Fetal Neuroassessment and Intrauterine Inflammation: Emerging Perspectives for Term Pregnancies

Subclinical maternal immune activation (MIA) is increasingly recognized as a potential contributor to long-term neurodevelopmental disorders even in pregnancies that reach full term without overt clinical complications. These inflammatory exposures often go undetected in standard perinatal care, leaving affected infants outside traditional follow-up protocols. This review synthesizes evidence from human observational studies, translational animal models, and placental pathology linking intrauterine inflammation, particularly sterile chorioamnionitis and elevated cytokine levels (e.g., interleukin-6 and tumor necrosis factor-alpha), with increased risk of neurodevelopmental conditions including autism spectrum disorder ASD, attention-deficit/hyperactivity disorder, and cognitive delay. We critically evaluate the current diagnostic limitations and explore the potential of emerging tools such as the Kurjak antenatal neurodevelopmental test and artificial intelligence-enhanced four-dimensional ultrasound to assess fetal neurobehavior. Many term infants affected by intrauterine inflammation remain outside current gestational age-based risk models. This review underscores the need for biologically informed screening strategies, integrated maternal-fetal neuroassessment, and earlier developmental surveillance. The integration of fetal neurobehavioral profiling, machine learning-based imaging diagnostics, and potential neuroprotective interventions (e.g., magnesium sulfate) offers a future-oriented framework for earlier identification and prevention. While promising, these approaches require further validation before widespread clinical implementation.