Fetal Pancreas in Growth Restriction: A Prenatal Window Into Metabolic and Genetic Risk

ABSTRACT Objective Animal models have demonstrated impaired pancreatic islet development in fetal growth restriction (FGR) cases, which can become apparent at or before birth and persist into adulthood, resulting in glucose intolerance. This study assessed the relationship between fetal pancreatic biometry and FGR. Methods A retrospective cohort study included fetuses diagnosed with FGR who underwent prenatal ultrasound at a tertiary center. Pancreatic circumference was measured and compared with established normative reference values. Associations between pancreatic size and estimated fetal weight (EFW), abdominal circumference (AC), Doppler findings, gestational age (GA), concurrent gestational diabetes mellitus (GDM), and the presence of anatomical or genetic abnormalities were analyzed. Results The study group comprised 69 cases. The mean GA at the ultrasound examination and pancreatic measurement was 31.5 ± 3.5 weeks. Pancreatic circumference was at or smaller than the 50th percentile of normative references in the majority of the cohort (75%), with 36.2% of cases falling below the 10th percentile and 27.5% below the 5th percentile. Pancreas size correlated moderately with EFW ( r = 0.53) and AC ( r = 0.54) but not with GA. Conclusion Fetuses with FGR exhibited reduced pancreatic size. These findings highlight the pancreas as a novel imaging marker and warrant further investigation into long‐term metabolic programming.