Eva Morsing

Cognitive Function After Intrauterine Growth Restriction and Very Preterm Birth

OBJECTIVE: To evaluate the effects of intrauterine growth restriction (IUGR) with absent or reversed end-diastolic blood flow in the umbilical artery and very preterm birth on cognitive outcome at 5 to 8 years of age. METHODS: We studied 34 children with IUGR born at a median of 26.9 gestational weeks (GWs) (range: 24–29 GWs) (PT-IUGR), 34 matched preterm appropriate-for-gestational age (PT-AGA) children, and 34 term AGA children (T-AGA) by using the Wechsler Preschool and Primary Scale of Intelligence, Wechsler Intelligence Scale for Children, Strengths and Difficulties Questionnaire, and Browns attention-deficit disorder (ADD) scales. RESULTS: The PT-IUGR group had mean (SD) scores on the verbal IQ (VIQ) and full-scale IQ (FSIQ) of 83.8 (17.3) and 78.9 (16.6), respectively, compared with the PT-AGA group, which had scores of 96.0 (14.5) and 90.1 (14.2) (P = .003 and P < .007), and the T-AGA group, which had scores of 101.3 (12) and 102.9 (13.2) (P < .001 and P < 001), respectively. The VIQ difference remained significant after adjustment for parental level of education, gestational age at birth, and neonatal morbidity. Performance IQ (PIQ) did not differ between the PT-IUGR and PT-AGA groups; their mean PIQs were lower than that of the T-AGA group (P < .001). Boys in the PT-IUGR group scored lower than girls in VIQ and FSIQ (P = .005 and .007, respectively). Behavior and ADD scores did not differ between the preterm groups. CONCLUSIONS: Children born very preterm after IUGR have an increased risk for cognitive impairment at early school age compared with children delivered very preterm for other reasons. Differences in cognitive outcome were restricted to boys who may have been especially vulnerable to the influence of IUGR and very preterm birth.

Early intervention in management of very preterm growth-restricted fetuses: 2-year outcome of infants delivered on fetal indication before 30 gestational weeks

To describe the outcome of growth‐restricted fetuses with absent or reversed end‐diastolic flow (ARED) in the umbilical artery delivered on fetal indication before 30 gestational weeks.

Lung function in children born after foetal growth restriction and very preterm birth.

Aims:  To assess lung function at early school age in children delivered at very early gestation owing to intrauterine growth restriction and abnormal foetal blood flow (IUGR).

Pre-eclampsia—An additional risk factor for cognitive impairment at school age after intrauterine growth restriction and very preterm birth

OBJECTIVE To explore the possible influence of pre-eclampsia on cognitive outcome in children born very preterm after intrauterine growth restriction (IUGR) and abnormal umbilical artery blood flow. METHODS Cognitive function was evaluated at 5-8 years of age with Wechsler scales in 34 children born before 30 gestational weeks after IUGR (PT-IUGR) (11 children were exposed to maternal pre-eclampsia, 23 non-exposed) and in 34 children with no maternal pre-eclampsia and birth weight appropriate-for-gestational age (PT-AGA) matched for gestational age at birth, gender and age at examination. RESULTS The subjects in the PT-IUGR group exposed to maternal pre-eclampsia had lower mean verbal IQ (VIQ) (mean ± SD 74 ± 16) and lower full scale IQ (FSIQ) (70 ± 19) in comparison with both the non-exposed PT-IUGR (VIQ 89 ± 15; p=0.013; FSIQ 83 ± 14, p=0.029), and, the PT-AGA group (VIQ 96 ± 15, p<0.001; FSIQ 90 ± 14, p=0.001). The differences remained significant after adjustment for known confounders. VIQ and FSIQ did not differ between the non-exposed IUGR and PT-AGA children. CONCLUSION Fetal exposure to maternal pre-eclampsia seems to have an additional negative impact to that of IUGR on cognitive function in children born very preterm.

Cardiovascular function in adulthood following intrauterine growth restriction with abnormal fetal blood flow

To examine whether intrauterine growth restriction (IUGR) is associated with increased cardiovascular risk later in life.

Cardiovascular function in children born very preterm after intrauterine growth restriction with severely abnormal umbilical artery blood flow.

Aims Low birthweight has been linked to increased cardiovascular risk in adulthood. We evaluated the effect on cardiovascular outcome of intrauterine growth restriction (IUGR) with abnormal fetal blood flow in children born very preterm. Methods Blood pressure, cardiac function and size, diameters, distensibility, and stiffness of the abdominal aorta, carotid, and popliteal arteries, and endothelial function were assessed non-invasively in 7-year-old children (n = 32) born very preterm with IUGR, with birthweight (median, range) 650 g (395–976 g) and gestational age 27 weeks (24–29 weeks). In addition, intima-media thickness was measured in the carotid artery. Controls were matched for gender and age and had birthweight appropriate-for-gestational-age (AGA). The study included 32 preterm-AGA children with birthweight 1010 g (660–1790) g and 32 term-AGA children with birthweight 3530 g (3000–4390) g. Results Preterm-IUGR children had lower microvascular response to acetylcholine, lower aortic stiffness, and higher distensibility compared with the preterm-AGA group (p = 0.019, p = 0.001, and p < 0.001, respectively) and lower carotid intima-media thickness compared with the term-AGA group (p = 0.047). The highest aortic β and lowest distensibility were found in the preterm-AGA group. Height-adjusted systolic blood pressure was higher in the preterm groups than in the term-AGA group (p = 0.018). Cardiac function and size did not differ between the groups. Conclusion IUGR and preterm birth appear to be associated with structural changes in the arterial wall, whereas preterm birth seems to be associated with higher blood pressure. Using conventional echocardiography, we observed no effect of IUGR on cardiac size and function.

Reduced Prevalence of Severe Intraventricular Hemorrhage in Very Preterm Infants Delivered after Maternal Preeclampsia

Background: Very preterm (VPT) delivery after severe preeclampsia (PE) has been associated with adverse perinatal outcome. It is unclear whether fetal exposure to PE per se modifies the prevalence of neonatal morbidities associated with VPT birth. Objectives: To evaluate neonatal morbidity in VPT infants exposed to maternal PE compared to morbidity in nonexposed VPT infants. Methods: This retrospective study consisted of all inborn infants delivered before 30 gestational weeks admitted to a tertiary-level neonatal intensive care unit between 1998 and 2014: 195 infants exposed to maternal PE were compared to 957 infants without maternal PE (background group). Prevalence rates of neonatal morbidity, cerebral palsy (CP), and mortality at 2 years of age were obtained from patient records. Results: The PE group had a lower median (IQR) birth weight (795 [262] g) and a higher median gestational age (GA) (27 [3] weeks) at birth than the background group (890 [385] g and 26 [3] weeks, respectively; both p < 0.001). Exposure to maternal PE was associated with lower rates of severe intraventricular hemorrhage (IVH) (2 vs. 11%), retinopathy of prematurity requiring treatment (2 vs. 7%), mortality (9 vs. 15%), and CP (4 vs. 8%). Exposure to PE remained associated with a reduced prevalence of severe IVH (OR 0.17, 95% CI 0.05–0.57) after adjustment for GA, multiple birth, Apgar score, delivery mode, sex, and antenatal steroid treatment. Conclusion: Fetal exposure to PE is associated with a decreased rate of severe IVH following VPT birth. Studies on underlying mechanisms may provide a basis for prevention of IVH in the VPT infant.

OC12.03: Cardiovascular function in adulthood following IUGR with ARED flow

K. Melchiorre1,4, G. Sutherland2, M. Liberati3, B. Thilaganathan1 1Fetal Maternal Medicine Unit, Department of Obstetrics and Gynecology, St Georges Hospital, University of London, London, United Kingdom; 2Department of Cardiology and Cardiothoracic Surgery, St Georges Hospital, University of London, London, United Kingdom; 3University of Chieti, Chieti, Italy; 4Department of Obstetrics and Gynaecology, Spirito Santo Hospital, Pescara, Italy

OC22.03: Cognitive function following intrauterine growth restriction and very preterm birth

Objectives: To evaluate the neurobehavioral outcome of earlyonset intrauterine growth restricted (IUGR) fetuses with abnormal umbilical artery (UA) Doppler and to compare the groups with and without brain sparing. Methods: A cohort of consecutive IUGR fetuses (birth weight < 10th centile) with abnormal UA Doppler (pulsatility index > 95th centile) and requiring delivery before 34 weeks was created and compared to a group of appropriate-for-gestational age (AGA) infants matched with cases by gestational age at delivery. Middle cerebral artery (MCA) was assessed by Doppler in all cases within 72 hours of delivery. Neonatal behavior was evaluated at 40-week corrected age with the Neonatal Behavioral Assessment Scale (NBAS). The effects of the study group and brain sparing (MCA pulsatility index < 5th centile) on each NBAS area were adjusted by multiple analysis of covariance or logistic regression for smoking during pregnancy, socioeconomic level, mode of delivery and gender. Results: A total of 126 fetuses (64 IUGR and 62 AGA) were included. Among IUGR fetuses, the proportion with abnormal MCA was 55%. All the neurobehavioral areas studied were poorer in the IUGR group, significantly in habituation, motor and socialinteractive. Abnormal habituation (36.2 vs. 16.3%; P = 0.027), motor (40.3 vs. 15.6%; P = 0.002) and social-interactive (25.8 vs. 8.2%; P = 0.009) scores were more frequent in IUGR than in AGA newborns. All the neurobehavioral areas studied were poorer in IUGR fetuses with brain sparing, significantly in habituation, motor, social-interactive and attention. Abnormal MCA identified IUGR fetuses with the highest risks of abnormal NBAS in motor (odds ratio 3.6; P = 0.011), social-interactive (odds ratio 4.1; P = 0.019) and attention (odds ratio 3.7; P = 0.011) areas. Conclusions: Early-onset IUGR with abnormal umbilical artery Doppler have poorer neurobehavioral competencies, which suggest a delayed neurological maturation. Abnormal MCA Doppler discriminates those cases at highest risk for abnormal neurobehavior.

OC22.05: Vascular properties and vascular function at early school age following IUGR with abnormal fetal blood flow and very preterm birth

F. Crispi1, B. Bijnens2, F. Figueras1, J. Bartrons3, E. Eixarch1, F. Le Noble4, A. Ahmed5, E. Gratacos1 1Maternal Fetal Medicine, Hospital Clinic Barcelona, Barcelona, Spain; 2ICREA-Universitat Pompeu Fabra (CISTIB) and Centro de Investigacion Biomedica en Red en Bioingenieria, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona, Spain; 3Department of Paediatric Cardiovascular Surgery, University Hospital Sant Joan de Deu, Esplugues de Llobregat, Spain; 4Laboratory for Angiogenesis and Cardiovascular Pathology, Max-Delbrueck-Center for Molecular Medicine, Berlin, Germany; 5Born Centre for Vascular Biology and Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, United Kingdom