Abstract
In children who are born small for gestational age (SGA), an adverse intrauterine environment has led to underdevelopment of both the body and the brain. The delay in body growth is (partially) restored during the first two years in a majority of these children. In addition to a negative influence on these physical parameters, decreased levels of intelligence and cognitive impairments have been described in children born SGA. In this study, we used magnetic resonance imaging to examine brain anatomy in 4- to 7-year-old SGA children with and without complete bodily catch-up growth and compared them to healthy children born appropriate for gestational age. Our findings demonstrate that these children strongly differ on brain organisation when compared with healthy controls relating to both global and regional anatomical differences. Children born SGA displayed reduced cerebral and cerebellar grey and white matter volumes, smaller volumes of subcortical structures and reduced cortical surface area. Regional differences in prefrontal cortical thickness suggest a different development of the cerebral cortex. SGA children with bodily catch-up growth constitute an intermediate between those children without catch-up growth and healthy controls. Therefore, bodily catch-up growth in children born SGA does not implicate full catch-up growth of the brain.
Highlights
An optimal intrauterine environment is vital for normal brain development
Body length and head circumference at the time of magnetic resonance imaging (MRI) investigation was significantly lower in the SGA2 group when compared with either the small for gestational age (SGA)+ or appropriate for gestational age (AGA) group
The results of the current study demonstrate that being born small for gestational age (SGA) is associated with altered anatomy of the brain at the age of four to seven years
Summary
An optimal intrauterine environment is vital for normal brain development. The development of the neural system starts in the third week of gestation and progresses throughout pregnancy and after birth [1]. Postnatal environmental factors and genetic influences contribute to eventual outcome [2,3,4] Adverse circumstances such as placental insufficiency can interfere with brain development [5,6,7,8,9,10]. In addition to a negative influence on physical parameters, decreased intelligence levels and impaired cognitive function have been described in SGA children [17,18]. This is exemplified by SGA children having a poorer school performance and experiencing more learning difficulties compared to healthy children [19,20]. Catch-up growth of body and/or head circumference is associated with relatively better cognitive outcome [9,17,21]
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