741 Cross-sectional analysis of association between late pregnancy umbilical artery blood flow and childhood neurodevelopmental outcomes

Abstract

Reduced placental perfusion has been associated with adverse child neurodevelopmental (ND) outcomes. These studies were performed primarily in pregnancies complicated by fetal growth restriction. Our objective was to assess the association between incremental increases in umbilical artery Doppler measurements and ND outcomes in low-risk pregnancies. Serial ultrasound (US) exams were prospectively performed in 2,334 racially/ethnically diverse, healthy women with low-risk singleton pregnancies (July 2009-Jan 2013) as part of the NICHD- Fetal Growth Studies (NICHD-FGS). Umbilical artery Systolic/Diastolic ratio (UAS/D) and Pulsitility Index (UAPI) were recorded at the last US (mean 17.6 days prior to delivery). Mother-child pairs from the NICHD-FGS were re-recruited to the Environmental Influences on Child Health Outcomes (ECHO) Study (May 2017-April 2019). Cross-sectional analysis of ND was performed using the NIH Toolbox. Executive function domains included Inhibitory Control/Attention, Cognitive Flexibility and Working Memory. Motor domains included Dexterity, Grip Strength and Standing Balance. Multivariable adjusted general linear regression model was used to assess continuous relationships for children 3-7 and 8-11 years. The study group is described in Table 1. A 1-unit increase in the UAS/D was associated with significantly reduced Inhibitory Control/Attention and Cognitive Flexibility and improved Working Memory in children 8-11 years. Children age 3-7 had non-significant opposite effects compared to the older children. UAPI findings were similar to UAS/D in both direction and age-specificity and significant only for improved Working Memory. Neither UAS/D or UAPI had any impact on motor function. In late pregnancy a 1-unit rise in UAS/D or UAPI affected ND differently in younger compared to older children. Opposite effects between age groups were seen in each test of executive function. Cognitive Flexibility at 3-7 years and Inhibitory Control/Attention at 8-11 years were most negatively impacted. Working Memory was enhanced in older children.View Large Image Figure ViewerDownload Hi-res image Download (PPT)