Department of Child and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA.
Ultrasound Obstet Gynecol. 2021 Aug;58(2):245-253. doi: 10.1002/uog.22185.
Antenatal Doppler measurements of the fetal umbilical and cerebral circulations can predict perinatal complications; however, it is unclear if subtle variations in antenatal Doppler measurements are associated with long-term neurodevelopmental outcome. In this study, we examined whether antenatal Doppler measurements of the fetal-placental circulation are associated with cognitive and motor abilities and brain morphology in childhood.
To evaluate differences in long-term sequelae across the continuum of the umbilical and cerebral artery circulations in the general population, we utilized a population-based longitudinal cohort study approach. In women from the Generation R study, we measured second- and third-trimester umbilical artery pulsatility index (UA-PI). Children underwent non-verbal intelligence testing at 4-8 years of age, and at 8-12 years they underwent finger-tapping tests to measure fine motor skills, balance beam tests to measure gross motor skills and brain magnetic resonance imaging. We assessed the relationships between prenatal UA-PI and neurodevelopmental outcome using linear regression. We adjusted for child age and sex, maternal age, education, parity and smoking status.
The study sample included 2803 pregnancies. Higher third-trimester UA-PI was associated with poorer fine motor performance (0.41 (95% CI, 0.11-0.70) fewer taps on the finger-tapping test per 1 SD higher UA-PI) and gross motor performance (0.64 (95% CI, 0.20-1.08) fewer steps on the balance beam test per 1 SD higher UA-PI). One SD higher third-trimester UA-PI was also associated with 0.65 (95% CI, 0.04-1.25) points lower intelligence quotient; however, unlike the associations with motor abilities, this finding did not persist after correction for multiple testing. Higher second-trimester UA-PI was associated with smaller brain volume (6.1 (95% CI, 1.0-11.3) cm reduction per 1 SD higher UA-PI), but the association did not persist after correction for multiple testing.
Higher placental vascular resistance may have mild adverse effects on neurodevelopmental outcome at school age. While these effects are subtle at population level, we encourage future research into the role of early circulation in brain development. This information could be used to develop targeted interventions. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
胎儿脐带动脉和大脑循环的产前多普勒测量可以预测围产期并发症；然而，产前多普勒测量的细微变化是否与长期神经发育结局有关尚不清楚。在这项研究中，我们研究了胎儿胎盘循环的产前多普勒测量是否与儿童期的认知和运动能力以及大脑形态有关。
为了评估一般人群中脐带动脉和大脑动脉循环连续体中长期后果的差异，我们采用了基于人群的纵向队列研究方法。在 Generation R 研究的女性中，我们测量了第二和第三孕期的脐动脉搏动指数（UA-PI）。儿童在 4-8 岁时进行非语言智力测试，在 8-12 岁时进行手指敲击测试以测量精细运动技能，平衡木测试以测量粗大运动技能和大脑磁共振成像。我们使用线性回归来评估产前 UA-PI 与神经发育结果之间的关系。我们调整了儿童年龄和性别、母亲年龄、教育程度、产次和吸烟状况。
研究样本包括 2803 例妊娠。较高的第三孕期 UA-PI 与精细运动表现较差（每增加 1 个 SD 的 UA-PI，手指敲击测试的 taps 减少 0.41（95%CI，0.11-0.70））和粗大运动表现较差（每增加 1 个 SD 的 UA-PI，平衡木测试的 steps 减少 0.64（95%CI，0.20-1.08））相关。第三孕期 UA-PI 每增加 1 个 SD，智商也会降低 0.65（95%CI，0.04-1.25）分；然而，与运动能力的关联不同，这种关联在经过多次测试校正后并不存在。较高的第二孕期 UA-PI 与脑体积较小相关（每增加 1 个 SD 的 UA-PI，脑体积减少 6.1（95%CI，1.0-11.3）cm），但在经过多次测试校正后，这种关联并不存在。
胎盘血管阻力升高可能对学龄期的神经发育结果产生轻微的不良影响。虽然在人群水平上这些影响是微妙的，但我们鼓励未来对早期循环在大脑发育中的作用进行研究。这些信息可以用于制定有针对性的干预措施。© 2020 作者。《超声医学》由 John Wiley & Sons Ltd 出版，代表国际妇产科超声学会。
