Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Mar 29:10:188.
doi: 10.3389/fendo.2019.00188. eCollection 2019.

Knowledge Gaps and Emerging Research Areas in Intrauterine Growth Restriction-Associated Brain Injury

Bobbi Fleiss  1   2   3 , Flora Wong  4   5   6 , Fiona Brownfoot  7 , Isabelle K Shearer  1 , Olivier Baud  2   8 , David W Walker  1 , Pierre Gressens  2   3   9 , Mary Tolcos  1
Affiliations
Review

Knowledge Gaps and Emerging Research Areas in Intrauterine Growth Restriction-Associated Brain Injury

Bobbi Fleiss et al. Front Endocrinol (Lausanne). .

Abstract

Intrauterine growth restriction (IUGR) is a complex global healthcare issue. Concerted research and clinical efforts have improved our knowledge of the neurodevelopmental sequelae of IUGR which has raised the profile of this complex problem. Nevertheless, there is still a lack of therapies to prevent the substantial rates of fetal demise or the constellation of permanent neurological deficits that arise from IUGR. The purpose of this article is to highlight the clinical and translational gaps in our knowledge that hamper our collective efforts to improve the neurological sequelae of IUGR. Also, we draw attention to cutting-edge tools and techniques that can provide novel insights into this disorder, and technologies that offer the potential for better drug design and delivery. We cover topics including: how we can improve our use of crib-side monitoring options, what we still need to know about inflammation in IUGR, the necessity for more human post-mortem studies, lessons from improved integrated histology-imaging analyses regarding the cell-specific nature of magnetic resonance imaging (MRI) signals, options to improve risk stratification with genomic analysis, and treatments mediated by nanoparticle delivery which are designed to modify specific cell functions.

Keywords: brain development; growth restriction; neurobiology and brain physiology; neuroinflammation; neuroprotection.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Outline of the causes of IUGR including contributions from maternal, placental and umbilical cord, and fetal dysfunction or injury. Adapted from Vijayaselvi and Cherian (22) and Gaccioli and Lager (23).
Figure 2
Figure 2
Representation of the physical presentation of symmetrical and asymmetrical IUGR and a short list of clinical characteristics and causes. * note that incidence data are from high-resource settings. A third phenotype is proposed in low-resource settings, that includes characteristics of malnutrition and late gestation placental insufficiency (10), not shown. # Ponderal index, (birth weight (g)/length(cm)3 × 100). HC, head circumference. AC, Abdominal circumference. GW, gestational weeks. AC, abdominal circumference. EFW, Estimated fetal weight. Delphi criteria from Gordijn et al. (4).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Lee AC, Kozuki N, Cousens S, Stevens GA, Blencowe H, Silveira MF, et al. Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH-21(st) standard: analysis of CHERG datasets. BMJ. (2017) 358:j3677 10.1136/bmj.j3677 - DOI - PMC - PubMed
    1. Mcgaghie WC. Varieties of integrative scholarship: why rules of evidence, criteria, and standards matter. Acad Med. (2015) 90:294–302. 10.1097/ACM.0000000000000585 - DOI - PubMed
    1. Unterscheider J, Daly S, Geary MP, Kennelly MM, Mcauliffe FM, O'donoghue K, et al. Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO study editorial comment. Obst Gynecol Surv. (2013) 68:549–51. 10.1097/OGX.0b013e3182a0597f - DOI - PubMed
    1. Gordijn SJ, Beune IM, Thilaganathan B, Papageorghiou A, Baschat AA, Baker PN, et al. . Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstetr Gynecol. (2016) 48:333–9. 10.1002/uog.15884 - DOI - PubMed
    1. Dammann O, Ferriero D, Gressens P. Neonatal encephalopathy or hypoxic-ischemic encephalopathy? Appropr Terminol. Matters Pediatr Res. (2011) 70:1–2. 10.1203/PDR.0b013e318223f38d - DOI - PubMed

LinkOut - more resources

-