Fetal growth restriction (FGR), failing to achieve genetically determined growth potential in utero, significantly contributes to morbidity and mortality during the perinatal period. Moreover, it is associated with lifelong adverse consequences, including impaired fetal neurodevelopment and poorer educational outcomes in childhood. However, studying the relationship between FGR and long-term outcomes is complex for several reasons.
A new study published by PLOS Medicine has found evidence that fetuses with antenatal fetal growth restriction (FGR) may have an increased likelihood of lower educational attainment during mid-childhood. The study, conducted by researchers at a single center in Cambridge, UK, utilized data collected by the UK Department of Education, including pupils in state-funded schools in England.
The study found that the association between FGR and lower educational attainment was consistent across serial assessments aged 5 through 7, although it was not statistically significant at age 5. The impact of FGR on academic achievement is consistent throughout the early school years, as the effect estimate was reasonably stable across all ages studied. Children with FGR had significantly worse reading, writing, and math skills by age seven than typically developing youngsters.
The study’s authors think that poor intrauterine environmental quality due to placental insufficiency—which may result in low oxygen partial pressure, inadequate nourishment, or a chronic pro-inflammatory response—may predict poor cognitive ability in adulthood. The environmental disruption caused by placental failures, such as preeclampsia, may jeopardize the highly patterned transcriptional and epigenetic modulations required for fetal brain development.
Clinicians considering intervention for suspected FGR shortly should consider the findings of this study. The risk of stillbirth is significant enough in this case that early-term delivery is being considered. The study’s findings, however, suggest that FGR occurring too late is a substantial predictor of educational failure.
Still, the study’s results suggest that late FGR is an independent predictor of poor educational outcomes. This association cannot be explained by iatrogenic harm arising from earlier delivery at term. The study suggests better methods for diagnosing FGR may help avoid unnecessary interventions for constitutionally small fetuses. Deep phenotyping may allow for stratified antenatal care, targeting early-term delivery specifically to FGR cases most likely to benefit.
However, the study has some limitations. The UK Department of Education collected the educational data used in the study. It only included pupils in state-funded schools in England, which may only fully represent some of the population.
Additionally, the cohort used in the study originated from a single center in Cambridge, UK, and may be less socioeconomically and ethnically diverse than the whole population of the UK. Despite these limitations, the study’s findings suggest that FGR should be a priority area for further research to identify new predictors and determine interventions’ short- and long-term consequences.
