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.

项目概要/摘要 胎盘在调节胎儿的生长发育中起着核心作用。 2015年，尤尼斯 肯尼迪施赖弗国家儿童健康和人类发展研究所拨款 4150 万美元给 人类胎盘项目 (HPP) 认识到这一作用的重要性并认识到其局限性 了解影响胎盘功能的因素。 HPP 主要关注实时技术的进步 胎盘成像。虽然这是一项重要举措，但所开发的技术和方法可能不会 用于低风险妊娠，因此对于理解这种关系的适用性可能有限 一般人群的胎盘表型和胎儿结局之间的关系。产后胎盘措施， 因此，可以补充 HPP 的研究结果，以更好地理解这种关系。此外，还有几个 研究表明，胎盘功能和效率与胎盘形态相关。 目前，根据估计，胎儿和新生儿被确定为胎儿生长不理想。 胎儿体重或出生体重相对胎龄百分位数。这些措施错误地捕捉到了以下新生儿： 体质较小，但未能捕获较大但仍处于次优胎儿状态的新生儿 生长。识别这些新生儿很重要，因为他们面临更大的认知延迟和其他问题的风险 儿童期的不良后果以及成年期的心血管疾病。如果及早发现，三级 预防资源可以用于减轻不良后果的可能性。这项拟议的研究 该项目旨在调查胎盘形态特征（包括厚度、形状、表面 面积和脐带插入的中心性）可用于识别经历次优的新生儿 胎儿生长，因此出现不良认知结果的风险更高。目标 1 将评估使用的有效性 胎盘直径来计算表面积，这将为后续目标的敏感性分析提供信息。 目标 2 将评估双绒毛膜胎盘形态特征与出生体重之间的关系 双胞胎。目标 3 将评估胎盘形态特征与认知结果之间的关联 在五至七岁的儿童中，分别对单胎和双绒毛膜双胞胎进行评估。双绒毛膜双胞胎 是一个未被充分研究的人群，其胎儿生长不良的发生率较高，并呈现出独特的特征 有机会控制关键混杂因素（例如胎龄、子宫内环境）。结果由此 拟议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 和发展以及这与儿童时期不良认知结果的相关程度。更好的 识别出不良认知结果风险较高的新生儿将有助于加强早期针对性治疗 干预资源，从而有可能改善儿童时期的认知结果。