Intrauterine Growth Retardation

There are expected ranges of growth for an unborn child at a given gestational age. The growth of an unborn child depends on the health and nutrition of the mother and the health of the baby.

IUGR may occur if the health of the placenta or its blood supply is impaired. IUGR may also occur if the mother's nutrition, health, or lifestyle prevents a healthy pregnancy.

There are often no symptoms of IUGR. Symptoms that do occur may include the following:

• a uterus that is smaller than in previous pregnancies
• fewer fetal movements than expected

Women with certain conditions may be more likely to have a child with IUGR. These conditions include the following:

• placental insufficiency, which leads to poor nutrition of the fetus
• multiple pregnancies, such as twins
• IUGR in a previous pregnancy
• high blood pressure
• diabetes
• severe kidney disease
• heavy smoking
• poor weight gain in pregnancy
• preeclampsia or eclampsia, which are complications of pregnancy causing high blood pressure in the mother
• exposure to high altitudes
• drug abuse
• HIV infection
• severe inflammatory bowel disease or ulcerative colitis
• alcohol dependence or abuse
• TORCH infections, a set of infectious diseases that can harm the baby if the mother is infected during her pregnancy
• poor nutrition in the mother
• congenital or chromosome abnormalities in the fetus
• recurrent bleeding, such as placenta previa, a condition in which the placenta implants over or near the opening of the cervix
• blood disorders, such as sickle cell anemia or thalassemia
• small stature in the mother
• placenta abruptio, which is a premature separation of the placenta from the uterine wall

Most cases of IUGR cannot be prevented, especially if they are due to genetic causes. Some cases can be prevented by taking the following precautions:

• avoiding risk factors for the TORCH infections
• eliminating use of alcohol, tobacco, and illicit drugs
• careful monitoring and early treatment for high blood pressure and diabetes
• eating a diet high in folate before and during pregnancy to protect against certain birth defects

The diagnosis can be made with 2 tests:

• pregnancy ultrasound which uses many measurements to evaluate the unborn child.
• the nonstress test which measures the heart rate and the movement of the baby.

Other tests can be used to check for other conditions affecting the fetus.

Long-term effects in the baby before or during delivery include the following:

• premature delivery
• poor tolerance of labor
• increased chances of a Cesarean birth, or delivery of the baby through an incision in the mother's abdomen
• increased risk of birth defects
• asphyxia, or too little oxygen, at birth, which may lead to cerebral palsy

Long-term effects in the infant after delivery include the following:

• temperature instability
• hypoglycemia, or low blood sugar
• difficulty fighting infection
• death

Complications later in childhood may include:

• learning disabilities
• developmental delays

IUGR is not contagious, but it does pose a risk for the fetus. IUGR may also occur in future pregnancies.

Treatment of IUGR depends on the suspected cause and may include the following:

• stopping smoking
• stopping all drugs, such as cocaine and alcohol
• eating a good diet with proper amounts of folic acid and other vitamins
• increasing bed rest, lying on the left side as much as possible
• if prescribed, taking low-dose aspirin to prevent tiny clots from forming in the placenta
• monitoring fetal movements, contractions, or spontaneous rupture of membranes
• close monitoring by the healthcare provider
• using continuous internal fetal heart monitoring during labor to detect fetal distress
• using minimal anesthesia, although epidurals are safe
• having a Cesarean birth or forceps delivery if distress of the unborn child is suspected

Treatments are intended to prevent serious complications in infants with IUGR. Side effects of surgery include bleeding, infection, and reaction to anesthesia.

Recovery from surgery may take a few days to several weeks, depending on the procedure used. The baby may be given oxygen, antibiotics, and intravenous fluids after delivery. An infant with cerebral palsy or seizures may need physical therapy. Other disabilities may require other treatments.

The following may be used to monitor the pregnancy:

• nonstress testing every week or two
• biophysical profile every week or two. This test uses ultrasound and a series of measurements to determine the health status of the developing baby.
• pregnancy ultrasounds every 10 to 14 days

Any new or worsening symptoms should be reported to the healthcare provider.