Intrauterine Growth Retardation

What is intrauterine growth retardation?

Intrauterine growth retardation (IUGR) means the unborn baby is not growing properly. The baby's weight is lower than it should be for its stage of the pregnancy. The 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?

Women whose babies are more likely to have this problem include:

• women who do not have a balanced diet or whose health is poor
• women who drink alcohol during the pregnancy
• teenagers
• women who smoke
• women who weigh very little before they become pregnant
• women with a history of small babies in other pregnancies
• women who take certain medicines or use illegal drugs
• women with certain other medical problems, such as high blood pressure or heart, lung, kidney, immune system, or blood problems
• women who have a multiple birth, such as twins or triplets

Some of the conditions that can cause IUGR include:

• a placenta that is unable to provide proper nourishment to the baby
• birth defects or inherited problems, such as heart, kidney, or chromosome problems in the baby
• high blood pressure (preeclampsia and gestational hypertension)
• infections in the baby including cytomegalovirus (CMV), toxoplasmosis, or syphilis
• physical defects in the uterus
• too little or too much fluid in the baby's sac
• exposure to very high doses of therapeutic radiation or chemicals
• chronic illness in the mother, such as heart, kidney, or lung disease, or lupus

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 growing as fast as it should. Your provider will also estimate the size of the baby. The best way to determine how a baby is growing is to have an ultrasound scan to measure 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 you have 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 ultrasound scans done at regular intervals to check the growth of the baby.
• You may be told to stop working or work less, rest more often or stay in bed, stop smoking, or talk to a dietitian about how you can improve your diet.
• Nonstress tests, contraction stress tests, or biophysical profiles may be done once or twice a week during the last 2 months of the pregnancy to check on your baby's condition.

Ultrasound scans help to detect problems and also follow 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 for the placenta is normal.

Signs that the baby may develop more serious problems include an abnormal fetal heart rate and failure to grow in 2 or 3 weeks. In these cases, your provider may consider delivering the baby immediately (or as soon as the baby could survive). The baby may grow better outside the womb in an intensive care nursery.

When it is time for the baby to be delivered, your provider may induce labor. Or the delivery may be done by cesarean section (C-section). Some babies with IUGR are weak. Labor might be too stressful and risky for the baby. 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 if it is born too early.

How long will the effects last?

The risk of problems for the baby will exist as long as the baby's growth problems continue, or until some form of treatment or delivery takes place.

Some of the possible problems for the baby 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 holding a normal body temperature
• high levels of bilirubin in the baby's blood, causing jaundice (bilirubin is a substance made from the breakdown of blood cells)
• problems at the time of delivery
• low blood sugar, calcium, and platelets
• convulsions
• 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 condition to be discovered 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 be sick.

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

What can be done to help prevent intrauterine growth retardation?

Some causes of growth retardation cannot be controlled. However, factors such as diet, rest, and exercise can be controlled. 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 areas with toxic chemicals or radiation.
• If you have had a previous pregnancy with a small baby or preeclampsia, talk to your provider to see if there are ways to reduce the chances of having a small baby 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.