Intrauterine growth restriction

  • Definition
    • Intrauterine growth restriction (IUGR) refers to the poor growth of a baby while in the mother's womb during pregnancy.

  • Alternative Names
    • Intrauterine growth retardation; IUGR

  • Causes
    • Many different things can lead to intrauterine growth restriction (IUGR). An unborn baby may not get enough oxygen and nutrition from the placenta during pregnancy because of:

      Problems at birth (congenital abnormalities) or chromosome problems are often associated with below-normal weight. Infections during pregnancy can also affect the weight of the developing baby. These include:

      Risk factors in the mother that may contribute to IUGR include:

      • Alcohol abuse
      • Smoking
      • Drug addiction
      • Clotting disorders
      • High blood pressure or heart disease
      • Kidney disease
      • Poor nutrition

      If the mother is small, it may be normal for her baby to be small, but this is not due to IUGR.

      Depending on the cause of IUGR, the developing baby may be small all over. Or, the baby's head may be normal size while the rest of the body is small.

  • Symptoms
    • A pregnant woman may feel that her baby is not as big as it should be. The measurement from the mother's pubic bone to the top of the uterus will be smaller than expected for the baby's gestational age. This measurement is called the uterine fundal height.

  • Exams and Tests
    • Intrauterine growth restriction may be suspected if the size of the pregnant woman's uterus is small. The condition is usually confirmed by ultrasound.

      Further tests may be needed to screen for infection or genetic problems if IUGR is suspected.

  • Treatment
    • IUGR increases the risk that the baby will die inside the womb before birth. If your obstetrician thinks you might have IUGR, you will be closely monitored with regular pregnancy ultrasounds to measure the baby's growth, movements, blood flow, and fluid around the baby.

      Nonstress testing will also be done. This involves simply listening to the baby's heart rate over a 20 to 30 minute time period.

      Depending on the results of these tests, your baby may need to be delivered early.

  • Outlook (Prognosis)
    • After delivery, the newborn's growth and development depends on the severity and cause of IUGR. Discuss the baby's outlook with your obstetrician and pediatrician.

  • Possible Complications
    • IUGR increases the risk of pregnancy and newborn complications, depending on the cause. Babies whose growth is restricted often become more stressed during labor and need C-section delivery.

  • When to Contact a Medical Professional
    • Contact your health care provider right away if you are pregnant and notice that the baby is moving less than usual.

      After giving birth, call your provider if your infant or child does not seem to be growing or developing normally.

  • Prevention
    • Following these guidelines will help prevent IUGR:

      • Do not drink alcohol, smoke, or use recreational drugs.
      • Eat healthy foods.
      • Get regular prenatal care.
      • If you have a chronic medical condition or you take prescribed medicines regularly, see your health care provider before you get pregnant. This can help reduce the effects your medical condition could have on your pregnancy and the baby.
  • References
    • Baschat AA, Galan HL, Ross MG, Gabbe SG. Intrauterine growth restriction. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics: Normal and Problem Pregnancies. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 31.

      Carlo WA. Prematurity and intrauterine growth restriction. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders;2011:chap 91.

      Figueras F, Gardosi J. Intrauterine growth restriction: new concepts in antenatal surveillance, diagnosis, and management. Am J Obstet Gynecol. 2011;204:288-300.