The correlation of antenatal sonographic parameters and neurodevelopmental outcomes in fetal growth restriction.

Abstract

Introduction: To explore preliminary associations between antenatal sonographic parameters and early childhood neurodevelopmental outcomes in fetuses with fetal growth restriction (FGR) or small for gestational age (SGA). FGR was defined as estimated fetal weight (EFW) < 3rd percentile or abnormal Doppler. SGA was defined as EFW 3rd -10th percentile with normal Doppler.

Methods: This pilot exploratory study (n=32; 28 FGR, 4 SGA) included infants with available Bayley-III Scales of Infant Development (BSID) scores from a larger prospective cohort of 90 FGR/SGA pregnancies. Sonographic parameters from the final pre-delivery ultrasound included abdominal circumference (AC), umbilical vein flow (UVF), corpus callosum length (CCL), cerebellar vermian height (CVH), transverse cerebellar diameter (TCD), and insular circumference to head circumference ratio (IC/HC). Associations between sonographic parameters and BSID neurodevelopmental outcomes were assessed. Multivariate linear regression model were constructed for each BSID scale using significant predictors.

Results: In this subset, AC (r = 0.516, p = 0.003) and EFW (r = 0.462, p = 0.008) were associated with motor scores; UVF was associated with language (r = 0.545, p = 0.001) and total scores (r = 0.440, p = 0.012); and IC/HC was associated with adaptive behavior (r = -0.478, p = 0.006). In multivariable models, AC remained associated with motor outcomes (β = 0.369, 95% CI 0.04 - 1.08), UVF with language outcomes (β = 0.408, 95% CI 0.07-0.67), and IC/HC with adaptive behavior (β = -0.474, 95% CI -826.04 - -170.78). After adjusting for gestational age at delivery, UVF and IC/HC associations remained significant. Findings should be interpreted cautiously, given the small sample size.

Conclusion: AC, UVF, and IC/HC may have preliminary associations with early neurodevelopmental outcomes. These findings are hypothesis-generating and warrant validation in larger cohorts before clinical application.