What Is Spared By Fetal Brain-Sparing? Fetal Circulatory Redistribution and Behavioral Problems in the General Population

Abstract

Several population-based studies have shown that intrauterine growth restriction is associated with childhood disabilities involving motor skills, cognitive function, concentration, attention, and mood. The most common cause of intrauterine growth restriction is placental insufficiency. Animal studies have shown that when there is growth restriction due to placental insufficiency, fetal circulatory redistribution occurs so that the is preferentially perfused, a fetal adaptive response known as the brain-sparing effect. The investigators tested the hypothesis that the brain effect could protect against behavioral problems in a cohort of 1232 women who were part of the Generation R Study, a population-based prospective study conducted in the Netherlands between 2003 and 2007. During late pregnancy, circulation in the fetal umbilical artery and the middle and anterior cerebral arteries was assessed with Doppler ultrasound. At age 17.5 to 22 months, 935 children resulting from these pregnancies were evaluated with the Child Behavior Checklist, a questionnaire designed to identify behavior problems. The investigators then evaluated the relationship between the umbilical/anterior cerebral ratio and The Total Problems summary score. Logistic regression analysis showed a higher risk of behavioral problems among children with fetal circulatory redistribution to the anterior cerebral artery. Specifically, there was a statistically significant association between a high umbilical artery/anterior cerebral artery ratio and total problems, as well as a higher risk of internalizing problems (emotional reactivity, somatic complaints) and externalizing problems (attention problems). The association between problem behavior and preferential perfusion of the middle cerebral artery was less evident; a high umbilical/middle cerebral ratio was related with problem behavior for only two categories: internalizing and somatic complaints (P <.05). The investigators conclude from these findings that brain sparing does not completely protect the from the consequences of intrauterine growth restriction. Infants who experience preferential perfusion of the during gestation are more likely to have behavioral problems in young childhood.