Abstract:
Many observational studies and some randomized trials demonstrate how fetal growth can be
influenced by environmental insults (for example, maternal infections)1 and preventive
interventions (for example, multiple-micronutrient supplementation)2 that can have a long-lasting
effect on health, growth, neurodevelopment and even educational attainment and income in
adulthood3. In a cohort of pregnant women (n = 3,598), followed-up between 2012 and 2019 at
six sites worldwide4, we studied the associations between ultrasound-derived fetal cranial growth
trajectories, measured longitudinally from <14 weeks' gestation, against international
standards5,6, and growth and neurodevelopment up to 2 years of age7,8. We identified five
trajectories associated with specific neurodevelopmental, behavioral, visual and growth outcomes,
independent of fetal abdominal growth, postnatal morbidity and anthropometric measures at birth
and age 2. The trajectories, which changed within a 20-25-week gestational age window, were
associated with brain development at 2 years of age according to a mirror (positive/negative)
pattern, mostly focused on maturation of cognitive, language and visual skills. Further research
should explore the potential for preventive interventions in pregnancy to improve infant
neurodevelopmental outcomes before the critical window of opportunity that precedes the
divergence of growth at 20-25 weeks' gestation.