Intrauterine Growth Restriction: Causes, Symptoms, Risks, and Treatment

Introduction

The journey of a healthy baby starts within the womb of the mother. In the womb, the baby gets the necessary food and oxygen from the mother for its development. However, in certain cases, the growth of the baby within the womb is hampered. Needless to say, this causes future problems for the baby. And, every one out of 12 babies in this world suffers from this issue.

What Is Intrauterine Growth Restriction?

Intrauterine Growth Restriction (IUGR) is a condition where the unborn baby does not achieve its proper growth within the womb. Here, the fetal growth and weight are below as per the fetal age or gestational age. According to doctors, if your unborn child is suffering from intrauterine growth restrictions, its weight must be less than that of nine out of ten babies (tenth percentile) of the same fetal age. Doctors also call it small for gestational age (SGA) or fetal growth restriction (FGR)

A sac inside the mother’s body protects the unborn baby. This sac is known as the placenta. The baby gets its food, nutrition, and oxygen through this sac from the mother’s body. However, if nutrient supply or oxygen supply is hampered, it can cause growth restrictions. Apart from this, an unfavourable environment inside the sac can also harm the fetal growth. This is why a fetal growth restriction has a weight much less than that of a normal baby.

Almost 10 to 27 pregnant mothers suffer from this issue. As a result, this is one of the biggest public health concerns around the world, which is responsible for the premature death of newborns or birth abnormalities. However, several factors like the mother's age, the medical condition of the mother, the socio-economic condition of the mother, and environmental issues are important in the prevalence of the condition. As a result, it is very common among mothers from underdeveloped countries or backward backgrounds.

What Are the Causes of Intrauterine Growth Restriction?

IUGR in pregnancy can be related to several factors. The risks of intrauterine growth restriction are very high among the following conditions;

1. The age of the mother is crucial. If the mother is too young (less than 16 years) or is older than 35, the chances of such bad incidents remain high.

2. It is very common among mothers with poor nutrition.

3. If the gap between two pregnancies is very little (less than six months or 120 months), you may suffer from this.

4. If you smoke during your pregnancy or drink alcohol during your pregnancy, you may suffer from IUGR.

All these factors increase the chance of growth restriction. However, the causes are;

1. Fetal Etiologies: Five percent of cases of fetal growth restriction are related to the fetus. Genetic abnormality is one of the main causes. Sometimes, deletion of a portion of a chromosome or addition of an extra copy of a chromosome can cause this.

2. Maternal Etiologies: As already said, issues like the mother's age, nutrition, or habits can increase the chance of this problem. However, suppose the mother has medical issues like diabetes during pregnancy, high blood pressure during pregnancy, kidney issues, severe anemia, or sickle cell disease. In that case, the unborn child might suffer from growth issues. Apart from this, infections like malaria, varicella-zoster virus, syphilis, and herpes simplex can damage the growth of the fetus.

3. Placental and Umbilical Cord Etiologies: If there is an abnormality in the sac or duct connecting the sac and the unborn child (umbilical cord), it can cause growth issues. Also, any blockage in the cord can block the flow of nutrition and oxygen and can cause growth problems. In some abnormal conditions, the placenta detaches itself from the uterus, or clot formation happens inside the umbilical cord or placenta; such conditions can cause placental growth restrictions.

How Is Intrauterine Growth Restriction Diagnosed?

A doctor will start with a simple examination to determine the presence of IUGR-related risk factors. The doctor will try to understand the following things;

1. The age of the mother.

2. Physical condition of the mother.

3. History and timing of your previous pregnancy.

4. Medical issues of the mother.

After this, the doctors will perform physical tests. These tests are;

1. Uterine Fundal Height: This method is a common test for determining fetal growth. Your doctor can do this test between the 24th and 38th week of pregnancy. However, within the 32nd to 34th week, the test shows a very accurate result. Here, the doctor measures the distance between the tip of the uterus and the tip of the hip bone. The distance is measured in centimeters, and the numerical value should be equal to the week of the pregnancy. This means if you are at your 35th week of pregnancy, the distance will be 35 centimeters. If the discrepancy is four centimeters or more, it indicates restricted fetal growth.

2. Weight Gain: The doctor will check your periodical weight gain. Poor weight gain or no weight gain can suggest fetal growth problems.

Apart from this, doctors can use certain diagnostic tests for the evaluation. These are;

1. Ultrasound: It is the most authentic method for knowing any kind of growth issues. Doctors use high-frequency sound waves to study your unborn child. They study different parameters like head circumference, abdominal circumference, and measurement of thigh (femur) length. Also, it can tell the doctor the amount of fluid present inside your sac.

2. Umbilical Artery Doppler Velocimetry: This is an advanced version of the ultrasound. Here, doctors can see the amount and nature of the blood flow through the cord (umbilical cord).

3. Nonstress Test: This can identify various parameters like heart rate, oxygen level, muscle tone, and body activity. Doctors usually advise you to do these tests after 28 weeks of your pregnancy. However, this test can be done within 26 to 28 weeks of pregnancy. It provides information about the general well-being of your unborn child.

What Are the Signs and Symptoms of IUGR in Pregnancy?

You will not find any symptoms of fetal growth restrictions. However, you can feel that the mother is not gaining weight or her belly is not growing with time. You must remember that fetal growth restriction symptoms are only seen through a doctor's examination.

When and How Is IUGR Detected?

Doctors usually perform these tests in the second or third trimester of the pregnancy.

1. The most common examination they do is to measure your weight. Also, uterine fundal height measurement can be a useful method. If the fundal height is at least four centimeters less than the numerical value of your week of pregnancy, the doctor suspects growth issues.

2. Ultrasound is a popular method that can detect growth defects.

3. If the doctor suspects a genetic problem, they can draw amniotic fluid from the sac and examine it for genetic problems.

What Are the Treatments and Management of Fetal Growth Restriction?

The treatment for IUGR in pregnancy mostly depends on the time of detection of the growth issues. After detection, doctors usually start treatment and regular surveillance for the child. These treatments not only save the child but also help in proper growth. Doctors use medicines like Aspirin, Heparin, or phosphodiesterase-5 inhibitors to improve the blood flow to the baby and to remove any blood clots. Also, before birth, corticosteroid injections can improve lung health.

1. In severe cases, doctors can think about a C-section delivery before the scheduled delivery. If the condition is very severe, they can perform delivery as early as 30 or 32 weeks of pregnancy. However, most of the time, it is done after the 37th week of pregnancy.

2. Even after delivery, the newborn can face several health issues due to poor development or health. That is why proper care after delivery is essential. It includes a warm room, proper sterilization control, periodic blood sugar monitoring of the child, and dextrose-containing intravenous fluid.

Is IUGR a High-Risk Pregnancy?

Yes, a baby with IUGR at birth can cause serious complications. It can have a negative result on both the baby and the mother.

Risks and Complications for Babies Born with IUGR: A baby with growth issues can cause problems like;

1. Death during delivery or death in the mother's womb. Such death can occur due to a lack of oxygen in the body of the child.

2. It can cause delivery before the scheduled time.

3. Due to a lack of nutrition and necessary substances, the baby will be born with a lower weight and inadequate development of various body parts.

4. It can cause a lack of immunity in the baby's body.

5. The baby will have breathing and eating problems along with low blood sugar.

6. The baby can swallow its own poop during delivery.

7. In the long run, your child may have poor nerve development, which can result in problems in daily life.

8. Also, they can face issues like lung problems, gynecological problems, heart issues, and kidney disorders when they become older.

Do Growth-Restricted Babies Catch Up?

Yes, growth-restricted children do catch up. However, factors like types of growth restrictions, detection period, and medical intervention are important for their recovery. Those who suffer from symmetrical growth problems suffer more. On the other hand, children with an asymmetrical growth problem show better response to treatment. They can easily live a normal life with proper care.

Conclusion

Intrauterine growth restriction is a major health issue for newborns. It is more common among mothers from a backward socioeconomic class or from developing countries. However, not only mothers' overall well-being, but also other issues like habits, age, and genetic factors are important. Early detection and proper medical care can not only save the newborn's life but also give the child a better future.

Key Takeaway From iCliniq

You must know that early detection is the key to detecting intrauterine growth restrictions. That is why periodic doctor visits during your pregnancy are necessary. Also, living a healthy life is important for the mother. Proper diet, adequate rest, and proper medical care can prevent such events. If you or your loved ones have any questions regarding fetal growth, doctors at iCliniq are always there to help you.