Journal
AMERICAN JOURNAL OF EPIDEMIOLOGY
Volume 168, Issue 10, Pages 1145-1152Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/aje/kwn233
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Funding
- Erasmus University Medical Center
- Erasmus University
- Netherlands Organization for Health Research and Development
- Netherlands Organization for Health Research and Development [10.000.1003]
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Intrauterine growth restriction has been linked to infant behavioral problems. While typically only birth weight is examined, here the authors assessed fetal circulatory redistribution, also called the brain-sparing effect, which is a fetal adaptive reaction to placental insufficiency. They aimed to investigate whether fetal circulatory redistribution protects against behavioral problems. Within the Generation R Study (Rotterdam, the Netherlands, 2003-2007), fetal circulation variables for the umbilical artery and the middle and anterior cerebral arteries were assessed with Doppler ultrasound in late pregnancy. Ratios between placental resistance and cerebral resistance were related to behavioral problems, as measured by the Child Behavior Checklist, in 935 toddlers aged 18 months. The umbilical/anterior cerebral ratio was associated with the Total Problems summary score from the Child Behavior Checklist (per standard-deviation increase, odds ratio = 1.2, 95% confidence interval: 1.0, 1.5). Children with higher umbilical/anterior cerebral ratios had higher risks of internalizing problems, emotional reactivity, somatic complaints, and attention problems. A high umbilical/middle cerebral ratio was related to higher scores on the Internalizing and Somatic Complaints scales. The authors conclude that infants with circulatory redistribution in gestation are more likely to have behavioral problems. This suggests that brain-sparing does not completely spare the brain and indicates underlying pathology with consequences for later behavior.
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