Features of placental morphology, fetal growth, and adverse cognitive outcomes in childhood

胎盘形态特征、胎儿生长和儿童期不良认知结果

• 批准号: 9470537
• 负责人: Alexa Ann Freedman
• 金额: $ 3.69万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-19 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9470537
• 关键词: 7 year old; Adult; Affect; Age; Alabama; Area; Attention; Birth Weight; Caliber; Cardiovascular Diseases; Characteristics; Child; Childhood; Clinical; Cognition; Cognitive; Constitutional; Data; Early Intervention; Early identification; Environment; Failure; Fetal Development; Fetal Growth; Fetal Weight; Fetus; General Population; Gestational Age; Growth; Growth and Development function; High Prevalence; Human; Image; Impaired cognition; Knowledge; Literature; Measurement; Measures; Mediating; Menstruation; Methods; Mothers; Motor; National Institute of Child Health and Human Development; Norway; Nutrient; Outcome; Oxygen; Perinatal; Perinatal mortality demographics; Phenotype; Placenta; Placentation; Play; Population; Pregnancy; Reproducibility of Results; Research; Research Personnel; Research Project Grants; Resources; Risk; Role; Shapes; Short-Term Memory; Spiral Artery of the Endometrium; Surface; Technology; Thick; Time; Twin Multiple Birth; Twin Studies; Ultrasonography; Umbilical cord structure; Visual Perception; adverse outcome; base; cognitive ability; cognitive development; cognitive function; cognitive testing; experience; fetal; high risk; improved; in utero; neonate; neuromechanism; perinatal morbidity; placental morphology; postnatal; stillbirth; tertiary prevention; wasting

Project Summary/Abstract The placenta plays a central role in regulating growth and development of the fetus. In 2015, the Eunice Kennedy Shriver National Institute of Child Health and Human Development allocated $41.5 million to the Human Placenta Project (HPP) in recognition of the importance of this role and in recognition of limitations in knowledge about factors that affect placental function. The HPP focuses primarily on advances in real-time placental imaging. While an important initiative, the technologies and methods developed likely won't be utilized in low-risk pregnancies, and thus may have limited applicability to understanding the relationship between placental phenotype and fetal outcomes in the general population. Postnatal placental measures, therefore, may supplement findings from the HPP to better understand this relationship. Additionally, several studies have demonstrated that placental function and efficiency are associated with placental morphology. Currently, fetuses and neonates are identified as experiencing suboptimal fetal growth based on estimated fetal weight or birth weight for gestational age percentiles. These measures incorrectly capture neonates who are constitutionally small while failing to capture neonates who are larger, yet still experienced suboptimal fetal growth. Identification of these neonates is important as they are at greater risk of cognitive delay and other adverse outcomes in childhood, as well as cardiovascular disease in adulthood. If identified early, tertiary prevention resources can be targeted to mitigate the potential for adverse outcomes. This proposed research project seeks to investigate whether features of placental morphology (including thickness, shape, surface area, and centrality of umbilical cord insertion) can be used to identify neonates who experienced suboptimal fetal growth and thus are at higher risk of adverse cognitive outcomes. Aim 1 will evaluate the validity of using placental diameters to calculate surface area, which will inform sensitivity analyses for the subsequent aims. Aim 2 will evaluate the relationships between features of placental morphology and birth weight in dichorionic twins. Aim 3 will estimate the associations between features of placental morphology and cognitive outcomes in five to seven year-old children, evaluated separately in singletons and dichorionic twins. Dichorionic twins are an understudied population that have a higher prevalence of suboptimal fetal growth and present a unique opportunity to control for key confounders (e.g., gestational age, in utero environment). Results from this proposed research project will improve our understanding of the role of the placenta in regulating fetal growth and development and the extent to which this correlates with adverse cognitive outcomes in childhood. Better identification of neonates at higher risk of adverse cognitive outcomes will allow for enhanced targeting of early intervention resources, thereby potentially leading to improved cognitive outcomes in childhood.

项目总结/摘要 胎盘在调节胎儿的生长和发育中起着核心作用。2015年，Eunice 肯尼迪·施赖弗国家儿童健康和人类发展研究所拨款4150万美元， 人类胎盘项目（HPP），以认识到这一作用的重要性，并认识到 了解影响胎盘功能的因素。HPP主要侧重于实时 胎盘成像虽然这是一项重要的举措，但开发的技术和方法可能不会成为 在低风险妊娠中使用，因此可能对理解关系的适用性有限。 胎盘表型和胎儿结局之间的关系。产后胎盘测量， 因此，可以补充HPP的发现，以更好地理解这种关系。此外，若干 研究表明胎盘功能和效率与胎盘形态有关。 目前，胎儿和新生儿被鉴定为经历次优的胎儿生长，基于估计的 胎儿体重或出生体重与胎龄比值。这些措施不正确地捕捉新生儿， 先天性小，而未能捕获较大的新生儿，但仍然经历了次优的胎儿 增长识别这些新生儿是重要的，因为他们有更大的认知延迟和其他风险。 儿童期的不良后果，以及成年期的心血管疾病。如果早期发现， 预防资源可用于减轻可能出现的不良后果。这项拟议的研究 该项目旨在研究胎盘形态学特征（包括厚度、形状、表面 区域和脐带插入的中心性）可用于识别经历次优 胎儿生长，因此处于不良认知结果的较高风险中。目标1将评估使用的有效性 胎盘直径以计算表面积，这将为后续目的的敏感性分析提供信息。 目的2探讨胎盘形态学特征与新生儿出生体重的关系 双胞胎目的3将评估胎盘形态学特征与认知结果之间的关系 在5至7岁的儿童中，分别对单胞胎和双胞胎进行评估。双绒毛膜双胎 是一个研究不足的人群，有较高的患病率次优胎儿生长，并提出了一个独特的 控制关键混杂因素的机会（例如，胎龄、子宫内环境）。结果从这个 一项拟议中的研究项目将提高我们对胎盘在调节胎儿生长中的作用的理解 以及这与儿童期不良认知结果的相关程度。更好 识别具有较高不良认知结果风险的新生儿将有助于加强早期 干预资源，从而可能导致儿童期认知结果的改善。