ArticleBMC pregnancy and childbirth2026
Impaired cortical fissure development in severe fetal growth restriction and correlation with cerebral hemodynamic adaptation: a prospective case-control study.
Article in BMC pregnancy and childbirth, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThis study aimed to evaluate cortical maturation and fissure development using fetal neurosonography in fetuses with severe fetal growth restriction (FGR) and to investigate the relationship between cerebral hemodynamic adaptation, assessed by middle cerebral artery pulsatility index (MCA PI), cerebroplacental ratio (CPR) and fetal brain morphology.
methodsThis prospective case-control study included 164 singleton pregnancies (n = 82 per group) between 29 and 34 weeks of gestation, comprising 82 fetuses with severe FGR (estimated fetal weight below the 3rd percentile) and 82 gestational age-matched healthy controls. Neurosonographic evaluation included measurements of Sylvian fissure, parieto-occipital fissure, and calcarine fissure depths, as well as corpus callosum length and cerebellar vermian dimensions. Doppler parameters, including umbilical artery and MCA PI, CPR were recorded. Correlations between MCA PI, CPR and neurosonographic measurements were analyzed within the FGR group.
resultsFetuses with FGR demonstrated significantly reduced Sylvian fissure depth (10.32 ± 1.71 mm vs. 11.79 ± 1.95 mm; p < 0.001) and calcarine fissure depth (8.07 ± 1.38 mm vs. 8.44 ± 1.24 mm; p = 0.043) compared with controls. No significant differences were observed in corpus callosum length, cerebellar vermian dimensions, or parieto-occipital fissure depth. Within the FGR group, significant inverse correlations were identified between MCA PI and calcarine fissure depth (r = - 0.415; p < 0.001), corpus callosum length (r = - 0.343; p = 0.003), vermian length (r = - 0.333; p = 0.004), and vermian anteroposterior depth (r = - 0.261; p = 0.027).
conclusionOur findings demonstrate that severe FGR is associated with delayed prenatal development of the Sylvian and calcarine fissures. Moreover, the observed inverse correlations between MCA PI values and selected neuroanatomical parameters may reflect region-specific cerebral hemodynamic adaptation and cortical remodeling associated with chronic placental insufficiency, rather than true accelerated or preserved maturation.
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