Fetal Growth Monitoring and Issues: The Intrauterine Monitoring of Middle Cerebral Artery and Its Role in Neuronal Development of the Newborn

Fetal growth restriction (FGR) represents a very common pathology of pregnancy in which the fetus, due to maternal, fetal, or placental causes, is unable to fully develop its growth potential. It is a leading cause of perinatal–neonatal morbidity and mortality, but it is also a cause of long-term adverse consequences such as neurodevelopmental impairment, increased risk of cardiovascular disease, and metabolic syndrome that span over a lifetime. Monitoring of fetal cardiovascular function with Doppler ultrasound is an essential part of the clinical care of such fetuses. The clinical standards for fetal surveillance and timely delivery are the umbilical artery, the middle cerebral artery (MCA), and ductus venosus. MCA Doppler, in particular, is considered a surrogate for fetal hypoxemia, and its value in predicting neurological damage in preterm and term FGR is. Individuals who had FGR experience a range of poorer developmental outcomes, encompassing cognitive, socioemotional, and behavioral domains, compared with individuals who were born appropriate for gestational age. Accumulating evidence suggests that cerebral redistribution may be associated with an increased risk of adverse neurodevelopmental outcomes, particularly neonatal motor and state organization, and lower communication and problem-solving scores at 2 years of age. It is very important to identify those children at risk of developing cognitive sequelae as early as possible, monitoring their development, and effectively intervening if and when needed to strengthen their cognitive profile. Human brain development is a finely orchestrated process that relies on the sequential execution of genetic programs, complex cellular interactions, and the formation and resolution of transient organs, and we have only a limited understanding of emerging neural activity during human fetal development. The fetal to neonatal period is a critical stage in brain development since rapid neurodevelopmental processes establish key functional neural circuits. Fetal magnetic resonance imaging (MRI) is an important diagnostic tool for the assessment of fetal brain development and pathologies. In FGR disease, MRI conventional sequences can demonstrate restricted fetal brain growth and delayed cortical gyration or focal ischemic or hemorrhagic lesions. Functional brain networks and microstructural abnormalities are not detectable by conventional MRI sequences but can be identified by functional magnetic resonance imaging (fMRI). The technique permitted researchers to infer human brain activity at rest or during any given task, detecting changes in cerebral blood flow or the movement of water molecules, and mapping white matter tracts, the large nerve fiber bundles connecting brain regions. The possibility to use these methods in utero gives an unprecedented look at the developing brain.