Background: The French population of the SAGhE study showed an increased morbidity and mortality due to cerebrovascular disease in growth hormone (GH) treated subjects compared to the general population. Cerebrovascular health can be assessed using neuroimaging markers on MRI. One of the markers is white matter hyperintensity (WMH).
Objective: To assess cerebrovascular health by scoring WMH on MRI in young adults born small for gestational age (SGA) who were treated with GH during childhood compared to age-matched untreated controls.
Methods: The study cohort consisted of 4 different groups; adults born SGA treated with GH during childhood (SGA-GH), adults born SGA with persistent short stature (SGA-S), adults born SGA with spontaneous catch-up growth to a normal adult height (SGA-CU) and adults born with normal birthweight and birthweight (AGA). We performed 3T-MRI of the brain which included a FLAIR sequence to assess WMH. WMH was scored by two independent medical doctors using the Fazekas scale and divided in deep WMH (DWMH) and periventricular WMH (PWMH).
Results: We included 306 subjects: 98 SGA-GH, 45 SGA-S, 64 SGA-CU, and 99 AGA. Mean age at MRI was 28.6 (SGA-GH), 31.6 (SGA-S), 32.3 (SGA-CU) and 32.3 years (AGA). Mean adult height SDS was -1.6 (SGA-GH), -2.3 (SGA-S), -0.2 (SGA-CU) and 0.4 (AGA). Percentage of total WMH was 52.2 (SGA-GH), 42.9 (SGA-S), 75.0 (SGA-CU) and 41.6 (AGA), resp. Percentage of DWMH was 45.7 (SGA-GH), 35.7 (SGA-S), 67.2 (SGA-CU) and 36.7 (AGA), resp. No differences between SGA-GH, SGA-S and AGA were shown concerning total WMH and DWMH. SGA-GH showed significantly less WMH and DWMH compared to SGA-CU (P=0.004, P=0.008). No differences between subgroups were seen in percentages of PWMH. Participants with DWMH had a lower birthweight (P=0.005), birth length (P=0.017) and gestational age (P=0.004) compared to those without DWMH. No difference in age at MRI, SES (income and education) and lifestyle (smoking, alcohol, drugs, physical activity) was found in participants with DWMH compared to those without DWMH.
Conclusion: No differences were found in WMH and DWMH between SGA-GH, SGA-S and AGA. However, SGA-CU had the highest percentage of WMH and DWMH. Prenatal characteristics might play a role in the development of WMH.
15 Sep 2022 - 17 Sep 2022