For the FGR group, the mean ratio of the pulsatility index for the umbilical artery/middle cerebral artery (UC-ratio = severity of brain sparing) was 1.42 ± 0.69. The mean gestational age was 31-6/7 ± 2-2/7 weeks. The mean birth weight was 1341 ± 454 g, and the mean birth weight ratio 0.68 ± 0.12. Neurocognitive outcomes were comparable between groups. Parents of children with FGR reported more social problems (mean T-score 56.6 ± 7.7; comparison 52.3 ± 4.3, P < .001, effect size = 1, 95% CI 0.52-1.46) and attention problems (mean T-score 57.3 ± 6.9; comparison 53.6 ± 4.2, P = .004, effect size = 0.88, 95% CI 0.42-1.33). UC-ratio was not associated with any of the outcomes, but low parental education and lower birth weight ratio were.
Conclusions:
In this prospective follow-up study of 12-year-old children with a history of FGR and confirmed brain sparing, neurocognitive functions were comparable with the comparison group, but parent-reported social and attention problem scores were increased.
