The impact of an adverse intrauterine environment on neurodevelopment

This chapter examines the impact of intrauterine conditions and an adverse intrauterine environment on neurodevelopment, with a specific focus on inflammation. Notably, chorioamnionitis, hypoxia-ischemia, placental insufficiency, and certain toxins, such as opioids and alcohol, can catalyze a pro-inflammatory intrauterine microenvironment and facilitate inflammatory signal transduction through the maternal-placental-fetal brain axis. Both molecular and cellular inflammatory mediators play essential roles in the pathophysiology of perinatal brain injury, and can confer damage to the developing central nervous system. In addition to causing direct injury, these mediators, including activated immune cells, chemokines, and cytokines, are key to priming the developing immune system and contributing to immune cell memory, potentially resulting in aberrant neural-immune signaling and exaggerated responses to subsequent inflammatory stimuli later in life. Indeed, this sustained immune hyperreactivity leaves both the immature brain and immune system vulnerable over extended developmental periods. Primary sequelae of severe and persistent intrauterine inflammation can manifest as a broad spectrum of perinatal brain injury, with the increased incidence of cerebral palsy, deficits of cognition, and neuropsychiatric conditions. While specific, targeted therapies remain elusive, emerging interventions aimed at neurorepair and neurorestoration may combat the brain injury associated with preterm birth and other conditions associated with robust intrauterine and perinatal inflammation.