Brain malformations significantly associated with preterm birth, Wake Forest research shows

Some types of brain defects have a stronger association with preterm birth than others, the study showed. The list itself could possibly offer some clue to the association. Among the malformations studied with the highest rates of preterm birth were hydrocephaly, an abnormal buildup of cerebrospinal fluid (CSF) in the ventricles of the brain (65.2 percent); anencephaly, a defect in the closure of the neural tube during fetal development resulting in the absence of a major portion of the brain, skull, and scalp (57.7 percent); multicystic encephalomalacia, the formation of multiple cystic cavities of various sizes in the cerebral cortex (50.5 percent); and hydranencephaly, a rare condition in which the brain's cerebral hemispheres are absent and replaced by sacs filled with cerebrospinal fluid (38.5 percent).

"There are a lot of preterm births where there are no apparent causes," Brown said. "I speculate that brain defects or other defects not easily detected could be causing some of them and perhaps we should focus on studying coagulopathy (a tendency to excessive blood coagulation and formation of blood clots) to find what the association is between that and preterm birth.

"The placenta could be a key element," he added. "In placental conditions such as preclampsia, which is strongly associated with preterm birth, there may be blood clots coming from the placenta, causing brain damage and malformations in the brain and then, perhaps, the malformed fetus induces its own preterm birth or perhaps the coagulopathy causes the preterm birth through some other mechanism. The next step is to look at the brain malformations that have the strongest association with preterm birth and see if it's possible to identify the factors associated with those malformations that may be causing preterm birth. These are possible new directions to explore."

Meanwhile, Brown endorses the use of folic acid before and during pregnancy.

"It's not completely known how it works, but it could be impacting coagulopathy because folic acid is involved with the pathways that are also involved with coagulation," he said.

Media Relations Contacts: Jessica Guenzel, , (336) 716-3487; Bonnie Davis, , (336) 716-4977; or Shannon Koontz, , (336) 716-4587.

Wake Forest University Baptist Medical Center (www.wfubmc.edu) is an academic health system comprised of North Carolina Baptist Hospital, Brenner Children's Hospital, Wake Forest University Physicians, and Wake Forest University Health Sciences, which operates the university's School of Medicine and Piedmont Triad Research Park. The system comprises 1,056 acute care, rehabilitation and long-term care beds and has been ranked as one of "America's Best Hospitals" by U.S. News & World Report since 1993. Wake Forest Baptist is ranked 32nd in the nation by America's Top Doctors for the number of its doctors considered best by their peers. The institution ranks in the top third in funding by the National Institutes of Health and fourth in the Southeast in revenues from its licensed intellectual property.