Developing Brain Institute, Children's National Hospital, Washington, District of Columbia.
Department of Quality and Patient Safety, Children's National Hospital, Washington, District of Columbia.
JAMA Netw Open. 2021 Mar 1;4(3):e213526. doi: 10.1001/jamanetworkopen.2021.3526.
Children raised in settings with lower parental socioeconomic status are at increased risk for neuropsychological disorders. However, to date, the association between socioeconomic status and fetal brain development remains poorly understood.
To determine the association between parental socioeconomic status and in vivo fetal brain growth and cerebral cortical development using advanced, 3-dimensional fetal magnetic resonance imaging.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study of fetal brain development enrolled 144 healthy pregnant women from 2 low-risk community obstetrical hospitals from 2012 through 2019 in the District of Columbia. Included women had a prenatal history without complications that included recommended screening laboratory and ultrasound studies. Exclusion criteria were multiple gestation pregnancy, known or suspected congenital infection, dysmorphic features of the fetus, and documented chromosomal abnormalities. T2-weighted fetal brain magnetic resonance images were acquired. Each pregnant woman was scanned at up to 2 points in the fetal period. Data were analyzed from June through November 2020.
Parental education level and occupation status were documented.
Regional fetal brain tissue volume (for cortical gray matter, white matter, cerebellum, deep gray matter, and brainstem) and cerebral cortical features (ie, lobe volume, local gyrification index, and sulcal depth) in the frontal, parietal, temporal, and occipital lobes were calculated.
Fetal brain magnetic resonance imaging studies were performed among 144 pregnant women (median [interquartile range] age, 32.5 [27.0-36.1] years) with gestational age from 24.0 to 39.4 weeks; 75 fetuses (52.1%) were male, and 69 fetuses (47.9%) were female. Higher parental education level was associated with significantly increased volume in the fetal white matter (mothers: β, 2.86; 95% CI, 1.26 to 4.45; P = .001; fathers: β, 2.39; 95% CI, 0.97 to 3.81; P = .001), deep gray matter (mothers: β, 0.16; 95% CI, 0.002 to 0.32; P = .048; fathers: β, 0.16; 95% CI, 0.02 to 0.31; P = .02), and brainstem (mothers: β, 0.06; 95% CI, 0.02 to 0.10; P = .01; fathers: β, 0.04; 95% CI, 0.004 to 0.08; P = .03). Higher maternal occupation status was associated with significantly increased volume in the fetal white matter (β, 2.07; 95% CI, 0.88 to 3.26; P = .001), cerebellum (β, 0.17; 95% CI, 0.04 to 0.29; P = .01), and brainstem (β, 0.03; 95% CI, 0.001 to 0.07; P = .04), and higher paternal occupation status was associated with significantly increased white matter volume (β, 1.98; 95% CI, 0.71 to 3.25; P < .01). However, higher socioeconomic status was associated with significantly decreased fetal cortical gray matter volume (mothers: β, -0.11; 95% CI, -0.18 to -0.03; P = .01; fathers: β, -0.10; 95% CI, -0.18 to -0.03; P = .01). Higher parental socioeconomic status was associated with increased volumes of 3 brain lobes of white matter: frontal lobe (mothers: β, 0.07; 95% CI, 0.02 to 0.13; P = .01; fathers: β, 0.06; 95% CI, 0.01 to 0.11; P = .03), parietal lobe (mothers: β, 0.07; 95% CI, 0.03 to 0.11; P < .001; fathers: β, 0.06; 95% CI, 0.03 to 0.10; P = .001), and temporal lobe (mothers: β, 0.04; 95% CI, 0.02 to 0.07; P < .001; fathers: β, 0.04; 95% CI, 0.02 to 0.07; P < .001), and maternal SES score was associated with significantly decreased volume in the occipital lobe (β, 0.02; 95% CI, 0.002 to 0.04; P = .03). Higher parental socioeconomic status was associated with decreased cortical local gyrification index (for example, for the frontal lobe, mothers: β, -1.1; 95% CI, -1.9 to -0.3; P = .01; fathers: β, -0.8; 95% CI, -1.6 to -0.1; P = .03) and sulcal depth, except for the frontal lobe (for example, for the parietal lobe, mothers: β, -9.5; 95% CI, -13.8 to -5.3; P < .001; fathers: β, -8.7; 95% CI, -13.0 to -4.4; P < .001).
This cohort study found an association between parental socioeconomic status and altered in vivo fetal neurodevelopment. While being born and raised in a lower socioeconomic status setting is associated with poorer neuropsychological, educational, and socioeconomic outcomes in children, these findings suggest that altered prenatal programming may be associated with these outcomes and that future targeted prenatal interventions may be needed.
重要性：在有较低父母社会经济地位的环境中成长的儿童，发生神经心理障碍的风险增加。然而，迄今为止，社会经济地位与胎儿大脑发育之间的关联仍知之甚少。
目的：使用先进的三维胎儿磁共振成像技术，确定父母社会经济地位与胎儿大脑生长和大脑皮质发育之间的关系。
设计、地点和参与者：这项关于胎儿大脑发育的队列研究纳入了 2012 年至 2019 年期间来自哥伦比亚特区 2 家低风险社区产科医院的 144 名健康孕妇。纳入的孕妇产前病史无并发症，包括推荐的筛查实验室和超声研究。排除标准为多胎妊娠、已知或疑似先天性感染、胎儿畸形特征以及记录的染色体异常。采集 T2 加权胎儿脑磁共振图像。每位孕妇在胎儿期最多可扫描 2 次。数据于 2020 年 6 月至 11 月进行分析。
暴露情况：记录了父母的教育水平和职业状况。
主要结果和措施：计算了皮质灰质、白质、小脑、深部灰质和脑干的区域性胎儿脑组织体积（用于额、顶、颞和枕叶），以及额叶、顶叶、颞叶和枕叶的大脑皮质特征（即叶体积、局部脑回指数和脑沟深度）。
结果：对 144 名孕妇（中位[四分位间距]年龄为 32.5[27.0-36.1]岁）进行了胎儿磁共振成像研究，其妊娠周数为 24.0 至 39.4 周；75 名胎儿（52.1%）为男性，69 名胎儿（47.9%）为女性。较高的父母教育水平与胎儿白质（母亲：β，2.86；95%置信区间，1.26 至 4.45；P = .001；父亲：β，2.39；95%置信区间，0.97 至 3.81；P = .001）、深部灰质（母亲：β，0.16；95%置信区间，0.002 至 0.32；P = .048；父亲：β，0.16；95%置信区间，0.02 至 0.31；P = .02）和脑干（母亲：β，0.06；95%置信区间，0.02 至 0.10；P = .01；父亲：β，0.04；95%置信区间，0.004 至 0.08；P = .03）体积显著增加相关。母亲的较高职业状况与胎儿白质（β，2.07；95%置信区间，0.88 至 3.26；P = .001）、小脑（β，0.17；95%置信区间，0.04 至 0.29；P = .01）和脑干（β，0.03；95%置信区间，0.001 至 0.07；P = .04）体积显著增加相关，父亲的较高职业状况与胎儿白质体积显著增加（β，1.98；95%置信区间，0.71 至 3.25；P < .01）相关。然而，较高的社会经济地位与胎儿皮质灰质体积显著减少（母亲：β，-0.11；95%置信区间，-0.18 至 -0.03；P = .01；父亲：β，-0.10；95%置信区间，-0.18 至 -0.03；P = .01）相关。较高的父母社会经济地位与 3 个脑叶白质体积增加相关：额叶（母亲：β，0.07；95%置信区间，0.02 至 0.13；P = .01；父亲：β，0.06；95%置信区间，0.01 至 0.11；P = .03）、顶叶（母亲：β，0.07；95%置信区间，0.03 至 0.11；P < .001；父亲：β，0.06；95%置信区间，0.03 至 0.10；P = .001）和颞叶（母亲：β，0.04；95%置信区间，0.02 至 0.07；P < .001；父亲：β，0.04；95%置信区间，0.02 至 0.07；P < .001），母亲的社会经济地位评分与枕叶体积显著减少（β，0.02；95%置信区间，0.002 至 0.04；P = .03）相关。较高的父母社会经济地位与皮质局部脑回指数降低（例如，额叶，母亲：β，-1.1；95%置信区间，-1.9 至 -0.3；P = .01；父亲：β，-0.8；95%置信区间，-1.6 至 -0.1；P = .03）和脑沟深度降低相关，除了额叶（例如，顶叶，母亲：β，-9.5；95%置信区间，-13.8 至 -5.3；P < .001；父亲：β，-8.7；95%置信区间，-13.0 至 -4.4；P < .001）。
结论和相关性：这项队列研究发现，父母的社会经济地位与胎儿体内神经发育改变之间存在关联。虽然在较低的社会经济地位环境中出生和成长与儿童较差的神经心理、教育和社会经济结果相关，但这些发现表明，产前编程的改变可能与这些结果相关，未来可能需要针对这些结果的有针对性的产前干预措施。
