Intrauterine growth retardation and the developing brain

Fetal growth restriction is the second leading cause of perinatal morbidity and mortality, behind prematurity, and is present in 5-12% of all pregnancies in the general population. Often confused with children constitutionally small for gestational age, those who had not achieved their potential for fetal growth and therefore having true growth restriction can be identified using customized growth curves. The point is to accurately identify fetuses with slowing growth or cessation of growth reflecting a pathological process, because these are at risk of death in utero or chronic fetal hypoxia with a significant impact on brain development. The kinetics of growth and prenatal markers of fetal growth restriction will influence the decision to extract the fetus and the gestational age at birth, as well as other factors involved in the neurodevelopmental outcome. Cognitive deficits and executive, motor, and behavioral dysfunctions described in the short term seem to persist together with greater risk of metabolic syndrome in adulthood. Decisions of fetal extraction by C-section continue to be debated until new epidemiological data will be available on large cohorts monitored over the long term using accurate neurocognitive tools. Understanding the effects of fetal growth restriction on the structure and function of the developing brain is essential for improving the relevance of fetal extraction decisions, perinatal care, and early evaluation of treatments for the prevention of neurodevelopmental disorders. (C) 2013 Published by Elsevier Masson SAS.