Fetal Growth Restriction Is Associated With Altered Optic Nerve Head Morphology in Term-Born Children and Adolescents.
Fieß Achim, Gißler Sandra, Grabitz Stephanie, Hoffmann Esther M, Mildenberger Eva, Uphaus Timo, Hahn Marianne, Pfeiffer Norbert, Hartmann Alica, Schuster Alexander K
AI Summary
Fetal growth restriction in term-born children is linked to thinner optic nerve layers, suggesting reduced neuronal reserve and potential neurodevelopmental risks requiring monitoring.
Abstract
Purpose
Restricted fetal growth is associated with impaired neurodevelopment in childhood. We examined the effects of fetal growth restriction, fetal overgrowth, and other perinatal parameters on optic nerve head (ONH) morphology in term-born children and adolescents.
Methods
This retrospective cohort study with a prospective ophthalmologic examination included full-term born children aged 4 to 17 years who were grouped according to their birth weight correlated to gestational age (GA). We formed the following groups: severe fetal growth restriction (<3rd birth weight [BW] percentile, group 1), moderate fetal growth restriction (BW percentile 3rd to <10th, group 2), appropriate for gestational age (AGA, 10th-90th BW percentile, group 3, control group), moderate fetal overgrowth (>90th-97th BW percentile, group 4), and severe fetal overgrowth (>97th percentile, group 5). The participants underwent spectral-domain optical coherence tomography and fundus photography to evaluate the peripapillary retinal nerve fiber layer (pRNFL) thickness, minimal rim width (MRW), Bruch's membrane opening (BMO), and vertical cup-to-disc ratio (vCDR), focusing on their relationship to perinatal factors like nutritional status, GA, maternal smoking, and maternal breastfeeding. The relationships between the ONH parameters and perinatal factors were adjusted for variables such as age, sex, and axial length.
Results
This study included 732 eyes of 375 participants (mean age of 11.4 ± 3.71 years, 193 female subjects). Multivariable regression analyses showed an association between a thinner global pRNFL thickness in the participants with severe fetal growth restriction (B = -4.95; 95% confidence interval [CI], -9.43 to -0.47 µm; P = 0.03) compared to the reference AGA group. Furthermore, an association with a thinner MRW was found in the children born with moderate fetal growth restriction (B = -32.46; 95% CI, -51.52 to -13.40 µm; p < 0.001). BW percentile was associated with median vCDR (B = -0.001; 95% CI, -0.002 to 0.00; P = 0.02). No consistent association was observed between altered fetal growth and BMO.
Conclusions
Severe fetal growth restriction appears to affect the optic nerve head in term-born children and adolescents, suggesting a possible reduction in neuronal reserve, and may indicate a potentially elevated risk of abnormal neurodevelopment.
MeSH Terms
Shields Classification
Key Concepts5
In term-born children and adolescents, severe fetal growth restriction (<3rd birth weight percentile) is associated with a thinner global peripapillary retinal nerve fiber layer (pRNFL) thickness (B = -4.95; 95% confidence interval [CI], -9.43 to -0.47 µm; P = 0.03) compared to those appropriate for gestational age.
In term-born children and adolescents, moderate fetal growth restriction (birth weight percentile 3rd to <10th) is associated with a thinner minimal rim width (MRW) (B = -32.46; 95% CI, -51.52 to -13.40 µm; p < 0.001) compared to those appropriate for gestational age.
In term-born children and adolescents, birth weight percentile is associated with median vertical cup-to-disc ratio (vCDR) (B = -0.001; 95% CI, -0.002 to 0.00; P = 0.02).
No consistent association was observed between altered fetal growth (severe fetal growth restriction, moderate fetal growth restriction, moderate fetal overgrowth, severe fetal overgrowth) and Bruch's membrane opening (BMO) in term-born children and adolescents.
A retrospective cohort study with a prospective ophthalmologic examination of 732 eyes from 375 full-term born children aged 4 to 17 years investigated the effects of fetal growth restriction, fetal overgrowth, and other perinatal parameters on optic nerve head (ONH) morphology.
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