# Fetal Growth Restriction Is Associated With Altered Optic Nerve Head Morphology in Term-Born Children and Adolescents

## TL;DR

Children born with restricted fetal growth show changes in optic nerve structure, which may indicate a higher risk of neurodevelopmental issues.

## Contribution

This study identifies a link between fetal growth restriction and altered optic nerve head morphology in term-born children.

## Key findings

- Severe fetal growth restriction is associated with thinner peripapillary retinal nerve fiber layer in term-born children.
- Moderate fetal growth restriction correlates with reduced minimal rim width of the optic nerve head.
- Birth weight percentile is linked to vertical cup-to-disc ratio changes.

## Abstract

Restricted fetal growth is associated with impaired neurodevelopment in childhood. We examined the effects of fetal growth restriction, fetal overgrowth, and other perinatal parameters on optic nerve head (ONH) morphology in term-born children and adolescents.

This retrospective cohort study with a prospective ophthalmologic examination included full-term born children aged 4 to 17 years who were grouped according to their birth weight correlated to gestational age (GA). We formed the following groups: severe fetal growth restriction (<3rd birth weight [BW] percentile, group 1), moderate fetal growth restriction (BW percentile 3rd to <10th, group 2), appropriate for gestational age (AGA, 10th–90th BW percentile, group 3, control group), moderate fetal overgrowth (>90th–97th BW percentile, group 4), and severe fetal overgrowth (>97th percentile, group 5). The participants underwent spectral-domain optical coherence tomography and fundus photography to evaluate the peripapillary retinal nerve fiber layer (pRNFL) thickness, minimal rim width (MRW), Bruch's membrane opening (BMO), and vertical cup-to-disc ratio (vCDR), focusing on their relationship to perinatal factors like nutritional status, GA, maternal smoking, and maternal breastfeeding. The relationships between the ONH parameters and perinatal factors were adjusted for variables such as age, sex, and axial length.

This study included 732 eyes of 375 participants (mean age of 11.4 ± 3.71 years, 193 female subjects). Multivariable regression analyses showed an association between a thinner global pRNFL thickness in the participants with severe fetal growth restriction (B = −4.95; 95% confidence interval [CI], −9.43 to −0.47 µm; P = 0.03) compared to the reference AGA group. Furthermore, an association with a thinner MRW was found in the children born with moderate fetal growth restriction (B = −32.46; 95% CI, −51.52 to −13.40 µm; p < 0.001). BW percentile was associated with median vCDR (B = −0.001; 95% CI, −0.002 to 0.00; P = 0.02). No consistent association was observed between altered fetal growth and BMO.

Severe fetal growth restriction appears to affect the optic nerve head in term-born children and adolescents, suggesting a possible reduction in neuronal reserve, and may indicate a potentially elevated risk of abnormal neurodevelopment.