Small for Gestational Age – Intrauterine Growth Retardation
Intrauterine growth retardation, or IUGR, is a condition in which a fetus grows at a slower rate than expected.
What is going on in the body?
There are expected ranges of growth for a fetus at a given gestational age. The growth of a fetus depends on the health and nutrition of the mother and the health of the fetus. 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.
What are the causes and risks of the disease?
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
severe kidney disease
poor weight gain in pregnancy
preeclampsia or eclampsia, which are complications of pregnancy causing high blood pressure in the mother
exposure to high altitudes
severe inflammatory bowel disease or ulcerative colitis
alcohol dependence or abuse
toxoplasma infection, also called toxoplasmosis \ \other infections, such as hepatitis B, syphilis, and herpes zoster, the virus that causes chickenpox \ \ rubella, the virus that causes German measles\ \ cytomegalovirus, or CMV\ \ herpes simplex virus, the cause of genital herpes \ ‘,CAPTION,’TORCH Infections’);” onmouseout=”return nd();”>TORCH infections, a set of infectious diseases that can harm the fetus 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
Symptoms & Signs
What are the signs and symptoms of the disease?
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
Diagnosis & Tests
How is the disease diagnosed?
The diagnosis can be made with 2 tests: pregnancy ultrasound and the nonstress test. Ultrasound uses many measurements to evaluate expected fetal growth. The nonstress test measures the heart rate and the movement of the fetus. Other tests can be used to check for other conditions affecting the fetus.
Prevention & Expectations
What can be done to prevent the disease?
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 toxoplasma infection, also called toxoplasmosis \ \other infections, such as hepatitis B, syphilis, and herpes zoster, the virus that causes chickenpox \ \ rubella, the virus that causes German measles\ \ cytomegalovirus, or CMV\ \ herpes simplex virus, the cause of genital herpes \ ‘,CAPTION,’TORCH Infections’);” onmouseout=”return nd();”>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
What are the long-term effects of the disease?
Long-term effects in the fetus before or during delivery include the following:
poor tolerance of labor
increased chances of a C-section, 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:
hypoglycemia, or low blood sugar
difficulty fighting infection
Complications later in childhood may include:
communication\ \education, including reading, writing, and basic math\ \motor function\ \personal care, such as bathing, dressing, eating, and toileting\ \social skills\ \thinking skills, such as decision making, problem solving, and self-direction\ \working\ ‘,CAPTION,’Mental Retardation’);” onmouseout=”return nd();”>mental retardation
What are the risks to others?
IUGR is not contagious, but it does pose a risk for the fetus. IUGR may also occur in future pregnancies.
Treatment & Monitoring
What are the treatments for the disease?
Treatment of IUGR depends on the suspected cause and may include the following:
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 C-section or forceps delivery if fetal distress is detected
What are the side effects of the treatments?
Treatments are intended to prevent serious complications in infants with IUGR. Side effects of surgery include bleeding, infection, and allergic reaction to anesthesia.
What happens after treatment for the disease?
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.
How is the disease monitored?
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 fetus.
pregnancy ultrasounds every 10 to 14 days
Any new or worsening symptoms should be reported to the healthcare provider.