Effects of umbilical vein flow on midbrain growth and cortical development in late onset fetal growth restricted fetuses: a prospective cross-sectional study

Ilenia Mappa; Maria Chiara Marra; Maria Elena Pietrolucci; Jia Li Angela Lu; Francesco D’Antonio; Giuseppe Rizzo

doi:10.1515/jpm-2023-0487

Article

Effects of umbilical vein flow on midbrain growth and cortical development in late onset fetal growth restricted fetuses: a prospective cross-sectional study

Ilenia Mappa , Maria Chiara Marra , Maria Elena Pietrolucci , Jia Li Angela Lu , Francesco D’Antonio and Giuseppe Rizzo

Published/Copyright: February 1, 2024

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From the journal Journal of Perinatal Medicine Volume 52 Issue 4

Abstract

Objectives

To investigate midbrain growth, including corpus callusum (CC) and cerebellar vermis (CV) and cortical development in late fetal growth restricted (FGR) subclassified according to the umbilical vein blood flow (UVBF) values.

Methods

This was a prospective study on singleton fetuses late FGR with abnormal placental cerebral ratio (PCR). FGR fetuses were further subdivided into normal (≥fifth centile) and abnormal (<fifth centile) UVBF blood flow corrected for AC (UVBF/AC), neurosonography was performed at 33–34 weeks of gestation to assess CC and CV lengths and the depth of Sylvian fissure (SF), parieto-occipital (POF) and calcarine fissures (CF). Neurosonographic variables were normalized for fetal head circumference size.

Results

The study cohort included 60 late FGR, 31 with normal UVBF/AC and 29 with abnormal UVBF/AC values. The latter group showed significant differences in CC (median (interquartile range (IQR) normal 0.96 (0.73–1.16) vs. abnormal UVBF/AC 0.60 (0.47–0.87); p<0.0001)), CV (normal 1.04 (0.75–1.26) vs. abnormal UVBF (AC 0.76 (0.62–1.18)); p=0.0319), SF (normal 0.83 (0.74–0.93) vs. abnormal UVBF/AC 0.56 (0.46–0.68); p<0.0001), POF (normal 0.80 (0.71–0.90) vs. abnormal UVBF/AC l 0.49 (0.39–0.90); p≤0.0072) and CF (normal 0.83 (0.56–1.01) vs. abnormal UVBF/AC 0.72 (0.53–0.80); p<0.029).

Conclusions

Late onset FGR fetuses with of reduced umbilical vein flow showed shorter CC and CV length and a delayed cortical development when compared to those with normal umbilical vein hemodynamics. These findings support the existence of a link between abnormal brain development and changes in umbilical vein circulation.

Keywords: fetal growth restriction; corpus callosum; cerebellar vermis; cortical folding; neurosonography; umbilical vein flow

Corresponding author: Giuseppe Rizzo, MD, Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Viale Oxford 81, Rome 00133, Italy, Phone: +39 06 2090 2750, E-mail: giuseppe.rizzo@uniroma2.it

Funding source: Italian Ministry of University and Research

Award Identifier / Grant number: MUR PE00000006 MNESYS PNRR

Research ethics: The study was approved by our Institutional Ethical Board (January 2022 protocol no prot.0001446/2022).
Informed consent: All women included in this study signed an informed consent.
Author contributions: All authors provided a substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Competing interests: The authors state no conflict of interest.
Research funding: The study was supported by a grant of the Italian Ministry of University and Research (MUR PE00000006 MNESYS PNRR).
Data availability: Data are available from the authors on reasonable request.

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Received: 2023-11-19

Accepted: 2023-12-23

Published Online: 2024-02-01

Published in Print: 2024-05-27

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Articles in the same Issue

https://doi.org/10.1515/jpm-2023-0487

Keywords for this article

fetal growth restriction; corpus callosum; cerebellar vermis; cortical folding; neurosonography; umbilical vein flow