Placental Versus Cerebral Doppler Parameters in Early-Onset and Late-Onset Fetal Growth Restriction: No Additional Prognostic Value of Middle Cerebral Artery Diastolic Deceleration Area.

To evaluate the association between middle cerebral artery (MCA) diastolic deceleration area (DDA) and fetal growth restriction (FGR), as well as composite adverse neonatal outcomes (CANOs), and to assess its independent predictive value compared with established Doppler parameters in both early-onset (EO) and late-onset (LO) FGR. This prospective case-control study included 240 singleton pregnancies (120 FGR, 120 gestational age-matched controls). Among FGR cases, 45 were classified as early-onset (<32 weeks) and 75 as late-onset (≥32 weeks), each with gestational age-matched controls. Fetal Doppler assessments of the umbilical artery (UA), MCA, ductus venosus, and MCA DDA were performed. Independent predictors of FGR and CANOs were evaluated using multivariable logistic regression analysis. Both EO-FGR and LO-FGR were associated with significantly higher UA pulsatility index (PI) and lower CPR compared with controls (all p < .05). MCA DDA did not differ significantly between FGR subgroups and controls. In multivariable analyses, UA PI and CPR independently predicted both EO-FGR and LO-FGR, whereas MCA DDA and other cerebral Doppler indices did not. CANOs were more frequent in the FGR group; however, no Doppler parameter independently predicted CANOs after adjustment for confounding factors. MCA DDA was not independently associated with FGR or CANOs in either EO-FGR or LO-FGR. In contrast, placental Doppler parameters, particularly UA PI and CPR, showed stronger and independent associations with FGR, reinforcing their central role in clinical evaluation. CANOs were multifactorial and not independently linked to any Doppler parameter. Further studies are needed to validate the clinical utility of MCA DDA.