An abnormal cerebroplacental ratio (CPR) is predictive of early childhood delayed neurodevelopment in the setting of fetal growth restriction.
Monteith C., Flood K., Pinnamaneni R., Levine TA., Unterscheider J., Mcauliffe FM., Alderdice FA., Dicker P., Tully EC., Malone FD., Foran A.
BACKGROUND: Fetal growth restriction (FGR) accounts for a significant proportion of perinatal morbidity and mortality. The cerebroplacental ratio (CPR) is gaining much interest as a useful tool in differentiating the "at-risk" fetus in both FGR and appropriate for gestational age (AGA) pregnancies. The Prospective Observational Trial to Optimize Pediatric Health in FGR (PORTO) group, have previously demonstrated that the presence of this 'brain-sparing' effect is significantly associated with adverse perinatal outcomes in the FGR cohort. However, data about neurodevelopment in children from pregnancies complicated by FGR are sparse and conflicting. OBJECTIVE: The aim of the PORTO NeuroDevelopmental Assessment Study (PANDA) was to determine whether children born after FGR pregnancies are at additional risk of adverse early childhood developmental outcomes compared to children born small for gestational age (SGA). The objective of this secondary analysis was to describe the role of CPR in the prediction of adverse early childhood neurodevelopmental outcome. MATERIALS AND METHODS: Participants were prospectively recruited from the Perinatal Ireland multicenter observational PORTO study cohort. FGR was defined as birth weight <10th with abnormal antenatal umbilical artery (UA) Doppler indices. SGA was similarly defined in the absence of abnormal Doppler indices. CPR was calculated using the pulsatility indices of the middle cerebral and divided by UA with an abnormal value <1. Children (n=375) were assessed at three years using the Ages and Stages Questionnaire and the Bayley Scales of Infant and Toddler Development, 3rd edition. SGA pregnancies with normal Doppler indices were compared with: 1) FGR cases with abnormal UA Doppler and normal CPR; or 2) FGR cases with both abnormal UA & CPR. Statistical analysis was performed using SAS version 9.2 via two-sample t-test with Bonferroni adjustment and p-value of 0.00625 significant. RESULTS: Assessments were performed on 198 SGA children; 136 FGR children with abnormal UA Doppler and normal CPR and 41 FGR children with both abnormal UA Doppler and CPR. At three years of age, while there were no differences in head circumference, children who also had an abnormal CPR had persistently shorter stature (p=0.005) and lower weight (p=0.18). Children from FGR affected pregnancies demonstrated poorer neurodevelopmental outcome than their SGA counterparts. FGR pregnancies with an abnormal CPR had significantly poorer neurological outcome at three years of age across all measured variables (Tables 1 & 2). CONCLUSION: We have demonstrated that growth restricted pregnancies with a CPR <1, have significantly increased risk of delayed neurodevelopment at three years of age when compared to pregnancies with abnormal UA Doppler alone. This study further substantiates the benefit of routine assessment of CPR in FGR pregnancies and for counseling parents regarding the long-term outcome of affected infants.