Is the Cerebroplacental Ratio Predictive of Adverse Neonatal Outcomes in Fetal Growth Restriction?

Background This study aimed to evaluate the prognostic accuracy of the cerebroplacental ratio (CPR) for predicting adverse neonatal outcomes in pregnancies complicated by fetal growth restriction (FGR). Methods A prospective cohort study was conducted in …., from March 2021 to March 2023, including 114 women with estimated fetal weight <10th percentile between 28 and 38 weeks of gestation. The primary objective was to assess the prognostic accuracy of CPR for adverse neonatal outcomes. The secondary objective was to identify clinical and neonatal predictors of adverse outcomes. CPR was calculated as the ratio of the middle cerebral artery pulsatility index to the umbilical artery pulsatility index, with abnormal values defined as ≤1.1. Participants were categorized into normal and abnormal CPR groups. Adverse neonatal outcomes included umbilical artery pH <7.1, 5-minute Apgar score <7, neonatal hypoglycemia (<45 mg/dL), and NICU admission >10 days. ROC curve analysis assessed prognostic accuracy, while logistic regression identified significant predictors. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CPR were calculated. Results A total of 98 patients were included in the analysis (49 per group). Neonates in the normal CPR group had significantly higher mean birth weight compared to the abnormal CPR group (2372.5 ± 649 g vs. 1802.5 ± 579 g, p < 0.001). ROC analysis indicated an area under the curve (AUC) of 0.71 (95% CI: 0.56–0.75, p=0.011) for CPR in predicting adverse neonatal outcomes. Using a cutoff value of 1.087, CPR demonstrated 78% sensitivity, 73% specificity, 77% positive predictive value, and 68% negative predictive value. Logistic regression showed that higher birth weight was protective against adverse outcomes, with each 100-g decrease associated with a 2% higher odds of an adverse neonatal event (adjusted OR 1.02; 95% CI 1.01–1.03; p < 0.001). Conclusion CPR is a valuable, non-invasive tool for predicting adverse neonatal outcomes in FGR pregnancies. Lower CPR values were associated with poorer neonatal condition and increased NICU admissions. These findings support the use of CPR for risk assessment and clinical decision-making in high-risk pregnancies.