Intrauterine Growth Restriction (Poor Growth of Baby during Pregnancy)

What is intrauterine growth restriction?

Intrauterine growth restriction (IUGR) means that a baby is growing more slowly than normal during a pregnancy. The baby's weight is lower than it should be for how far along the pregnancy is.

A baby's growth and weight are important. Small babies are more likely to have problems near the time of birth and after delivery.

How does it occur?

Slowed growth is more likely to be problem if you (the mother):

• Are a smoker
• Do not have a healthy diet.
• Drink alcohol during the pregnancy.
• Are a teenager.
• Are underweight.
• Have had small babies in other pregnancies.
• Take certain medicines or use illegal drugs.
• Are pregnant with more than 1 baby, like twins or triplets.
• Have other medical problems, such as lupus, high blood pressure or heart, lung, or kidney disease.

Some of the things that can cause IUGR include:

• a placenta that does not give enough nourishment to the baby
• a baby who has birth defects or genetic problems, such as heart, kidney, or chromosome problems
• high blood pressure during the pregnancy
• infections in the baby
• problems with the uterus
• too little or too much fluid in the baby's sac
• exposure to chemicals or very high doses of radiation

What are the symptoms?

The only symptom might be that you are not gaining as much weight as expected. Your healthcare provider may find that your uterus is smaller than expected for your stage of pregnancy.

How is it diagnosed?

Your healthcare provider will examine you and measure the size of your uterus. The exam of the uterus may show that it is not as big as it should be for the stage of your pregnancy. The best way to determine how a baby is growing is to have an ultrasound scan to estimate the size of the baby.

Sometimes the uterus is smaller because you are not as far along in your pregnancy as you thought. Your provider will try to determine the baby's correct age.

Your provider may do blood tests or other tests to see if there is a genetic problem, infection, or other medical problem that may be slowing the baby's growth.

How is it treated?

When IUGR is suspected:

• You may have repeat ultrasound scans to check the growth of the baby.
• Tests, such as a nonstress test or biophysical profile, may be done once or twice a week during the last 2 months of the pregnancy to check on your baby's condition
• You may need to rest more often or stay in bed. You may also need to stop smoking or to talk to a dietitian about how you can improve your diet.
• You may need to stop working or to work less.

Ultrasound scans help find problems and check the baby's growth during the pregnancy. Important measurements are the size of the baby's belly (abdomen), head, and thighs, and the size of the baby's head compared with the size of the body. Your provider can estimate the weight of the baby using these measurements. Your provider can also see if your uterus has enough amniotic fluid and if the blood flow through the placenta is normal.

Signs that a baby may develop more serious problems include an abnormal heart rate and failure to grow in 2 or 3 weeks. In these cases, your provider may consider delivering the baby right away or as soon as the baby can survive. The baby may grow better outside the uterus in an intensive care nursery.

When it is time for the baby to be delivered, your provider may induce labor. For some babies with IUGR, labor might be too stressful and risky for the baby. In these cases, the baby may be delivered by cesarean section (C-section).

If the baby needs to be born early, your healthcare provider may give you a steroid shot to help the baby's lungs develop. This will help the baby breathe better after delivery.

How long will the effects last?

The baby may be at risk as long as the baby keeps having growth problems or until birth. Some of the possible problems for a baby with intrauterine growth restriction are:

• not getting enough oxygen
• pneumonia after birth because meconium got into the baby's lungs (meconium is a substance from the baby's bowels)
• trouble keeping a normal body temperature after birth
• jaundice (yellowing of the skin and eyes)
• problems at the time of delivery
• seizures
• brain and kidney damage
• death, in extreme cases

How can I take care of myself?

Early and regular prenatal visits with your healthcare provider allow this problem to be found early. Then you and the baby can be carefully checked throughout the rest of your pregnancy.

Pay attention to your baby's movements. If your baby does not move very often, call your healthcare provider because the baby may have problems.

The best way to take care of yourself is to stay calm and follow your provider's directions. Your baby may be perfectly normal. Keep all appointments with your provider. Be sure to talk to your provider about any concerns you have.

How can I help prevent intrauterine growth restriction?

Some causes of IUGR cannot be controlled. However, you have control over things like diet, rest, and exercise. To help prevent serious complications during your pregnancy, make sure you:

• Follow your healthcare provider's instructions.
• Eat healthy meals.
• Do not smoke and do not drink alcohol or abuse drugs.
• Reduce stress.
• Get regular exercise, rest, and sleep.
• Avoid poisonous chemicals and radiation.
• If you have had a previous pregnancy with a small baby or preeclampsia (high blood pressure), talk to your healthcare provider to see if there are ways to lower the chances of having a small baby or high blood pressure again.

If you have chronic health problems, it is especially important to see your healthcare provider as soon as you think you may be pregnant.