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Neurological Complications

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Fetal Growth Restriction

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Abstract

Fetal growth restriction (FGR) is one of the major determinants of perinatal mortality and morbidity in singleton pregnancies. Placental insufficiency represents the most common cause of FGR and affects about 5–10% of all gestations. Chronic placental insufficiency commonly leads to progressive fetal hypoxemia resulting in a peculiar modification of fetal hemodynamic and metabolism which is responsible of the high burden of neurological disabilities observed in children affected by FGR, such as motor, cognitive, and developmental delay. In the last decade, ultrasound and especially fetal magnetic resonance imaging (MRI) have been shown to provide useful information on brain structure, hemodynamics, and metabolism in fetuses affected by FGR, thus highlighting the need for a thorough assessment of the neurodevelopmental performance of children affected by growth restriction in utero. Despite this, prediction of neurodevelopmental outcome in fetuses affected by FGR is challenging; small sample size of previously published studies, retrospective design, inclusion of cases affected by different types of growth anomalies and heterogeneity in neurodevelopmental tools adopted, gestational age at birth, and time at follow-up make difficult to extrapolate a robust evidence on the actual risk of abnormal neurodevelopmental outcome in children affected by FGR. The aim of this chapter will be to provide an up-to-date overview on the neurological complications and developmental disabilities occurring in children affected by FGR due to placental insufficiency.

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Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy

    Danilo Buca

  2. Women’s Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT – The Arctic University of Norway, Tromsø, Norway

    Marco Liberati

  3. Department of Obstetrics and Gynaecology, University Hospital of Northern Norway, Tromsø, Norway

    Marco Liberati

  4. Department of Clinical Medicine, Faculty of Health Sciences, UiT – The Arctic University of Norway, Tromsø, Norway

    Francesco D’Antonio

Authors
  1. Danilo Buca
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  2. Marco Liberati
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  3. Francesco D’Antonio
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Corresponding author

Correspondence to Francesco D’Antonio .

Editor information

Editors and Affiliations

  1. Paulista School of Medicine, Federal University of São Paulo, São Paulo, São Paulo, Brazil

    Luciano Marcondes Machado Nardozza

  2. Paulista School of Medicine, Federal University of São Paulo, São Paulo, São Paulo, Brazil

    Edward Araujo Júnior

  3. University of Rome Tor Vergata, Roma, Italy

    Giuseppe Rizzo

  4. Baylor College of Medicine, Houston, TX, USA

    Russell Lee Deter

Appendix

Appendix

Summary of the main abnormal neurodevelopmental measures observed in infants affected by early fetal growth restriction in utero .

  • Lower scores on cognitive testing

  • Difficulties in schools or require special education

  • Gross motor and minor neurologic dysfunction

  • Behavioral problems (attention deficit hyperactivity syndrome)

  • Growth failure

  • Lower strength and work capacity

  • Cerebral palsy

  • Low social competence

  • Poor academic performance

  • Lower levels of intelligence

  • Hyperactive behavior

  • Poor perceptual performance

  • Poor visuomotor perception, motor incompetence, reading, and mathematics learning

Structural Anomalies

  • Reduced head circumference

  • Reduced total and gray matter volume

  • Reduced hippocampal and cerebellar volume

  • Reduced total number of cells

  • Reduced myelin content

  • Thinning cortex

  • Delayed myelination

  • Reduced connectivity

Motor Anomalies

  • Reduced gross and fine motor skills

  • Reduced visuomotor skills

  • Clumsiness

  • Cerebral palsy

Cognitive and Learning Anomalies

  • Reduced IQ/ executive function

  • Reduced verbal IQ

  • Poor memory

  • Reduced IQ/executive function

  • Reduced verbal IQ

  • Poor memory

Behavioral Anomalies

  • Attention and interaction

  • Hyperactivity

  • Mood and irritability

  • Anxiety

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Buca, D., Liberati, M., D’Antonio, F. (2019). Neurological Complications. In: Nardozza, L., Araujo Júnior, E., Rizzo, G., Deter, R. (eds) Fetal Growth Restriction. Springer, Cham. https://doi.org/10.1007/978-3-030-00051-6_14

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  • DOI: https://doi.org/10.1007/978-3-030-00051-6_14

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-00050-9

  • Online ISBN: 978-3-030-00051-6

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