title: The assessment of fetal brain growth in diabetic pregnancy using in utero magnetic resonance imaging.
abstract: OBJECTIVE
  To assess fetal brain growth over the third trimester in pregnant women with diabetes using in utero magnetic resonance imaging (iuMRI) to determine if greater brain growth occurs in type 1 (T1DM) when compared to gestational (GDM) diabetes mellitus.
  
  
  METHODS
  Each consented participant was scanned at three fixed times during the third trimester using iuMRI. One hundred and fifty-seven patients were approached, 48 participants were recruited, and 36 complete data sets were analysed. Three-dimensional (3D) iuMRI volume data sets were manually segmented using software to construct models of the fetal brain from which brain volumes could be calculated. Inter-rater analysis was performed, and volume differences and growth rates were compared between T1DM and GDM.
  
  
  RESULTS
  Recruitment proved difficult with low uptake and high attrition rates (77.1%). Inter-rater analysis revealed excellent correlation (intraclass correlation coefficient=0.93, p<0.001) and agreement with no significant difference between operators (p=0.194). There was no evidence of increased brain volume in the T1DM group. Growth rates between visit 1 and 3 for T1DM and GDM were not significantly different (p=0.095).
  
  
  CONCLUSIONS
  T1DM brain volumes were not significantly larger than GDM volumes and there was no significant divergence of brain growth over the third trimester. Constructing volume models from 3D iuMRI acquisitions is a novel technique that can be used to assess fetal brain growth. No specialist software or knowledge is required. Larger studies attempting to recruit pregnant women in the later stages of pregnancy should employ multicentre recruitment to overcome recruitment difficulties and high attrition rates.
authors.affiliation: Academic Unit of Radiology, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK. Electronic address: michael.paddock@doctors.org.uk.
authors.forename: M
authors.initials: M
authors.lastname: Paddock
authors.affiliation: The Medical School, The University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK.
authors.forename: R
authors.initials: R
authors.lastname: Akram
authors.affiliation: Academic Unit of Radiology, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
authors.forename: D A
authors.initials: DA
authors.lastname: Jarvis
authors.affiliation: Academic Unit of Radiology, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
authors.forename: P
authors.initials: P
authors.lastname: Armitage
authors.affiliation: Department of Diabetes and Endocrinology, Northern General Hospital, Sheffield S5 7AU, UK.
authors.forename: S
authors.initials: S
authors.lastname: Song
authors.affiliation: Department of Obstetrics & Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK.
authors.forename: P
authors.initials: P
authors.lastname: Madhuvrata
authors.affiliation: Academic Unit of Radiology, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
authors.forename: P D
authors.initials: PD
authors.lastname: Griffiths
mesh_terms: D000328:Adult; D001921:Brain / Q000033:anatomy & histology* / Q000196:embryology*; D005260:Female; D047109:Fetal Development; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation; D011247:Pregnancy; D011254:Pregnancy in Diabetics; D015203:Reproducibility of Results; D055815:Young Adult