# Reduced T2*-weighted placental MRI predicts foetal growth restriction in women with chronic rheumatic disease—a Danish explorative study

## TL;DR

This study shows that T2*-weighted placental MRI can predict fetal growth restriction in pregnancies of women with chronic rheumatic disease, as early as 24 weeks gestation.

## Contribution

The study is the first to show that reduced T2*P-MRI values at 24 weeks gestation predict small for gestational age births in women with chronic rheumatic disease.

## Key findings

- Women with chronic rheumatic disease had significantly lower T2*P-MRI values at 24 weeks gestation compared to healthy controls.
- T2*P-MRI values at 24 weeks gestation correlated with birth weight and identified pregnancies with small for gestational age outcomes.
- Three out of four small for gestational age pregnancies were undetected by routine ultrasound.

## Abstract

Women with chronic rheumatic disease (CRD) are at greater risk of foetal growth restriction than their healthy peers. T2*-weighted magnetic resonance imaging of placenta (T2*P-MRI) is superior to conventional ultrasonography in predicting birth weight and works as a proxy metabolic mirror of the placental function. We aimed to compare T2*P-MRI in pregnant women with CRD and healthy controls. In addition, we aimed to investigate the correlation between T2*P-MRI and birth weight.

Using a General Electric (GE) 1.5 Tesla, we consecutively performed T2*-weighted placental MRI in 10 women with CRD and 18 healthy controls at gestational week (GW)24 and GW32. We prospectively collected clinical parameters during pregnancy including birth outcome and placental weight.

Women with CRD had significantly lower T2*P-MRI values at GW24 than healthy controls (median T2*(IQR) 92.1 ms (81.6; 122.4) versus 118.6 ms (105.1; 129.1), p = 0.03). T2*P-MRI values at GW24 showed a significant correlation with birth weight, as the T2*P-MRI value was reduced in all four pregnancies complicated by SGA at birth. Three out of four pregnancies complicated by SGA at birth remained undetected by routine antenatal ultrasound.

This study demonstrates reduced T2*P-MRI values and a high proportion of SGA at birth in CRD pregnancies compared to controls, suggesting an increased risk of placental dysfunction in CRD pregnancies. T2*P-MRI may have the potential to focus clinical vigilance by identifying pregnancies at risk of SGA as early as GW24.
Key Points• Placenta-related causes of foetal growth restriction in women with rheumatic disease remain to be investigated.• T2*P-MRI values at gestational week 24 predicted foetuses small for gestational age at birth.• T2*P-MRI may indicate pregnant women with chronic rheumatic disease (CRD) in need of treatment optimization.

Key Points

• Placenta-related causes of foetal growth restriction in women with rheumatic disease remain to be investigated.

• T2*P-MRI values at gestational week 24 predicted foetuses small for gestational age at birth.

• T2*P-MRI may indicate pregnant women with chronic rheumatic disease (CRD) in need of treatment optimization.

The online version contains supplementary material available at 10.1007/s10067-024-06889-5.