BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
Ultrasound Obstet Gynecol. 2022 Jun;59(6):737-746. doi: 10.1002/uog.24853. Epub 2022 May 13.
To explore the pattern of fetal cortical development in pregnancies complicated by pre-eclampsia (PE), with and without a small-for-gestational-age (SGA) fetus, compared to uncomplicated pregnancies.
This was a prospective observational study including singleton pregnancies complicated by normotensive SGA (birth weight < 10 centile) (n = 77), PE with an appropriate-for-gestational-age (AGA) fetus (n = 76) or PE with a SGA fetus (n = 67), and 128 uncomplicated pregnancies (normotensive AGA) matched by gestational age at ultrasound. All pregnancies underwent detailed neurosonography, using a transabdominal and transvaginal approach, at 31-35 weeks' gestation to assess the depth of the insula, Sylvian fissure, parieto-occipital sulcus, cingulate sulcus and calcarine sulcus. All measurements were adjusted for biparietal diameter (BPD). In addition, a grading score of cortical development was assigned to each brain structure, ranging from Grade 0 (no development) to Grade 5 (maximum development). Univariate and multiple regression analyses were conducted.
Similar to findings in previous studies, normotensive pregnancies with a SGA fetus showed significant differences in cortical development compared with controls, with reduced Sylvian fissure depth adjusted for BPD (14.5 ± 2.4 vs 16.6 ± 2.3; P < 0.001) and increased insula depth adjusted for BPD (33.2 ± 2.0 vs 31.8 ± 2.0; P < 0.001). Interestingly, a similar cortical development pattern was observed in PE pregnancies with a SGA fetus and in PE pregnancies with an AGA fetus, manifested by reduced Sylvian fissure depth adjusted for BPD (14.2 ± 2.3 and 14.3 ± 2.3 vs 16.6 ± 2.3; P < 0.001 for both) and greater insula depth adjusted for BPD (33.2 ± 2.1 and 32.8 ± 1.7 vs 31.8 ± 2.0; P < 0.001 for both) compared with controls. No significant differences were observed in parieto-occipital, cingulate sulcus or calcarine sulcus depth across the study groups. The Sylvian fissure was scored as Grade 4 in significantly more (93.2% vs 59.5%) and as Grade 5 in significantly fewer (2.7% vs 37.3%) PE pregnancies with an AGA fetus compared with controls (P < 0.05 for both). These differences remained significant even after statistical adjustment for potential confounders, including ethnicity, low socioeconomic status, nulliparity, chronic hypertension, pregestational diabetes, assisted reproductive technologies, smoking and fetal gender, with the application of Benjamini-Hochberg procedure for multiple comparisons.
PE with or without SGA is associated with a differential fetal cortical development pattern which is similar to that described previously in small fetuses. Future research is warranted to elucidate better the mechanism(s) underlying these changes. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
探讨与单纯妊娠相比，子痫前期（PE）合并和不合并胎儿生长受限（SGA）时胎儿皮质发育的模式。
这是一项前瞻性观察研究，纳入了 128 例单纯性 SGA（出生体重<第 10 百分位数）（n=77）、PE 合并合适胎龄（AGA）胎儿（n=76）或 PE 合并 SGA 胎儿（n=67）的单胎妊娠，以及 128 例匹配超声胎龄的正常血压 AGA 妊娠。所有妊娠均在 31-35 孕周行详细的经腹和经阴道神经超声检查，以评估脑岛、大脑外侧裂、顶枕沟、扣带回沟和距状裂的深度。所有测量值均根据双项径（BPD）进行调整。此外，还对每个脑结构的皮质发育进行分级评分，范围从 0 级（无发育）到 5 级（最大发育）。进行了单变量和多变量回归分析。
与以往研究的发现相似，与对照组相比，单纯性 SGA 胎儿的妊娠皮质发育存在显著差异，BPD 校正后的大脑外侧裂深度较浅（14.5±2.4 vs 16.6±2.3；P<0.001），脑岛深度较深（BPD 校正后 33.2±2.0 vs 31.8±2.0；P<0.001）。有趣的是，PE 合并 SGA 胎儿和 PE 合并 AGA 胎儿的皮质发育模式相似，表现为 BPD 校正后的大脑外侧裂深度较浅（14.2±2.3 和 14.3±2.3 vs 16.6±2.3；P<0.001），脑岛深度较深（BPD 校正后 33.2±2.1 和 32.8±1.7 vs 31.8±2.0；P<0.001），与对照组相比。研究组之间在顶枕沟、扣带回沟或距状裂深度上没有显著差异。SGA 胎儿的大脑外侧裂评分明显更高（93.2% vs 59.5%），评分明显更低（2.7% vs 37.3%），差异具有统计学意义（均为 P<0.05）。即使在统计学调整了潜在混杂因素，包括种族、低社会经济地位、初产妇、慢性高血压、孕前糖尿病、辅助生殖技术、吸烟和胎儿性别后，这些差异仍然具有统计学意义，同时应用了 Benjamini-Hochberg 程序进行多重比较。
PE 合并或不合并 SGA 与胎儿皮质发育的差异模式相关，与之前描述的小胎儿相似。需要进一步的研究来阐明这些变化背后的机制。© 2022 年国际妇产科超声学会。
