Association of maternal hemoglobin and ferritin levels with fetal cortical maturation: a prospective neurosonographic study

OBJECTIVE: To evaluate the association between maternal hemoglobin and ferritin levels and fetal cortical maturation assessed by neurosonography between 30 and 34 weeks of gestation. METHODS: This prospective observational study included 187 singleton pregnancies between 30 + 0 and 34 + 6 weeks of gestation. Maternal hemoglobin and ferritin levels were measured at the time of fetal neurosonographic evaluation. Detailed neurosonography was performed using standardized axial and coronal planes to assess linear cortical measurements and semi-quantitative cortical maturation scores. Global cortical development and Sylvian fissure opercularization were graded using established scoring systems. Group comparisons were performed according to maternal anemia status (hemoglobin < 11 g/dL). Correlation, multivariable regression, receiver operating characteristic (ROC), dose-response, effect size, and sensitivity analyses were conducted. RESULTS: Maternal hemoglobin levels showed weak but statistically significant positive correlations with selected regional cortical parameters, including the frontal angle/parameter, cingulate sulcus depth, and cavum septi pellucidi (CSP) length. Maternal ferritin levels were not significantly associated with any cortical maturation marker. CSP length was significantly shorter in anemic pregnancies. In multivariable regression analysis, gestational age was the only independent predictor of the global cortical development score. ROC analyses demonstrated poor discriminative performance of hemoglobin and ferritin for identifying low global cortical development or reduced CSP length. Dose-response analyses across hemoglobin tertiles showed monotonic increases in selected regional cortical parameters, although effect sizes were small. CONCLUSION: Maternal hemoglobin levels are weakly associated with selected regional neurosonographic markers of fetal cortical maturation during the third trimester, whereas ferritin levels show no significant association. Gestational age remains the primary determinant of global cortical maturation. These findings suggest subtle within-cohort associations rather than definitive evidence of overt abnormal cortical maturation.