Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Neuroscience Intensive Care Nursery Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Dev Med Child Neurol. 2019 Sep;61(9):1002-1007. doi: 10.1111/dmcn.14160. Epub 2019 Jan 28.
Childhood brain development begins before birth, and obstetric management, tests, and technologies designed to diagnose and treat fetal conditions can have an impact on development. Preconception counseling for maternal diabetes and hypertension affect the risk of fetal congenital anomalies and growth restriction. Patients with risk factors for pre-existing maternal diabetes are offered early diabetic screening because earlier diagnosis and treatment can decrease the risk of fetal and neonatal complications. Screening for chromosomal abnormalities in the first or second trimester is offered to all females regardless of age. Cell-free fetal DNA screening can be used to test for fetal genetic abnormalities as early as 9 weeks of gestation with results available in 10 days. Ultrasound performed around 20 weeks' gestation can identify the 3% of fetuses that have a major congenital malformation. Fetal magnetic resonance imaging can be used to better assess fetal central nervous system abnormalities when neurosonography is inconclusive. Doppler ultrasound can be used to assess blood flow in the umbilical artery and fetal middle cerebral artery to aid in the management of the growth-restricted fetus. In summary, diagnosis and treatment of maternal and fetal conditions from the preconception period throughout pregnancy are important for optimizing fetal health and provide the best opportunity for optimal child development. WHAT THIS PAPER ADDS: Cell-free fetal DNA screening can identify fetal genetic abnormalities as early as 9 weeks' gestation. Ultrasound performed around 20 weeks' gestation can detect major fetal congenital malformations. Fetal magnetic resonance imaging can aid neurosonography in the assessment of fetal central nervous system abnormalities. Doppler ultrasound to assess fetal blood flow is used to successfully manage the growth-restricted fetus.
儿童大脑发育始于出生前，旨在诊断和治疗胎儿疾病的产科管理、检查和技术可能会对其发育产生影响。对患有母体糖尿病和高血压的产妇进行孕前咨询会影响胎儿先天畸形和生长受限的风险。对于存在母体糖尿病前期危险因素的患者，会提供早期糖尿病筛查，因为早期诊断和治疗可以降低胎儿和新生儿并发症的风险。对所有女性（无论年龄大小）都提供第一或第二孕期的染色体异常筛查。游离胎儿 DNA 筛查可用于在妊娠 9 周时尽早检测胎儿遗传异常，结果可在 10 天内获得。妊娠 20 周左右进行的超声检查可以识别出 3%存在重大先天畸形的胎儿。当神经超声检查结果不确定时，胎儿磁共振成像可用于更好地评估胎儿中枢神经系统异常。多普勒超声可用于评估脐动脉和胎儿大脑中动脉的血流，以帮助管理生长受限的胎儿。总之，从孕前到整个孕期对母体和胎儿状况的诊断和治疗对于优化胎儿健康和提供最佳儿童发育机会非常重要。本文的新发现：游离胎儿 DNA 筛查可在妊娠 9 周时识别胎儿遗传异常。妊娠 20 周左右进行的超声检查可检测出主要的胎儿先天畸形。胎儿磁共振成像可辅助神经超声评估胎儿中枢神经系统异常。多普勒超声评估胎儿血流用于成功管理生长受限的胎儿。
