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American Journal of Epidemiology Advance Access published online on September 30, 2008
American Journal of Epidemiology, doi:10.1093/aje/kwn233
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American Journal of Epidemiology © The Author 2008. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Original Contribution

What Is Spared by Fetal Brain-Sparing? Fetal Circulatory Redistribution and Behavioral Problems in the General Population

Sabine J. Roza, Eric A. P. Steegers, Bero O. Verburg, Vincent W. V. Jaddoe, Henriette A. Moll, Albert Hofman, Frank C. Verhulst and Henning Tiemeier

Correspondence to Dr. Henning Tiemeier, Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, P.O. Box 2060, 3000 CB Rotterdam, the Netherlands (e-mail: h.tiemeier{at}erasmusmc.nl).

Received for publication January 22, 2008. Accepted for publication July 11, 2008.

Intrauterine growth restriction has been linked to infant behavioral problems. While typically only birth weight is examined, here the authors assessed fetal circulatory redistribution, also called the "brain-sparing effect," which is a fetal adaptive reaction to placental insufficiency. They aimed to investigate whether fetal circulatory redistribution protects against behavioral problems. Within the Generation R Study (Rotterdam, the Netherlands, 2003–2007), fetal circulation variables for the umbilical artery and the middle and anterior cerebral arteries were assessed with Doppler ultrasound in late pregnancy. Ratios between placental resistance and cerebral resistance were related to behavioral problems, as measured by the Child Behavior Checklist, in 935 toddlers aged 18 months. The umbilical/anterior cerebral ratio was associated with the Total Problems summary score from the Child Behavior Checklist (per standard-deviation increase, odds ratio = 1.2, 95% confidence interval: 1.0, 1.5). Children with higher umbilical/anterior cerebral ratios had higher risks of internalizing problems, emotional reactivity, somatic complaints, and attention problems. A high umbilical/middle cerebral ratio was related to higher scores on the Internalizing and Somatic Complaints scales. The authors conclude that infants with circulatory redistribution in gestation are more likely to have behavioral problems. This suggests that "brain-sparing" does not completely spare the brain and indicates underlying pathology with consequences for later behavior.

cerebrovascular circulation; fetal blood; fetal hypoxia; infant behavior

Abbreviations: CI, confidence interval; OR, odds ratio; SD, standard deviation; U/C, umbilical/cerebral


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