Uterine artery resistance in pregnancy linked to reduced offspring cognitive flexibility

Uterine artery resistance in pregnancy linked to reduced offspring cognitive flexibility | Image Credit: © imtmphoto - © imtmphoto - stock.adobe.com.

There is a link between higher maternal mid-pregnancy uterine artery (UtA) resistance and slight declines in child executive domain function, but not motor domain function, according to a recent study published in Pregnancy.¹

A developmental disability or delay is reported in approximately 1 in 6 US children, with many of these conditions traced back to the antenatal period. This may occur when the musculoelastic layer of the maternal spiral arteries experience remodeling, leading to low-resistance placental circulation.² This may be detected through Doppler flow patterns in the maternal UtA.¹

“UtA Doppler findings consistent with increased utero-placental resistance have been used to screen for pregnancy complications… and have been associated with adverse perinatal outcomes. Notably… subsequent childhood neurodevelopment has not been well characterized,” wrote investigators.

Assessing UtA and neurodevelopment

Women aged 18 to 40 years with a singleton, low-risk, uncomplicated pregnancy were recruited from 8- to 13-weeks’ gestation. Exclusion criteria included assisted reproductive technology use, substance use, prior obstetric complications, and chronic medical conditions.

Maternal and antenatal variables were collected from participants, alongside pregnancy complications and birth outcomes. Fetal biometry, umbilical, and UtA Doppler findings were obtained as sonographic measures. Investigators also classified birthweight as small, appropriate, or large for gestational age.

Reassessments of offspring development were performed after 4 to 8 years. Participating children underwent physical examination, interval history, standardized observations of executive and motor domains, and parental reports of behavior at in-person visits.

Neurodevelopment and behavior measures

The National Institute of Health Toolbox was used to evaluate neurodevelopmental outcomes. This Toolbox includes tests for executive motor domains such as inhibitory control and sustained attention, cognitive flexibility, and working memory.

Behavioral problems were assessed using a Child Behavioral Checklist. This checklist included internalizing and externalizing problems, attention deficits, oppositional defiance, depression, and anxiety. Higher scores indicated greater behavioral problems.

From 18- to 27-weeks’ gestation, investigators obtained maternal UtA systolic and diastolic flow alongside pulsatility index (PI) measurements, with PI measured as the systolic flow, minus the diastolic flow, divided by the mean. Maternal stress and depression were reported as covariates based on maternal report.

Cognitive flexibility and attention impacts

Residing with a partner was reported in 73% of patients, at least some college education in 73.8%, primigravid status in 45.9%, and preeclampsia in 2.5%. The mean gestational age and birthweight at delivery were 39.29 weeks and 3348 g, respectively, and offspring were aged a mean 6.9 years at follow-up.

While mid-pregnancy UtA PI measurements were not linked to executive domain functioning in offspring, cognitive flexibility significantly decreased in children aged 4 to 7 years for a 1-standard deviation (SD) increase in UtA PI. For each SD increase, an adjusted mean difference (aMD) of -0.97 was reported.

A significantly higher mean inhibitory control/sustained attention score was reported in children aged 8 years for a 1-SD increase in UtA PI, with an aMD of 1.95. However, this effect was not found in children aged 4 to 7 years or in offspring overall. There was also no link between increased UtA resistance and motor domain functioning.

Implications

Preeclampsia risk was increased in patients with higher UtA PI, with an odds ratio of 1.16.Additionally, executive functioning was not significantly impacted by preeclampsia or birthweight z-scores. Overall, the results highlighted reduced cognitive flexibility from mid-pregnancy UtA resistance in offspring aged 4 to 7 years.

“The clinical implications of these findings are unknown but should be of interest to both researchers and clinicians interested in the link between placental vascular findings and later childhood outcomes,” wrote investigators. “These possible associations should be explored in future studies.”

References

1. McElwee ER, Lee S, Babineau V, et al. Mid-pregnancy uterine artery Dopplers and child neurodevelopment. Pregnancy. 2025. doi:10.1002/pmf2.70076
2. Lin S, Shimizu I, Suehara N, Nakayama M, Aono T. Uterine artery Doppler velocimetry in relation to trophoblast migration into the myometrium of the placental bed. Obstet Gynecol. 1995;85:760-5. doi:10.1016/0029-7844(95)00020-r