Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv 64239, Israel.
Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv 69978, Israel.
Cereb Cortex. 2024 Jun 4;34(6). doi: 10.1093/cercor/bhae250.
Placental-related fetal growth restriction, resulting from placental dysfunction, impacts 3-5% of pregnancies and is linked to elevated risk of adverse neurodevelopmental outcomes. In response, the fetus employs a mechanism known as brain-sparing, redirecting blood flow to the cerebral circuit, for adequate supply to the brain. In this study we aimed to quantitatively evaluate disparities in gyrification and brain volumes among fetal growth restriction, small for gestational age and appropriate-for gestational-age fetuses. Additionally, we compared fetal growth restriction fetuses with and without brain-sparing. The study encompassed 106 fetuses: 35 fetal growth restriction (14 with and 21 without brain-sparing), 8 small for gestational age, and 63 appropriate for gestational age. Gyrification, supratentorial, and infratentorial brain volumes were automatically computed from T2-weighted magnetic resonance images, following semi-automatic brain segmentation. Fetal growth restriction fetuses exhibited significantly reduced gyrification and brain volumes compared to appropriate for gestational age (P < 0.001). Small for gestational age fetuses displayed significantly reduced gyrification (P = 0.038) and smaller supratentorial volume (P < 0.001) compared to appropriate for gestational age. Moreover, fetal growth restriction fetuses with BS demonstrated reduced gyrification compared to those without BS (P = 0.04), with no significant differences observed in brain volumes. These findings demonstrate that brain development is affected in fetuses with fetal growth restriction, more severely than in small for gestational age, and support the concept that vasodilatation of the fetal middle cerebral artery reflects more severe hypoxemia, affecting brain development.
胎盘相关胎儿生长受限是由胎盘功能障碍引起的，影响了 3-5%的妊娠，并与不良神经发育结局的风险增加有关。为了应对这种情况，胎儿采用了一种称为脑保护的机制，将血流重新分配到大脑回路，以保证大脑的充分供应。在这项研究中，我们旨在定量评估胎儿生长受限、小于胎龄儿和适于胎龄儿之间的脑回和脑容量差异。此外，我们比较了有和没有脑保护的胎儿生长受限胎儿。该研究纳入了 106 例胎儿：35 例胎儿生长受限（14 例有脑保护，21 例无脑保护），8 例小于胎龄儿，63 例适于胎龄儿。从 T2 加权磁共振图像中自动计算脑回、大脑顶叶和小脑的体积，然后进行半自动的脑分割。与适于胎龄儿相比，胎儿生长受限胎儿的脑回和脑容量明显减少（P<0.001）。与适于胎龄儿相比，小于胎龄儿的脑回明显减少（P=0.038），大脑顶叶体积明显较小（P<0.001）。此外，与无脑保护的胎儿生长受限胎儿相比，有脑保护的胎儿生长受限胎儿的脑回发育较差（P=0.04），但脑容量无显著差异。这些发现表明，胎儿生长受限的胎儿脑发育受到影响，比小于胎龄儿更为严重，支持胎儿大脑中动脉扩张反映更为严重的缺氧，影响脑发育的概念。
