What's the problem and who does it affect?

Consequences of brain damage before birth

Some babies develop injuries or abnormalities in the brain during pregnancy. Babies can suffer brain damage if their mother has a severe illness, infection or injury while pregnant, for example, or if the baby has a twin brother or sister who dies in the womb. Babies can also develop genetic brain abnormalities during pregnancy.

Sadly, some babies who have brain injuries or abnormalities are stillborn. Those who survive can go on to suffer a wide range of lifelong problems, including cerebral palsy, learning disabilities and behavioural disorders. They may be hospitalised repeatedly during childhood, rely on long-term therapies and need special education. The babies’ families can find it difficult to cope, both emotionally and financially.

Signs of brain damage or abnormalities in the brain can sometimes be detected during pregnancy using ultrasound scans. MRI has the potential to provide extra information. It is already well established as a powerful tool for diagnosing brain problems in newborn babies, children and adults. However, its use during pregnancy has been limited – the success of most scanning procedures depends on patients staying totally still, and it’s obviously impossible to tell an unborn baby to do this.

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What is the project trying to achieve?

Superior quality MRI images

The researchers have recently developed a radical new way of using MRI to produce 3-dimensional images of babies in the womb, even if the baby is moving around. Funded by an earlier grant from Action Medical Research, the breakthrough technique provides previously unobtainable measures of the sizes of different parts of the brain.

In this project, the researchers are applying their new technique to a more sophisticated type of MRI scan, called diffusion tensor imaging, so that it too can be used during pregnancy. They believe diffusion tensor imaging will have the power to identify injuries and abnormalities in unborn babies’ brains. It may also show how different areas of the brain are connected to each other, by revealing pathways that nerve fibres follow within the brain.

The researchers are using diffusion tensor imaging to follow the progress of around 30 unborn babies who are at high risk of suffering brain damage. Scans are taking place twice during pregnancy and are being repeated after birth. The babies’ development is then being followed until two years of age.

The researchers are also scanning around 20 healthy unborn babies and comparing the results with scans of premature babies, so they can assess how premature birth affects the brain’s development.

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What are the researchers' credentials?

The researchers are world experts in imaging the developing brain using MRI. In 2002, the project leader, Professor Mary Rutherford, edited a prize-winning textbook on using MRI to assess the brains of newborn babies – the first book of its kind. Professor Rutherford has been working in this field for 20 years, helping some of our most premature and vulnerable newborns.

The group works within a multidisciplinary imaging unit led by Professor Jo Hajnal, which has developed state-of-the-art techniques for acquiring and interpreting MRI scans. They help provide antenatal care for women with high-risk pregnancies who are referred to them by other hospitals. They help care for newborns and have pioneered therapeutic interventions for babies with brain injuries. They also have close links with a specialist unit that provides longer term follow up of children with brain injuries.

As an extended team, the researchers have published extensively on all aspects of brain development in babies and on brain imaging.

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Who stands to benefit from this research and how?

Better diagnosis

The researchers hope to develop a groundbreaking new way of taking MRI scans during pregnancy, so doctors are better equipped to diagnose brain injuries and abnormalities in unborn babies.

MRI can safely provide spectacular images of inside the human body. The new scans are designed to overcome problems caused by babies’ movements in the womb and could facilitate diagnosis of some brain injuries, possibly within just hours of them developing.

The researchers hope the revolutionary new scans will benefit pregnant women whose babies are at risk of developing brain problems – women who suffer severe illness or injury during pregnancy, for example, women whose babies have congenital abnormalities and women who are carrying one surviving baby after a twin has died in the womb.

The new MRI technique could also benefit premature babies. Babies who are born very early are at high risk of developing brain damage. Scans could reveal how the brain normally grows and develops during pregnancy, and how premature birth changes things. This information could be invaluable in the design of new treatments for brain damage, treatments that could dramatically transform the whole of a baby’s life for the better.

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