目的:具有迟发性生长受限(FGR)的胎儿在出生后神经认知能力欠佳的风险较高。先前的研究报道,受损的大脑和皮质发育可以在子宫内开始。本研究的主要目的是根据FGR的严重程度报告胎儿的中线结构生长和皮质发育;次要目的是阐明FGR的严重程度。根据多普勒异常发现的定义,在影响大脑生长和成熟方面发挥作用。
方法:这是一项前瞻性观察性研究,包括在妊娠32至34周期间接受神经超声检查的迟发性FGR(根据DelphiFGR标准定义)的胎儿。中线结构(call体(CC)和小脑蠕虫(CV))长度和皮质发育,包括西尔维安(SF)的深度,顶枕骨(POF)和钙质(CF)裂隙,比较了迟发性FGR,小于胎龄(SGA)和适合胎龄(AGA)的胎儿。还根据FGR的严重程度(正常与异常胎儿多普勒)进行了亚组分析。采用单因素分析对数据进行分析。
结果:共52例晚发性FGR胎儿,多普勒表现正常,60例具有异常多普勒表现的晚发性FGR胎儿,分析中包括64例SGA胎儿和100例AGA胎儿。当比较AGA对照与SGA胎儿时,多普勒表现正常的晚发型FGR胎儿和多普勒表现异常的晚发型FGR胎儿,以下参数的绝对值逐渐显着降低:CC长度(中位数(四分位距(IQR)),43.5(28.9-56.1)毫米vs41.9(27.8-51.8)毫米vs38.5(29.1-50.5)毫米vs31.7(23.8-40.2)毫米;K=26.68;P<0.0001),SF深度(中位数(IQR),14.5(10.7-16.8)mmvs12.7(9.8-15.1)mmvs11.9(9.1-13.4)mmvs8.3(6.7-10.3)mm;K=75.82;P<0.0001),POF深度(中位数(IQR),8.6(6.3-11.1)毫米vs8.1(5.6-10.4)毫米vs7.8(6.1-9.3)毫米vs6.6(4.2-8.0)毫米;K=45.06;P<0.0001)和CF深度(中位数(IQR),9.3(6.7-11.5)mmvs8.2(5.7-10.7)mmvs7.7(5.2-9.4)mmvs6.3(4.5-7.2)mm;K=46.14;P<0.0001)。与所有其他组相比,AGA胎儿的绝对CV长度明显更高,尽管没有注意到相同的渐进模式(中位数(IQR),24.9(17.6-29.2)mmvs21.6(15.2-26.1)mmvs19.1(13.8-25.9)mmvs21.0(13.5-25.8)mm;K=16.72;P=0.0008。当神经超声检查变量校正胎儿头围时,CC长度和SF有显著差异,POF和CF深度,但不是CV长度,与AGA和SGA胎儿相比,仅在多普勒发现异常的晚发性FGR胎儿中观察到。
结论:与AGA胎儿相比,晚发性FGR胎儿的CC长度较短,皮质发育延迟。在控制胎儿头围后,仅在多普勒异常的晚发型FGR胎儿中,这些差异仍然显著.这些发现支持大脑发育与胎盘功能受损之间存在联系。©2024国际妇产科超声学会。
OBJECTIVE: Fetuses with late-onset growth restriction (FGR) have a higher risk of suboptimal neurocognitive performance after birth. Previous studies have reported that impaired brain and cortical development can start in utero. The primary aim of this study was to report midline structure growth and cortical development in fetuses with late-onset FGR according to its severity; the secondary aim was to elucidate whether the severity of FGR, as defined by the presence of abnormal Doppler findings, plays a role in affecting brain growth and maturation.
METHODS: This was a prospective observational study that included fetuses with late-onset FGR (defined according to the Delphi FGR criteria) undergoing neurosonography between 32 and 34 weeks\' gestation. Midline structure (corpus callosum (CC) and cerebellar vermis (CV)) length and cortical development, including the depth of the Sylvian (SF), parieto-occipital (POF) and calcarine (CF) fissures, were compared between late-onset FGR, small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) fetuses. Subgroup analysis according to the severity of FGR (normal vs abnormal fetal Doppler) was also performed. Univariate analysis was used to analyze the data.
RESULTS: A total of 52 late-onset FGR fetuses with normal Doppler findings, 60 late-onset FGR fetuses with abnormal Doppler findings, 64 SGA fetuses and 100 AGA fetuses were included in the analysis. When comparing AGA controls with SGA fetuses, late-onset FGR fetuses with normal Doppler findings and late-onset FGR fetuses with abnormal Doppler findings, there was a progressive and significant reduction in the absolute values of the following parameters: CC length (median (interquartile range (IQR)), 43.5 (28.9-56.1) mm vs 41.9 (27.8-51.8) mm vs 38.5 (29.1-50.5) mm vs 31.7 (23.8-40.2) mm; K = 26.68; P < 0.0001), SF depth (median (IQR), 14.5 (10.7-16.8) mm vs 12.7 (9.8-15.1) mm vs 11.9 (9.1-13.4) mm vs 8.3 (6.7-10.3) mm; K = 75.82; P < 0.0001), POF depth (median (IQR), 8.6 (6.3-11.1) mm vs 8.1 (5.6-10.4) mm vs 7.8 (6.1-9.3) mm vs 6.6 (4.2-8.0) mm; K = 45.06; P < 0.0001) and CF depth (median (IQR), 9.3 (6.7-11.5) mm vs 8.2 (5.7-10.7) mm vs 7.7 (5.2-9.4) mm vs 6.3 (4.5-7.2) mm; K = 46.14; P < 0.0001). Absolute CV length was significantly higher in AGA fetuses compared with all other groups, although the same progressive pattern was not noted (median (IQR), 24.9 (17.6-29.2) mm vs 21.6 (15.2-26.1) mm vs 19.1 (13.8-25.9) mm vs 21.0 (13.5-25.8) mm; K = 16.72; P = 0.0008). When the neurosonographic variables were corrected for fetal head circumference, a significant difference in the CC length and SF, POF and CF depths, but not CV length, was observed only in late-onset FGR fetuses with abnormal Doppler findings when compared with AGA and SGA fetuses.
CONCLUSIONS: Fetuses with late-onset FGR had shorter CC length and delayed cortical development when compared with AGA fetuses. After controlling for fetal head circumference, these differences remained significant only in late-onset FGR fetuses with abnormal Doppler. These findings support the existence of a link between brain development and impaired placental function. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.