PL 6 Long-term growth and neurodevelopmental outcome after early fetal growth restriction

Abstract

Introduction Early onset hypertensive disorders of pregnancy are strongly associated with placental insufficiency and consequently fetal growth restriction (FGR) and preterm birth. Some children may remain small or thin, but there is especially concern about high BMI. Neurocognitive and behavioral disabilities have been described in FGR children. Brain sparing might be protective. Children ( n = 96) born from mothers participating in the Preeclampsia Eclampsia TRial Amsterdam were followed from birth to age twelve years. Anthropometry was performed, and neurocognitive outcomes were assessed with an extensive battery including attention and executive function (EF) and parental questionnaires and compared with a normal birthweight comparison group. They had a mean BWR of 0.68 (p2), a highest UC-ratio above 0.72 indicating brain sparing, and a mean GA of 31 weeks (range 27–38). Results Growth [1] : Mean height SDS (SD) corrected for target height was −0.09 (0.94), mean body mass index (BMI) SDS was 0.00 (1.16) and mean head circumference SDS was −0.37 (1.11). Neither FGR severity nor gestational age was related to height and BMI at age 12.5 years. Neurocognitive and behavioral outcome [2] : Mean IQ was comparable for FGR and comparison children. Parents of the FGR-children reported significantly more social and attention problems than parents of the comparison children) Further, all EF- and attention test performances and parent-reports were comparable between FGR and comparison children. Psychiatric diagnoses were comparable to nationwide rates. Discussion In these 12-year children born FGR with signs of brain sparing there is excellent catch up growth. Their neurocognitive outcome is hardly different from comparison children, nor nationwide numbers. Because in this cohort mortality was relatively high especially at low gestation, we need to compare these data with data from recent cohorts with lower mortality rates.