Intrauterine Growth Restriction (IUGR) During Pregnancy

Pregnant women naturally want their baby to be healthy and grow well in the womb. However, not all pregnancies progress smoothly. Intrauterine growth restriction (IUGR) is a pregnancy complication that can have serious effects on fetal growth and development. IUGR occurs when a fetus is smaller in size and weight than expected for its gestational age. This may also be accompanied by low amniotic fluid or abnormal blood flow to the fetus, which can be detected via ultrasound.

Types of Intrauterine Growth Restriction

Symmetric IUGR

In symmetric IUGR, the overall size of the fetus is small or below average, including the internal organs. This represents a proportional growth restriction affecting the whole fetus.

Asymmetric IUGR

In asymmetric IUGR, fetal growth is uneven. The head and brain are normal in size for gestational age, while other body parts are smaller than expected.

Approximately 80% of IUGR cases are asymmetric.
It is harder to detect early and is often diagnosed in the second or third trimester.

Causes of IUGR

IUGR can result from issues related to the mother, the placenta, or the umbilical cord. Common risk factors include:

Maternal health conditions: preeclampsia, hypertension, kidney disease, diabetes, heart disease, anemia, lung disease, or clotting disorders.
Fetal abnormalities: chromosomal anomalies, Down syndrome, anencephaly, kidney defects.
Lifestyle factors: smoking before or during pregnancy.
Infections: toxoplasmosis, rubella, cytomegalovirus, herpes simplex, syphilis.
Nutrition problems: inadequate or excessive maternal nutrition.
Multiple pregnancy: twins or more.
Medications: anti-seizure drugs for neurological conditions.
Maternal body weight: very low pre-pregnancy weight.
Genetics: family history of low birth weight.

Signs and Symptoms

IUGR may be suspected if:

Fetal weight is below the 10th percentile for gestational age.
Fetal movements are reduced, especially after the 20th week.
Ultrasound shows slower-than-expected growth.

If these signs appear, consult a doctor promptly.

Complications of IUGR

Babies with restricted growth are at higher risk of health problems at birth and later in life:

Increased likelihood of cesarean delivery.
Low blood sugar at birth, raising infection and jaundice risk.
Meconium aspiration (breathing in first stool).
High red blood cell count.
Stillbirth in severe cases.
Long-term risks: cerebral palsy, high blood pressure, heart disease, obesity, diabetes.
Low birth weight and preterm birth.

Diagnosis

Fundal height measurement: Distance from the top of the uterus to the pubic bone, usually checked after 20 weeks.
Ultrasound: Measures head, abdomen, fetal weight, and amniotic fluid volume.
Doppler ultrasound: Assesses blood flow in fetal vessels.

Treatment

After 34 weeks: Early delivery may be recommended.
Before 34 weeks: Close monitoring until the fetus reaches a safer gestational age.
Treatment depends on the severity, gestational age, and underlying cause. Obstetric consultation is essential.

Prevention

Eat nutritious foods:
- Fish, pasteurized milk, green vegetables, nuts, and fruits support fetal growth.
Prenatal vitamins:
- Folic acid (400 mcg daily) prevents brain and spinal cord defects. Always consult a doctor before starting supplements.
Exercise regularly:
- Safe activities like walking, swimming, or prenatal yoga for 30 minutes daily improve blood flow and oxygen delivery to the fetus.

IUGR does not occur in every pregnancy, even if a woman had it previously. Women with high-risk pregnancies, such as those with hypertension, should work closely with their doctor to reduce risks and ensure optimal fetal growth.