Prentice Ralley E, Hunt Rod W, Spittle Alicia J, Ditchfield Michael, Chen Jeff, Burns Megan, Flanagan Emma K, Wright Emily, Ross Alyson L, Goldberg Rimma, Bell Sally J
Department of Gastroenterology, Monash Health, Melbourne, VIC, Australia.
Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.
Brain Behav Immun Health. 2024 Jul 22;40:100827. doi: 10.1016/j.bbih.2024.100827. eCollection 2024 Oct.
Exposure to maternal inflammation is associated with an increased risk of neurocognitive and developmental disorders in offspring. Early diagnosis and intervention improves childhood motor and cognitive functioning. Neonatal cerebral MRI and remote app-based generalised movement assessments (GMAs) are both predictive of adverse neurocognitive outcomes but have only been used in infants at significantly increased risk for these outcomes, rather than following in utero exposure to maternal inflammatory disorders.
Pregnant women with inflammatory bowel disease were assessed clinically and biochemically in each trimester of pregnancy in this single centre prospective study. Neonatal cerebral MRIs were performed at 6-12 weeks post-corrected term. Two GMA videos were filmed using the 'BabyMoves' app from 12 to 16 weeks of age. MRIs and GMAs were assessed by a blinded highly qualified practitioner using validated scoring systems.
40/53 of invited maternal-infant dyads were recruited. C-reactive protein was elevated antenatally in less than 13%. 5/37 neonatal MRIs had incidental or obstetric trauma related gross anatomical abnormalities, with none abnormal on validated gross abnormality scoring. 3/35 GMAs were abnormal, with one GMA abnormality being clinically significant. Of those with abnormal GMAs, 2/3 were in exposed to severely active IBD in-utero.
Neonatal cerebral MRI and GMA for neurocognitive screening is feasible in the setting of maternal inflammatory bowel disease, where the risk of cerebral palsy is poorly defined and thus burdensome screening interventions are less appealing to parents. Larger studies are required to stratify adverse neurocognitive outcome risk in infants born to women with maternal inflammatory disorders, but these data are reassuring for women with IBD in remission antenatally.
暴露于母体炎症与后代神经认知和发育障碍风险增加有关。早期诊断和干预可改善儿童的运动和认知功能。新生儿脑部磁共振成像（MRI）和基于远程应用程序的全身运动评估（GMA）都可预测不良神经认知结果，但仅用于这些结果风险显著增加的婴儿，而非用于子宫内暴露于母体炎症性疾病的情况。
在这项单中心前瞻性研究中，对患有炎症性肠病的孕妇在孕期的每个阶段进行临床和生化评估。在矫正胎龄6至12周时进行新生儿脑部MRI检查。使用“BabyMoves”应用程序在婴儿12至16周龄时拍摄两段GMA视频。MRI和GMA由一名不知情的高素质从业者使用经过验证的评分系统进行评估。
招募了受邀的母婴二元组中的40/53。产前C反应蛋白升高的比例不到13%。37例新生儿MRI中有5例有与偶然或产科创伤相关的大体解剖异常，在经过验证的大体异常评分中均无异常。35例GMA中有3例异常，其中1例GMA异常具有临床意义。在GMA异常的婴儿中，2/3在子宫内暴露于严重活动期炎症性肠病。
在母体炎症性肠病的情况下，进行新生儿脑部MRI和GMA以进行神经认知筛查是可行的，因为在这种情况下脑瘫风险定义不明确，因此繁重的筛查干预对父母吸引力较小。需要进行更大规模的研究来对患有母体炎症性疾病的女性所生婴儿的不良神经认知结果风险进行分层，但这些数据让产前病情缓解的炎症性肠病女性放心。
