Placental pathology is associated with lower quality fidgety movements in preterm infants.

Abstract

Background: Preterm infants are at risk for neurodevelopmental disabilities later in life, like motor delays and cerebral palsy (CP). The placenta plays a critical role throughout pregnancy, particularly in preterm birth. Our aim is to explore the relation between placental lesions and accurate predictors of neurodevelopmental outcomes in preterm infants.

Methods: Preterm infants (<30 weeks and/or birthweight <1000 g) were included with histopathological examination (according to Amsterdam criteria) of the placentas. We predicted the risk for future possible neurodevelopmental impairment using Prechtl's General Movement Assessment to evaluate fidgety movements (FM) at 3 months post-term. We also calculated the Motor Optimality Score-Revised (MOS-R).

Results: In total 78 infants were included. The gestational age ranged from 24.1 to 32.6 weeks and birth weight was between 550 and 1950 g. The presence of AIUI (ascending intrauterine infection) was significantly associated with absent FMs (p = 0.034). Both the presence of fetal and maternal vascular malperfusion (FVM and MVM) were associated with a MOS-R < 23[OR4.58, 95% CI[1.35, 15.55], p = 0.015;OR2.55, 95% CI[1.02, 6.64], p = 0.045).

Conclusion: AIUI is associated with a higher risk of absent FMs and therefore an increased risk for CP. FVM and MVM are significantly associated with MOS-R < 23, which is predictive of an elevated risk for adverse neurodevelopmental (non-CP) outcomes. This finding supports the hypothesis that impaired neurodevelopment in preterm infants already starts before birth.

Impact: Our article underscores a key message: neurodevelopmental challenges in preterm infants originate prenatally. Our research has identified a significant association between certain placental lesions and a lower quality of fidgety movements, placing these preterm born infants at a high risk for adverse neurodevelopmental outcomes. To our knowledge, this is the first study to investigate the role of placental pathologies and risk of neurodevelopmental outcomes, while using general movements during the fidgety period. We advocate for neonatologists to integrate placental pathology assessments into their treatment strategies for newborns, recognizing its importance in enhancing care outcomes.