Main lines of research

Leader: Fàtima Crispi

The focus of this line of research is the prenatal problems that can cause an increased cardiovascular risk; among these problems are those derived from intrauterine growth restriction, pregnancies obtained after assisted reproduction techniques, prematurity, and others. The main objectives of the line include getting a better understanding of the pathophysiologic mechanisms of fetal cardiovascular programming, the development of biomarkers that allow early detection and monitoring of cardiovascular remodeling and finally to test therapies that can improve the cardiovascular prognosis of these children. To accomplish these objectives we integrate medical translational fetal medicine specialists, pediatricians and cardiologists, as well as biologists, biotechnologists and engineers.

The main highlights of this past year have been:

• Description and validation in fetal life of a new diagnostic method in functional echocardiography allow improved understanding of cardiovascular remodeling in fetal life.
• Development of a diagnostic algorithm that includes various cardiovascular parameters for the prediction of perinatal outcome in pregnancies with severe growth restriction.
• Promising preliminary results in various therapeutic strategies for the improvement of cardiovascular remodeling in prenatal life.

Leader: Magda Sanz

About 10% of children have a neurodevelopmental problem throughout their lives. However, most of these problems are subtle and often, the imaging tests do not show any abnormalities. However, in most cases there has been an alteration in the maturation process of the brain that cannot be identified with the usual tests. For this reason, different research lines on brain development were created:

Metabolomics and Microstructure:
As part of our group’s overall goal of finding biomarkers and determining which children are at risk for anomalous neurodevelopment, we have developed a line of Metabolomics and Microstructure.
In this line, doctors, biologists, psychologists, and engineers work together using different technologies, especially those based on MRI in order to find and define what the metabolic differences are in the brain of fetuses and children that are diagnosed with growth restriction and that can be found at risk for neurodevelopmental problems.
Knowing what changes occur in the brain will be of great value in identifying and helping these children at risk, improving their prognosis.

Leader: Elisenda Eixarch

The main objective of the connectomic research is to develop a quantitative imaging biomarker for early diagnosis of neurodevelopmental disorders. A new techno- logy to measure brain function based on analyzing the connections in the brain by magnetic resonance ima- ging (MRI) is key in this research line. In which different techniques of MRI are being used, including diffusion MRI which provides information about the distribution of white matter tracts that connect different areas of the brain, functional MRI which provides information on areas of the brain that work together, and anatomical MRI which establishes the connection through morpho- logical information of the different areas.

The availability of these biomarkers would allow for early identification of neurodevelopmental disorders and, therefore, the implementation of specific programs of early stimulation and education to improve the development of these children.

Leader: Francesc Figueras

This line of research aims at identifying before birth which babies with growth problems will have abnormal neurodevelopment. A majority of the babies considered small in utero are naturally smaller which does not entail any disadvantage for future development. However, a proportion of the small fetuses are due to pro- blems of the placenta, which do not manifest themselves in any of the parameters that are commonly used in monitoring pregnancy. Our group was the first to observe that despite not being born prematurely, these babies have more neurobehavioral problems at birth that persist into childhood. When there are problems with the placenta, the fetus itself initiates a series of mechanisms to optimize the amount of available oxygen.

One of the earliest mechanisms established is the redirection of more blood to the brain. Our group has developed a noninvasive method using Doppler quantification to measure how much blood reaches the brain. Babies who are born before this alteration have a slightly increased risk of neurodevelopmental problems. These subtle changes have been given more attention in recent years, and this attention will grow more if they are recognized as a family and social problem. The prenatal identification of at risk babies is es- pecially important because preventive measures could be taken during pregnancy and childbirth, as well as during early childhood.

Leader: Montse Palacio

This line of research on prematurity aims to advance the knowledge of the causes of preterm birth. In recent years, despite improvements in managing a pregnancy, prematurity has not only remained common, but also has even increased in incidence. Since prematurity is the leading cause of perinatal morbidity and mortality, it is crucial to understand the determinants that trigger the premature delivery so that we can postpone the birth and improve perinatal outcomes, as well.

Our research takes place in several areas: First, we are working to refine the detection of patients at real risk of preterm delivery, second, at the clinical level, we are working to optimize the management and care of neonatal patients, and finally we are developing noninvasive methods for monitoring lung maturity in fetuses.

The development and improvements in each of these projects will allow us, firstly to have biomarkers to distinguish at risk patients from the patients who will follow a good evolution, thereby minimizing needless intervention and overtreatment, and streamlining the management of time and resources to achieve the best possible results.