Exploring Fetal Neurobehavior in Gestational Diabetes Using 4D Ultrasound: A Window into Early Brain Function

ProsPective cohort study IntroductIonFetal neurobehavior reflects spontaneous fetal activity and responses to external stimuli.A major advance in this field was achieved with the introduction of two-dimensional ultrasound (2D ultrasound), 1 while four-dimensional ultrasound (4D ultrasound) further enhanced the assessment of the quantity and quality of fetal movements and facial expressions. [2][3]][4] Owing to its near real-time three-dimensional (3D) display, this technique enables assessment of subtle qualitative features of fetal movements, including complexity and variability, thereby supporting refined evaluation of general movements and detailed visualization of the fetal face. 3,4Spontaneous fetal movements emerge early in gestation and progressively become more complex and organized.Changes in movement patterns reflect central nervous system maturation, and analysis of general movements is considered a reliable indicator of fetal neuromotor development.Alterations in fetal movements have been reported in various pathological pregnancies, including those complicated by diabetes. [5][6]][7] Evaluation of general movements, therefore, enables early