The following is a summary of “Placental fetal vascular malperfusion, neonatal neurologic morbidity, and infant neurodevelopmental outcomes: a systematic review and meta-analysis,” published in the DECEMBER 2023 issue of Obstetrics and Gynecology by Spinillo, et al.

For a study, researchers sought to assess the association between placental fetal vascular malperfusion lesions, neonatal brain injury, and adverse neurodevelopmental outcomes in infants.

A comprehensive search was conducted in PubMed, Medline, Scopus, and Cochrane databases from their inception to July 2022. Cohort and case-control studies that investigated the relationships between fetal vascular malperfusion lesions and neonatal encephalopathy, perinatal stroke, intracranial hemorrhage, periventricular leukomalacia, and neurodevelopmental or cognitive outcomes in infants were included in the analysis. The data were analyzed by considering fetal vascular malperfusion lesions as an exposure variable and assessing their impact on brain injuries and neurodevelopmental impairment outcomes. Random-effect models were employed, and subgroup analyses were conducted to evaluate the influence of moderators such as gestational age or study type. The quality of the studies and the risk of bias were evaluated using the Observational Study Quality Evaluation method.

From 1,115 identified articles, 26 were included in the quantitative analysis. In term or near-term infants, fetal vascular malperfusion cases showed higher rates of neonatal central nervous system injury (neonatal encephalopathy or perinatal stroke) compared to controls (odds ratio, 4.00; 95% CI, 2.72–5.90). For premature deliveries, fetal vascular malperfusion lesions did not significantly affect the risk of intracranial hemorrhage or periventricular leukomalacia (odds ratio, 1.40; 95% CI, 0.90–2.18). The risk of abnormal infant neurodevelopmental outcomes associated with fetal vascular malperfusion lesions (314 cases and 1,329 controls) was influenced by gestational age, with a higher risk observed in term infants (odds ratio, 5.02; 95% CI, 1.59–15.91) compared to preterm infants (odds ratio, 1.70; 95% CI, 1.13–2.56). Abnormal infant cognitive and mental development were more prevalent among fetal vascular malperfusion cases (n=241) compared to controls (n=2,477) (odds ratio, 2.14; 95% CI, 1.40–3.27). The type of study (cohort vs case-control) did not significantly impact the association between fetal vascular malperfusion and subsequent infant brain injury or abnormal neurodevelopmental outcomes.

The results from cohort and case-control studies suggested a substantial association between fetal vascular malperfusion placental lesions and an increased risk of brain injury in term neonates, as well as neurodevelopmental impairment in both term and preterm infants. Clinicians, including pediatricians and neurologists, should consider a diagnosis of placental fetal vascular malperfusion during the follow-up of infants at risk of adverse neurodevelopmental outcomes.

Source: ajog.org/article/S0002-9378(23)00385-X/fulltext