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Differences in placental oxygenation and perfusion status between fetal growth-restricted and small-for-gestational-age pregnancies: a functional magnetic resonance imaging study

  • Magnetic Resonance
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Abstract

Objective

Functional magnetic resonance imaging (MRI) can assess oxygenation and perfusion status in the placenta. We aimed to explore the differences in functional parameters between pregnancies complicated by fetal growth restriction (FGR) and small-for-gestational-age (SGA).

Methods

This was a prospective study. A pregnancy complicated by SGA was defined by prenatal ultrasonic estimated fetal weight (EFW) and a final birthweight < the 10th percentile. A pregnancy complicated by FGR was defined as a more severe subtype (ultrasonic EFW < the 3rd percentile or abnormal Doppler results). All pregnant women underwent T2* and intravoxel incoherent motion (IVIM) scans using a 3.0-T MRI scanner. Functional parameters in the control, SGA, and FGR groups, namely, the T2* Z score, apparent diffusion coefficient (ADC), diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f), were calculated and compared.

Results

In total, 30 pregnancies complicated by SGA, 24 pregnancies complicated by FGR, and 28 control pregnancies were included in the final analysis. Oxygenation status, as assessed by the T2* Z score, was significantly lower in pregnancies complicated by FGR than in pregnancies complicated by SGA (p < 0.001). However, diffusion and perfusion parameters, including the ADC, D, D*, and f, were similar between pregnancies complicated by SGA and FGR (p > 0.05 for all). Compared to the control pregnancies, all the parameters were significantly decreased in the SGA and FGR groups, except for the D* value. The T2* Z score, ADC, and D values were negatively correlated with birthweight.

Conclusion

Although both pregnancies complicated by SGA and FGR were associated with significantly lower oxygenation and perfusion than normal control pregnancies, placental hypoxia seemed to be more predominant in pregnancies complicated by FGR than in pregnancies complicated by SGA.

Key Points

• Pregnancy complicated by FGR was associated with a more severe type of hypoxia than pregnancy complicated by SGA.

• The diffusion and perfusion parameters of pregnancies complicated by SGA and FGR were similar.

• SGA may represent another growth disorder that is not entirely healthy.

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Abbreviations

95% CI:

95% confidence interval

EFW:

Estimated fetal weight

FGR:

Fetal growth restriction

IVIM:

Intravoxel incoherent motion

MRI:

Magnetic resonance imaging

NICU:

Neonatal intensive care unit

ROI:

Region of interest

SGA:

Small-for-gestational-age

SPSS:

Statistical Product and Service Solutions

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Funding

This study has received funding by the National Key Research and Development Program of China (2018YFC1004104).

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue, Guangzhou, 510515, China

    Junshen He, Chunlin Chen & Ping Liu

  2. Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China

    Zhao Chen

Authors
  1. Junshen He
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  2. Zhao Chen
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  3. Chunlin Chen
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  4. Ping Liu
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Corresponding authors

Correspondence to Chunlin Chen or Ping Liu.

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Guarantor

The scientific guarantor of this publication is Ping Liu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained (Medical Ethics Committee of Nanfang Hospital, Southern Medical University, NFEC-2019-133).

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

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He, J., Chen, Z., Chen, C. et al. Differences in placental oxygenation and perfusion status between fetal growth-restricted and small-for-gestational-age pregnancies: a functional magnetic resonance imaging study. Eur Radiol 33, 1729–1736 (2023). https://doi.org/10.1007/s00330-022-09185-5

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  • DOI: https://doi.org/10.1007/s00330-022-09185-5

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