Fieß Achim, Gißler Sandra, Grabitz Stephanie, Hoffmann Esther M, Mildenberger Eva, Uphaus Timo, Hahn Marianne, Pfeiffer Norbert, Hartmann Alica, Schuster Alexander K
Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
Division of Neonatology, Department of Pediatrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
Invest Ophthalmol Vis Sci. 2025 Apr 1;66(4):35. doi: 10.1167/iovs.66.4.35.
Restricted fetal growth is associated with impaired neurodevelopment in childhood. We examined the effects of fetal growth restriction, fetal overgrowth, and other perinatal parameters on optic nerve head (ONH) morphology in term-born children and adolescents.
This retrospective cohort study with a prospective ophthalmologic examination included full-term born children aged 4 to 17 years who were grouped according to their birth weight correlated to gestational age (GA). We formed the following groups: severe fetal growth restriction (<3rd birth weight [BW] percentile, group 1), moderate fetal growth restriction (BW percentile 3rd to <10th, group 2), appropriate for gestational age (AGA, 10th-90th BW percentile, group 3, control group), moderate fetal overgrowth (>90th-97th BW percentile, group 4), and severe fetal overgrowth (>97th percentile, group 5). The participants underwent spectral-domain optical coherence tomography and fundus photography to evaluate the peripapillary retinal nerve fiber layer (pRNFL) thickness, minimal rim width (MRW), Bruch's membrane opening (BMO), and vertical cup-to-disc ratio (vCDR), focusing on their relationship to perinatal factors like nutritional status, GA, maternal smoking, and maternal breastfeeding. The relationships between the ONH parameters and perinatal factors were adjusted for variables such as age, sex, and axial length.
This study included 732 eyes of 375 participants (mean age of 11.4 ± 3.71 years, 193 female subjects). Multivariable regression analyses showed an association between a thinner global pRNFL thickness in the participants with severe fetal growth restriction (B = -4.95; 95% confidence interval [CI], -9.43 to -0.47 µm; P = 0.03) compared to the reference AGA group. Furthermore, an association with a thinner MRW was found in the children born with moderate fetal growth restriction (B = -32.46; 95% CI, -51.52 to -13.40 µm; p < 0.001). BW percentile was associated with median vCDR (B = -0.001; 95% CI, -0.002 to 0.00; P = 0.02). No consistent association was observed between altered fetal growth and BMO.
Severe fetal growth restriction appears to affect the optic nerve head in term-born children and adolescents, suggesting a possible reduction in neuronal reserve, and may indicate a potentially elevated risk of abnormal neurodevelopment.
胎儿生长受限与儿童期神经发育受损有关。我们研究了胎儿生长受限、胎儿过度生长及其他围产期参数对足月儿和青少年视神经乳头（ONH）形态的影响。
这项回顾性队列研究并进行前瞻性眼科检查，纳入了4至17岁的足月儿，根据其出生体重与胎龄（GA）的相关性进行分组。我们形成了以下几组：严重胎儿生长受限（出生体重<第3百分位数，第1组）、中度胎儿生长受限（出生体重百分位数第3至<第10百分位数，第2组）、适于胎龄（AGA，出生体重百分位数第10至90百分位数，第3组，对照组）、中度胎儿过度生长（>第90至97百分位数，第4组）和严重胎儿过度生长（>第97百分位数，第5组）。参与者接受了光谱域光学相干断层扫描和眼底照相，以评估视乳头周围视网膜神经纤维层（pRNFL）厚度、最小边缘宽度（MRW）、布鲁赫膜开口（BMO）和垂直杯盘比（vCDR），重点关注它们与营养状况、胎龄、母亲吸烟和母亲母乳喂养等围产期因素的关系。对视神经乳头参数与围产期因素之间的关系进行了年龄、性别和眼轴长度等变量的校正。
本研究纳入了375名参与者的732只眼（平均年龄11.4±3.71岁，193名女性受试者）。多变量回归分析显示，与参考AGA组相比，严重胎儿生长受限的参与者整体pRNFL厚度较薄（B=-4.95；95%置信区间[CI]，-9.43至-0.47μm；P=0.03）。此外，中度胎儿生长受限出生的儿童中发现与较薄的MRW有关（B=-32.46；95%CI，-51.52至-13.40μm；p<0.001）。出生体重百分位数与vCDR中位数相关（B=-0.
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