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Prenatal human brain development is not spared by IUGR: A systematic review
Danilo Rodrigues Honório1, Ana Luiza da Silva Ribeiro1, Tamires Lorrayne Morais da Silva1
1School of Medicine, Atenas University Centre, Prefeito Alberto Moura, 6000, 35701-383 Sete Lagoas, MG, Brazil.
Insights
Intrauterine growth restriction (IUGR) impacts fetal brain development, causing abnormalities despite potential protective mechanisms. This review confirms prenatal brain development is significantly affected by IUGR.
Area of Science:
- Neuroscience
- Developmental Biology
- Perinatology
Background:
- Intrauterine growth restriction (IUGR) hinders fetal growth potential, leading to lifelong health issues.
- The brain-sparing effect is a proposed mechanism to protect the brain in IUGR fetuses, but its efficacy is uncertain.
Purpose of the Study:
- To systematically review prenatal morphofunctional brain abnormalities in newborns with IUGR.
Main Methods:
- A systematic literature search was conducted on PubMed for studies published between 2013 and 2024.
- Inclusion criteria focused on newborns (0-1 month) with IUGR, excluding reviews and animal models.
- Seventeen studies involving 2085 newborns (1203 IUGR, 882 appropriate for gestational age) were analyzed.
Main Results:
- Individuals with IUGR exhibited biometric, morphological, and cerebral vascular abnormalities.
- These brain abnormalities were present even when head circumference and biparietal diameter were comparable to controls.
- Findings indicate IUGR affects brain development across various subtypes and severities.
Conclusions:
- Prenatal brain development in humans is demonstrably affected by intrauterine growth restriction.
- The brain-sparing effect does not fully protect the developing brain from IUGR-related deficits.
Background:
Intrauterine growth restriction (IUGR) is a severe condition in which the fetus fails to reach its genetically predetermined growth potential, impairing prenatal development and predisposing individuals to postnatal consequences that may persist into adulthood. Although fetal mechanisms such as the brain-sparing effect have been proposed to protect the brain against IUGR-related deficits, the extent of this protection remains unclear.
Objective:
To conduct a systematic review that demonstrates prenatal morphofunctional abnormalities in the brain of individuals with IUGR.
Methods:
A comprehensive literature search was performed in the MEDLINE/PubMed database using keywords and Boolean operators: IUGR AND newborn AND nervous system NOT review. Inclusion criteria used: free and full-text availability, publication date from January 1, 2013, to July 31, 2024, newborns (birth to 1 month), and both sexes. Exclusion criteria included studies of older infants, lack of focus on the central nervous system, multiple pregnancies, concurrent pathologies with IUGR, use of animal models, and review articles. The review protocol is registered with PROSPERO (ID: CRD42024542500).
Results:
Seventeen studies were identified, totaling 2085 individuals. Of these, 1203 had some form of IUGR (early- or late-onset, symmetrical or asymmetrical, with or without circulatory centralization), whereas 882 were appropriate for gestational age (AGA) and served as controls. Across all studies, individuals with IUGR showed biometric, morphological, and/or cerebral vascular abnormalities, even when biparietal diameter or head circumference measurements were similar to those of AGA individuals.
Conclusion:
Prenatal human brain development is not spared by IUGR.
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