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A poor long-term neurological prognosis is associated with abnormal cord insertion in severe growth-restricted
Masamitsu Nakamura1, Nagayoshi Umehara2, Keisuke Ishii3
1Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan.
Insights
Fetal growth restriction (FGR) with abnormal umbilical cord insertion (CI) significantly increases the risk of poor neurological outcomes in children up to age 3. This includes higher rates of cerebral palsy and developmental disorders in infants with marginal (MCI) or velamentous cord insertion (VCI).
Area of Science:
- Perinatal Medicine
- Neonatology
- Developmental Neurology
Background:
- Fetal growth restriction (FGR) is associated with adverse neonatal outcomes.
- Umbilical cord insertion (CI) abnormalities, such as marginal (MCI) and velamentous (VCI) CI, are potential risk factors for FGR complications.
- Neurological outcomes in early childhood are critical indicators of long-term development.
Purpose of the Study:
- To investigate the association between abnormal umbilical cord insertion (CI) and neurological outcomes in fetuses with FGR.
- To compare the risk of poor neurological outcomes in FGR cases with abnormal CI versus normal CI.
- To identify specific neurological complications associated with different types of abnormal CI.
Main Methods:
- A multicenter retrospective cohort study of 365 neonates with FGR (birth weight <3rd percentile) in Japan.
- Analysis of neurological outcomes from birth to 3 years of age, including cerebral palsy and developmental disorders.
- Multivariate logistic regression models were used to calculate odds ratios (OR) for abnormal CI (MCI, VCI) compared to normal CI.
Main Results:
- Among 365 FGR neonates, 63 had MCI and 14 had VCI.
- Elevated risks for neurological complications were observed: Cerebral Palsy OR=10.1 (VCI) and 4.3 (MCI); Developmental Disorders OR=6.7 (VCI).
- Abnormal CI in FGR fetuses was significantly associated with increased odds of cerebral palsy and developmental disorders.
Conclusions:
- Fetal growth restriction with abnormal umbilical cord insertion (CI) presents a high risk for adverse neurological outcomes.
- Cerebral palsy and developmental disorders are significant risks associated with marginal (MCI) and velamentous cord insertion (VCI).
- Early identification and monitoring of FGR cases with abnormal CI are crucial for managing potential neurodevelopmental issues.
Objective:
To clarify and compare if the neurological outcomes of fetal growth restriction (FGR) cases with abnormal cord insertion (CI) are associated with a higher risk of a poor neurological outcome in subjects aged 3 years or less versus those with normal CI.
Methods:
A multicenter retrospective cohort study was conducted among patients with a birth weight lower than the 3rd percentile, based on the standard reference values for Japanese subjects after 22 weeks' gestation, who were treated at a consortium of nine perinatal centers in Japan between June 2005 and March 2011. Patients whose birth weights were less than the 3rd percentile and whose neurological outcomes from birth to 3 years of age could be checked from their medical records were analyzed. The relationship between abnormal CI and neurological outcomes was analyzed. Univariate and multivariate models of multivariate logistic regression were employed to estimate the raw and odds ratio (OR) with 95% confidence intervals comparing marginal (MCI) and velamentous cord insertion (VCI) to normal CI.
Results:
Among 365 neonates, 63 cases of MCI and 14 cases of VCI were observed. After excluding 24 cases with neonatal or infant death from the total FGR population, the assessment of the outcomes of the infants aged 3 years or younger showed the following rates of neurological complications: 7.3% (n=25) for cerebral palsy, 8.8% (n=30) for developmental disorders, 16.7% (n=57) for small-for-gestational-age short stature (SGA), 0.6% (n=2) for impaired hearing, 0.9% (n=3) for epilepsy, 1.2% (n=4). The ORs (95% confidence intervals) based on multivariate analysis were as follows: cerebral palsy=10.1 (2.4-41.5) in the VCI group and 4.3 (1.6-11.9) in the MCI group, developmental disorders=6.7 (1.7-26) in the VCI group and 3.9 (1.1-14.2) in the single umbilical artery (SUA) group, 5.1 (1.4-18.7) for birth weight <1000 g and 2.8 (1.2-6.7) for placental weight <200 g.
Conclusions:
The present results indicate that growth-restricted fetuses diagnosed with a birth weight below the 3rd percentile exhibiting abnormal umbilical CI are at a high risk for poor neurological outcomes, including cerebral palsy and/or developmental disorders.
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