BACKGROUND AND PURPOSE:

• Cerebroplacental ratio (CPR) reflects “brain-sparing” effect, with blood flow redirected to the brain
  • CPR is currently being studied as potentially predictive of poor outcome in at-risk pregnancies
• Monteith et al. (AJOG, 2019) sought to determine if CPR can predict adverse neurodevelopment

METHODS:

• Current study: Data derived from prospective multicenter observational PORTO-Associated Neuro Developmental Assessment (PANDA) study
  • Evaluate potential FGR complications in children including
    • Neurodevelopmental delay | Academic difficulties | Health complications | Reduced physical growth at age 3 years
  • Original prospective multicentered study: Prospective Observational Trial to Optimize Pediatric Health in FGR (PORTO Trial)
• Participants
  • Singleton pregnancies | 24w0d to 36w6d |EFW ≥500 g
• Definitions
  • FGR: birthweight <10th percentile with abnormal antenatal umbilical artery Doppler indices
  • SGA: birthweight <10th percentile with normal Doppler indices
• Study design
  • CPR calculated by dividing the pulsatility indices of the middle cerebral artery with that of the UA
  • Abnormal CPR: <1.0
  • Neurodevelopment assessment at 3 years: Ages and Stages Questionnaire | Bayley Scales of Infant and Toddler Development
• Data analysis
  • SGA compared with either
    • FGR cases and normal CPR
    • FGR cases with abnormal CPR
  • A probability (P) value of .00625 was considered significant

RESULTS:

• 375 children included
  • SGA: 198 children
  • FGR with normal CPR: 136 children
  • FGR with abnormal CPR: 41 children
• Compared to SGA, FGR with abnormal CPR had higher rates of the following  
  • Cesarean delivery:  33% vs 83% (P<.001)
  • 5-minute Apgar score of <7: 0.5% vs 7.3% (P=.002)
  • NICU admission: 20% vs 83% (P<.001)
• Children who had had an abnormal CPR (3 years of age) had
  • Shorter stature (P=0.005) but weight was not significantly lower weight (P=0.18)
• There were no differences in head circumference between the groups
• Neurodevelopmental outcomes
  • SGA vs FGR and normal CPR: Only gross and fine motor development were statistically significant
  • SGA vs FGR and abnormal CPR: Poorer neurologic outcome at 3 years of age across all measured variables including cognitive, language and motor skills

CONCLUSION:

• FGR and abnormal CPR were associated with increased risk of delayed neurodevelopment at 3 years of age
• The authors suggest the routine assessment of CPR in FGR pregnancies may be worthwhile
• While the data do not provide guidance regarding timing of delivery, knowledge of increased neurodevelopmental risk could help pediatricians monitor these children and determine who may benefit from early intervention

Learn More – Primary Sources:

An abnormal cerebroplacental ratio (CPR) is predictive of early childhood delayed neurodevelopment in the setting of fetal growth restriction

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