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  • Clinical Research Article
  • Published:

Placental pathology is associated with lower quality fidgety movements in preterm infants

Pediatric Research volume 98, pages 1102–1109 (2025)Cite this article

Abstract

Background

Preterm infants are at risk for neurodevelopmental disabilities later in life, like motor delays and cerebral palsy (CP). The placenta plays a critical role throughout pregnancy, particularly in preterm birth. Our aim is to explore the relation between placental lesions and accurate predictors of neurodevelopmental outcomes in preterm infants.

Methods

Preterm infants (<30 weeks and/or birthweight <1000 g) were included with histopathological examination (according to Amsterdam criteria) of the placentas. We predicted the risk for future possible neurodevelopmental impairment using Prechtl’s General Movement Assessment to evaluate fidgety movements (FM) at 3 months post-term. We also calculated the Motor Optimality Score-Revised (MOS-R).

Results

In total 78 infants were included. The gestational age ranged from 24.1 to 32.6 weeks and birth weight was between 550 and 1950 g. The presence of AIUI (ascending intrauterine infection) was significantly associated with absent FMs (p = 0.034). Both the presence of fetal and maternal vascular malperfusion (FVM and MVM) were associated with a MOS-R < 23[OR4.58, 95% CI[1.35, 15.55], p = 0.015;OR2.55, 95% CI[1.02, 6.64], p = 0.045).

Conclusion

AIUI is associated with a higher risk of absent FMs and therefore an increased risk for CP. FVM and MVM are significantly associated with MOS-R < 23, which is predictive of an elevated risk for adverse neurodevelopmental (non-CP) outcomes. This finding supports the hypothesis that impaired neurodevelopment in preterm infants already starts before birth.

Impact

  • Our article underscores a key message: neurodevelopmental challenges in preterm infants originate prenatally. Our research has identified a significant association between certain placental lesions and a lower quality of fidgety movements, placing these preterm born infants at a high risk for adverse neurodevelopmental outcomes.

  • To our knowledge, this is the first study to investigate the role of placental pathologies and risk of neurodevelopmental outcomes, while using general movements during the fidgety period.

  • We advocate for neonatologists to integrate placental pathology assessments into their treatment strategies for newborns, recognizing its importance in enhancing care outcomes.

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Fig. 1
Fig. 2: Distribution of MOS-R score of babies born to placentas affected by fetal vascular malperfusion (FVM), compared to placentas with no FVM.
Fig. 3: Distribution of MOS-R score of babies born to placentas affected by different number of pathologies.

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Data availability

The datasets generated during and/or analyzed during the current study are available in the DataverseNL repository, https://doi.org/10.34894/WPQLHB.

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Acknowledgements

General movements research group for the scoring of fidgety movements. For parents who gave consent for participation in this study.

Author information

Authors and Affiliations

  1. Division of Neonatology, Beatrix Children’s Hospital, University of Groningen, University Medical Center, Groningen, The Netherlands

    Ana S. Abrudan, Elisabeth M. W. Kooi, Karianne E. Kraft & Annemiek M. Roescher

  2. Department of Pathology and Medical Biology, Pathology Section, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Mirthe H. Schoots

  3. Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Sanne J. Gordijn & Jelmer R. Prins

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  1. Ana S. Abrudan
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Contributions

A.S. Abrudan: Substantial contribution to conception and design, acquisition of data, analysis an interpretation of data; drafting the article, final approval of the version to be published. M.H. Schoots: acquisition of data, revising the article critically for important intellectual content, final approval of the version to be published. E.M. Kooi: Substantial contribution to conception and design, analysis and interpretation of data, revising the article critically for important intellectual content, final approval of the version to be published. S.J. Gordijn: revising the article critically for important intellectual content, final approval of the version to be published. K.E. Kraft: acquisition of data, revising the article critically for important intellectual content, final approval of the version to be published. J.R. Prins: Substantial contribution to conception and design, analysis and interpretation of data, revising the article critically for important intellectual content, final approval of the version to be published. A.M. Roescher: Substantial contribution to conception and design, acquisition of data, analysis an interpretation of data, revising the article critically for important intellectual content, final approval of the version to be published.

Corresponding author

Correspondence to Ana S. Abrudan.

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The authors declare no competing interests.

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Consent was asked from all the parents of the babies included in the study. The parents were required to sign a consent form.

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Abrudan, A.S., Schoots, M.H., Kooi, E.M.W. et al. Placental pathology is associated with lower quality fidgety movements in preterm infants. Pediatr Res 98, 1102–1109 (2025). https://doi.org/10.1038/s41390-025-03905-5

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