Differential effect of intrauterine growth restriction on childhood neurodevelopment: a systematic review

Abstract

Background: Neurodevelopmental disorders are increasingly believed to originate from intrauterine growth restriction (IUGR). Current reviews exploring the neurodevelopmental effects of IUGR, however, are mostly based on birthweight, an inadequate proxy.

Objective: We aimed to examine the association between IUGR documented in utero, and neurodevelopmental outcomes during childhood.

Search strategy: Medline, CINAHL, PsycInfo and Scopus were searched for relevant studies published after 1970.

Selection criteria: The analysis included studies that identified IUGR in utero, with follow-up assessments between 1 month and 12 years of age.

Data collection and analysis: Data was extracted for cognitive, behavioural, language, motor, hearing, vision or sleep outcomes. Studies were summarised separately for children born at <35 and ≥35 weeks gestation.

Main results: Of 28 876 titles identified, 38 were suitable for inclusion. IUGR children born ≥35 weeks gestation scored on average 0.5 SD lower than non-IUGR children across all neurodevelopmental assessments. IUGR children born <35 weeks of gestation scored approximately 0.7 SD lower than non-IUGR children across all neurodevelopmental assessments. IUGR children with evidence of fetal circulatory redistribution (preferential perfusion of the brain) had more severe neurodevelopmental impairments than those born IUGR alone.

Conclusions: IUGR increases the risk of neurodevelopmental impairment during childhood differentially across domains. IUGR children born preterm or with evidence of fetal circulatory redistribution are more severely affected.

Tweetable abstract: IUGR is associated with an overall risk for neurodevelopmental delay in a range of neurodevelopmental domains.

Keywords: Doppler velocimetry; fetal growth retardation; intrauterine growth restriction; neurodevelopment; serial ultrasound biometry; small-for-gestational-age.