Fetal umbilical artery Doppler pulsatility index and childhood neurocognitive outcome at 12 years.
To determine whether an elevated fetal umbilical artery Doppler (UAD) pulsatility index (PI) at 28 weeks' gestation, in the absence of fetal growth restriction (FGR) and prematurity, is associated with adverse neurocognitive outcome in children aged 12 years.



Prospective cohort study, comparing children with a normal fetal UAD PI (<90th centile) (n=110) and those with an elevated PI (≥90th centile) (n=40). UAD was performed at 28, 32 and 34 weeks gestation. At 12 years of age, all children were assessed under standardised conditions at Queen's University, Belfast, UK to determine cognitive and behavioural outcomes using the British Ability Score-II and Achenbach Child Behavioural Checklist Parent Rated Version under standardised conditions. Regression analysis was performed, controlling for confounders such as gender, socioeconomic status and age at assessment.



The mean age of follow-up was 12.4 years (±0.5 SD) with 44% of children male (n=63). When UAD was assessed at 28 weeks, the elevated fetal UAD group had lower scores in cognitive assessments of information processing and memory. Parameters included (1) recall of objects immediate verbal (p=0.002), (2) delayed verbal (p=0.008) and (3) recall of objects immediate spatial (p=0.0016). There were no significant differences between the Doppler groups at 32 or 34 weeks' gestation.



An elevated UAD PI at 28 weeks' gestation in the absence of FGR or prematurity is associated with lower scores of declarative memory in children aged 12 years. A potential explanation for this is an element of placental insufficiency in the presence of the appropriately grown fetus, which affects the development of the fetal hippocampus and information processing and memory long-term. These findings, however, had no impact on overall academic ability, mental processing and reasoning or overall behavioural function.
UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland Department of Fetal Medicine, National Maternity Hospital, Dublin, Ireland.
Fionnuala
F
Mone
Department of Early Childhood Studies, Stranmillis University College, Belfast, UK.
Barbara
B
McConnell
Royal Belfast Hospital for Sick Children, Belfast Health & Social Care Trust, Belfast, UK.
Andrew
A
Thompson
CSTAR, School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland.
Ricardo
R
Segurado
Department of Psychology, Queen's University Belfast, Belfast, UK.
Peter
P
Hepper
Royal Belfast Hospital for Sick Children, Belfast Health & Social Care Trust, Belfast, UK.
Moira C
MC
Stewart
Department of Fetal Medicine, Royal Maternity Hospital, Belfast, UK.
James C
JC
Dornan
Department of Fetal Medicine, Royal Maternity Hospital, Belfast, UK.
Stephen
S
Ong
UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland Department of Fetal Medicine, National Maternity Hospital, Dublin, Ireland.
Fionnuala M
FM
McAuliffe
Royal Belfast Hospital for Sick Children, Belfast Health & Social Care Trust, Belfast, UK Centre for Infection & Immunity, Queen's University Belfast, Belfast, UK.
Michael D
MD
Shields
D000328:Adult; D015415:Biomarkers; D016022:Case-Control Studies; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D019965:Neurocognitive Disorders / Q000209:etiology*; D021041:Placental Circulation; D011247:Pregnancy; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011673:Pulsatile Flow; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging* / Q000502:physiology; D006113:United Kingdom
D015415:Biomarkers