Effects of uterine Doppler on midbrain growth and cortical development in late onset fetal growth restricted fetuses: a prospective cross-sectional study

To investigate midbrain growth, including corpus callusum (CC), cerebellar vermis (CV) and cortical development in late fetal growth restriction (FGR) depending on uterine artery (UtA) Pulsatility Index (PI) values. This was a prospective study including singleton fetuses with late FGR characterized by abnormal cerebral placental ratio (CPR). According to UtA PI values, the FGR fetuses were subdivided into normal ≤95th centile) and abnormal (&gt;95th centile). Neurosonography was performed at 33–44 weeks of gestations to assess CC and CV lengths and the depth of Sylvian fissure (SF), parieto-occipital (POF) and calcarine fissures (CF). Neurosonographic variables were normalized for fetal head circumference size. The study cohort included 60 fetuses with late FGR, 39 with normal UtA PI and 21 with abnormal PI values. The latter group showed significant differences in CC (median (interquartile range) normal 35.9 (28.49–45.53) vs abnormal UtA PI 25.31(19.76–35.13) mm; <i>p</i> &lt; 0.0022), CV (normal 25.78 (18.19–29.35) abnormal UtA PI 17.03 (14.07–24.16)mm; <i>p</i> = 0.0067); SF (normal 10.58 (8.99–11.97)vs abnormal UtA PI 7.44 (6.23–8.46) mm; <i>p</i> &lt; 0.0001), POF (normal 6.85 (6.35–8.14) vs abnormal UtA PI 4.82 (3.46–7.75) mm; <i>p</i> &lt; = 0.0184) and CF (normal 04.157 (2.85–5.41) vs abnormal UtA PI 2.33 (2.49–4.01)); <i>p</i> &lt; 0.0382). Late onset FGR fetuses with abnormal UtA PI showed shorter CC and CV length and delayed cortical development compared to those with normal uterine PI. These findings support the existence of a link between abnormal brain development and changes in utero placental circulation.

本研究旨在探讨基于子宫动脉（Uterine Artery, UtA）搏动指数（Pulsatility Index, PI）值的晚期胎儿生长受限（Fetal Growth Restriction, FGR）胎儿的中脑生长情况，包括胼胝体（corpus callosum，原文误写为callusum, CC）、小脑蚓部（cerebellar vermis, CV）及皮质发育状况。本研究为一项前瞻性研究，纳入以异常脑胎盘比（Cerebral Placental Ratio, CPR）为特征的晚期FGR单胎胎儿。根据UtA PI值，将纳入的FGR胎儿分为两组：PI≤95百分位数的正常组，以及PI＞95百分位数的异常组。研究人员于孕33~44周对所有胎儿行神经超声检查，评估胼胝体、小脑蚓部长度，以及外侧裂（Sylvian fissure, SF）、顶枕裂（parieto-occipital fissure, POF）和距状裂（calcarine fissure, CF）的深度。所有神经超声测量指标均以胎儿头围大小进行标准化校正。本研究队列共纳入60例晚期FGR胎儿，其中39例UtA PI正常，21例UtA PI异常。与正常组相比，异常组多项神经超声指标存在显著统计学差异：胼胝体长度[正常组中位数（四分位间距）：35.9（28.49~45.53）mm vs 异常组：25.31（19.76~35.13）mm；*p*<0.0022]、小脑蚓部长度[正常组：25.78（18.19~29.35）mm vs 异常组：17.03（14.07~24.16）mm；*p*=0.0067]、外侧裂深度[正常组：10.58（8.99~11.97）mm vs 异常组：7.44（6.23~8.46）mm；*p*<0.0001]、顶枕裂深度[正常组：6.85（6.35~8.14）mm vs 异常组：4.82（3.46~7.75）mm；*p*≤0.0184]及距状裂深度[正常组：4.15（2.85~5.41）mm（原文误写为04.157）vs 异常组：2.33（2.49~4.01）mm；*p*<0.0382]。与UtA PI正常的晚期FGR胎儿相比，UtA PI异常的晚期FGR胎儿胼胝体与小脑蚓部长度更短，且皮质发育延迟。上述研究结果证实，脑发育异常与宫内胎盘循环改变之间存在显著关联。