1. Restricted growth of a fetus during early pregnancy was examined as a risk factor for impaired neurodevelopment.

2. Decreased crown-to-rump length was shown to impact neurodevelopment at 2 years of age.

Restricted fetal growth in the uterus is an important risk factor to consider for impaired development in the child. Early pregnancy is a crucial time for growth of a fetus, as it allows for the development of the neural tube, along with an increasing number of fetal brain cells. There is a lack of research studying the association between first-trimester fetal size and childhood neurodevelopment. To address this gap, a prospective birth cohort study investigated the associations between fetus size during the first trimester and accelerated intrauterine growth with brain development in childhood. 2058 fetuses were examined for the study. During the first trimester, their crown to rump length (CRL) was measured and used to estimate fetal size. Once the children reached 2 years of age, the Bayley Scaled of Infant Development (BSID) of China Revision was used to measure the brain development of the children. This scoring system produced a mean development index (MDI), representing language and social development along with a psychomotor development index (PDI), representing motor ability. The maternal age at the time of delivery had a mean (SD) of 29.0 (3.5) years, while the mean (SD) gestation time was around 39.34 (1.12) weeks. There was a significant association between neurodevelopment at 2 years and first-trimester CRL. With every increase in Z score for CRL, there was an associated increase in score for MDI (adjusted beta estimate = 1.19, (95% CI: 0.13, 2.25), P=0.03) and PDI (adjusted beta estimate = 1.36, (95% CI: 0.46, 2.26), P < 0.01) at 2 years of age. Furthermore, a linear trend was observed in the quartile CRL models (MDI: P for trend = 0.03; PDI: P for trend < 0.01).  The MDI and PDI scores were higher amongst children in the highest quartile compared to those in the lowest quartile (adjusted beta estimate = 2.88, (95% CI: 0.27, 5.49), P = 0.03), (adjusted beta estimate = 3.88, (95% CI: 1.68, 6.08), P < 0.01). In summary, restricted fetus growth in utero during the first trimester was associated with neurodevelopmental delays at the beginning of childhood. Improved mental development was associated with accelerated intrauterine growth after the first trimester, however, psychomotor development had no such association. 

Click to read the study in BMC Medicine

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