BACKGROUND: This systematic review investigates potential differences in brain development between growth restricted (FGR)-fetuses compared to appropriate for gestational age (AGA) fetuses using MRI. METHODS: PubMed, Embase, Cochrane Library and Web of Science databases were searched from 1985 to 2023. FGR was defined as an estimated fetal weight (EFW) <
p10 and/or an abdominal circumference (AC) <
p10, or 20% reduction in EFW or AC using a minimum interval of two weeks. Outcomes included volumetrics, biometrics, apparent diffusion coefficients (ADC), RESULTS: Twenty-nine studies were included after three-phase screening, 13 used the FGR consensus definition according to the Delphi procedure. Total brain volume and cerebellar volume were significantly reduced in FGR fetuses (n = 183
74) when compared to AGA fetuses (n = 283
166) with a MD of -30.84 cm DISCUSSION: MRI provides additional information on fetal brain development in a growth restricted population. Smaller total brain and cerebellar volumes and lower ADC values in the FWM, OWM, TWM, thalami, CSO, basal ganglia, pons and cerebellum have been observed in FGR. These conclusions are drawn on relatively small sample sizes with high heterogeneity resulting from diverse study populations and MRI techniques. Furthermore, how these findings correlate to long-term neurocognitive abnormalities associated with FGR remains to be elucidated. A large cohort study comparing brain maturation, myelination, metabolic and hemodynamic status between brain-sparing FGR fetuses to healthy age-matched controls is needed.