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Brain Sparing Effect on Neurodevelopment in Children with Intrauterine Growth Restriction: A Systematic Review
María José Benítez-Marín1,2, Jesús Marín-Clavijo3, Juan Antonio Blanco-Elena4
1Obstetrics and Gynecology Section at Surgical Specialties, Biochemistry and Immunology Department, Medicine School, Málaga University, 29071 Málaga, Spain.
Insights
Fetal growth restriction (FGR) brain sparing may not fully protect against neurodevelopmental issues. Some cognitive abilities and executive functions may be impacted in children with FGR, despite initial adaptive responses.
Area of Science:
- Neurodevelopmental Pediatrics
- Fetal Medicine
- Developmental Neuroscience
Background:
- Fetal growth restriction (FGR) is a significant pregnancy complication linked to adverse neurodevelopmental outcomes in children.
- Brain sparing, an adaptive response to placental insufficiency, has been traditionally viewed as protective but may not offer complete neuroprotection.
- Understanding the long-term neurodevelopmental consequences of brain redistribution in FGR is crucial.
Purpose of the Study:
- To systematically review the impact of brain redistribution in fetuses with placental intrauterine growth restriction on childhood neurodevelopment.
- To evaluate the association between fetal brain sparing and cognitive, behavioral, and executive functions in children.
Main Methods:
- A systematic review was conducted following PRISMA guidelines.
- Studies included fetuses with intrauterine growth restriction or small-for-gestational-age (SGA) status, measuring middle cerebral artery flow and assessing childhood neurodevelopment.
- Literature search was performed on PUBMED and EMBASE databases.
Main Results:
- Twelve studies were included from an initial 526.
- Brain sparing in FGR was associated with poorer cognitive function and lower IQ scores.
- Cerebral redistribution correlated with better executive function and behavior at age 4, but these benefits were not sustained at age 12.
Conclusions:
- Fetal brain sparing is not a fully protective phenomenon against neurodevelopmental deficits.
- Heterogeneous results precluded definitive clinical differences in behavioral and executive functions.
- Certain cognitive abilities may be compromised in fetuses exhibiting brain sparing due to FGR.
Background:
Fetal growth restriction (FGR) is a pregnancy complication. Multiple studies have connected FGR to poor cognitive development, behavior disorders, and academic difficulties during childhood. Brain sparing has traditionally been defined as an adaptive phenomenon in which the brain obtains the blood flow that it needs. However, this adaptive phenomenon might not have a complete protective effect. This publication aims to systematically review the consequences of brain redistribution on neurodevelopment in children who presented with placental intrauterine growth restriction.
Methods:
We performed a systematic review according to PRISMA guidelines. It included studies on intrauterine growth restriction or small-for-gestational-age (SGA) fetuses, which middle cerebral artery was measured, and neurodevelopment assessed during childhood. PUBMED and EMBASE databases were searched for relevant published studies.
Results:
Of the 526 studies reviewed, only 12 were included. Brain sparing was associated with poor cognitive function and lower scores in IQ. Cerebral redistribution was related to better executive function and better behavior at 4 years old but not at 12 years old.
Conclusions:
We can assume that fetal brain sparing could not be a fully protective phenomenon. We could not find clinical differences in behavioral and executive functions because the results were heterogeneous. Some cognitive abilities could be affected in FGR brain sparing fetuses.
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