Evaluation of Anterior and Middle Brain Structures With Cerebrovascular Flow in Fetuses With Fetal Growth Restriction: A Prospective Study

ABSTRACT Objective To investigate the adaptation of the anterior cerebral artery (ACA) in fetuses with fetal growth restriction (FGR) and assess if forebrain and midbrain structures are affected by vascular adaptations. Methods A prospective case–control study involving normally developed fetuses and those with late‐onset FGR (estimated fetal weight < 3rd percentile and/or abdominal circumference < 3rd percentile). Doppler indices of the middle cerebral artery (MCA), ACA and umbilical artery (UA) were determined between 32 + 0 and 37 + 0 weeks. Neurosonography assessed the depth of the insula, the sylvian fissure, and the antero‐posterior diameter of the frontal lobes (FAPD). Results The cerebral‐placental ratio (CPR) and cerebro‐placental‐uterine ratio (CPUR) were lower in FGR cases. ACA PI percentile values were significantly lower in the FGR group ( p = 0.020). Sylvian fissure depth was significantly lower in FGR fetuses. Conclusion The ACA may be the first cranial vascular structure affected in fetuses with FGR. This may be related to the impact on postnatal cognitive functions in FGR patients. Trial Registration: NCT06215690