Delayed Growth of Baby During Pregnancy – How Intrauterine Growth Restriction Is Treated

Delayed Growth of Baby During Pregnancy – How Intrauterine Growth Restriction Is Treated

As a pregnant woman, you might be concerned about each and every aspect of your developing baby. You want your baby to come out in this world free of anomalies. However, some unfortunate woman will see their bump not growing at a normal pace, means the baby is not growing parallel to his or her gestational age. We will discuss this pregnancy complication in this story.

Intrauterine growth restriction

Intrauterine growth restriction (IUGR) is a condition in which the fetus or unborn baby does not develop at a normal rate. The condition is also known as intrauterine growth retardation. This term is also used for full-term babies less than 2.5 kgs of weight. This delayed growth during pregnancy can put both the baby and the mother to certain risks.

Types of intrauterine growth restriction

Growth retardation can be classified into two forms:

Symmetrical – Babies with symmetrical or primary form of growth restriction have a normally proportioned body. However, they are just smaller as compared to most children of their gestational age. It happens in 20-30 percent of cases.

Asymmetrical – Head size of these children is normal. However, their body size is much smaller than normal. Looking through ultrasound, their head appears to be much larger than the rest of the body. This is the most common type accounting for 70-80 percent of the total cases. Asymmetrical or secondary is mostly evident in the third trimester.

How common is intrauterine growth restriction?

In developing nations such as India, low-birth weight is a major cause of public health concern. According to UNICEF, about 72 percent of infants low in birth weight are born in Asia, out of which India accounts for 40 percent. And more than 50 percent of these infants are a result of intrauterine growth restriction.

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What causes intrauterine growth restriction?

IUGR could be an outcome of several conditions. It can start at any phase during the pregnancy. For easy understanding, we have divided the factor into three different categories.

Maternal factors

These factors involve the conditions associated with the pregnant woman or birthmother. These include:

  • Preeclampsia or eclampsia
  • Anemia or malnutrition
  • Certain infections
  • Smoking, alcohol or substance abuse
  • Chronic conditions such as diabetes, kidney disease, heart and respiratory disease

Fetal factors

These are conditions that the fetus can possibly have which can increase the risk of IUGR. These include:

Intrauterine factors

These factors involve the conditions that can develop within the uterus. These include:

  • Reduced uterine blood flow
  • Infections in the tissues around the fetus
  • Decreased blood flow to the placenta

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Are there any signs and symptoms of intrauterine growth restriction?

While majority of the pregnant women are unaware of their condition, some of them might notice that the baby is not as big as it should be. The weight is determined by taking measurement from the women’s pubic bone to the top of the uterus. This is known as fundal height.

If the fundal height is below than expected, then it’s a sign of intrauterine growth restriction. For example, if a woman is 27 weeks pregnant, the doctor would expect the fundal height to be approx. 27 centimeters. Fundal height below or higher than expected can also indicate other possible conditions such low amniotic fluid, larger than average baby (macrosomic baby) and too much amniotic fluid.

The growth restriction can be accurately determined by an ultrasound.

Ideal weight of baby during pregnancy – Trimester wise

In intrauterine growth restriction, the weight of the developing baby is less than 10th percentile of the gestational age. So, at full term, the weight of the baby less than 2.5 kg is considered as IUGR. Here is trimester wise normal weight of the baby during pregnancy.

  1. First trimester or 13 weeks – 23 g
  2. Second trimester or 27 weeks – 875 g
  3. Third trimester or 40 weeks – 3.5 kg

Baby weighing between 2.5 kg to 3.5 is considered as normal.

Complications of intrauterine growth restriction

Infants who are born with intrauterine growth restriction are at risk of developing several complications. These include:

  • Low birth weight
  • Difficulty handling the pressures of vaginal delivery
  • Reduced oxygen levels
  • Low blood sugar (hypoglycemia)
  • Neurological problems
  • Weak immune system or low resistance to infection
  • Low Apgar scores (a test conducted immediately after birth to check the physical condition of the newborn)
  • Inhalation of stools while in the womb (Meconium aspiration) which can lead to respiratory problems
  • Difficulty maintaining body temperature
  • High red blood cell count
  • In severe cases, it can lead to stillbirth causing long-term growth problems.

Diagnosis of intrauterine growth restriction

The doctor can determine the size and weight of the baby through several ways. The simplest technique is the fundus height. The measurement in centimeters typically corresponds with the number of weeks of pregnancy. Other procedures include:

Ultrasound

This technique will measure the head and abdomen of the baby. These measurements will then be compared to the growth charts to determine baby’s weight. Ultrasound also checks the volume of amniotic fluid.

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Doppler flow

Under this technique, the speed of blood flow in the blood vessels is analyzed using sound waves. Dopper flow can also be used for examining blood flow in the umbilical cord and the brain of the baby.
Fetal monitoring

The doctor will place sensitive electrodes on the abdomen of the pregnant woman. These electrodes are connected to a monitor and the sensors examine the pattern and rate of the baby’s heartbeat. These patterns are displayed on the monitor.

Amniocentesis

A small amount of amniotic fluid is extracted from the abdomen of the mother using a needle. This will be sent for lab testing to detect any infection or chromosomal abnormalities.

Weight check

The doctor conducts routine prenatal checkup and checks the weight of the mother. If she is not gaining required amount of weight, then it could indicate a problem.

Treatment and prevention of intrauterine growth restriction

Depending on the case, the IUGR may be preventable. Treatment will be mainly focused on addressing the underlying cause. Depending on the severity, the doctor may suggest following things:

  • Increase intake of nutrients
  • Keep checking baby’s movements
  • Bed rest to improve circulation of the fetus
  • In severe cases, induced delivery is the final resort to avoid any complications

In addition to these, the doctor may also suggest practicing healthy lifestyle habits such as quitting smoking and eating balanced diet. Besides, regularly going through prenatal checkups can help detect the problem early and let the doctor treat the condition in a better way.

Sources

1. Intrauterine Growth Restriction: Identification and Management(1998, August). American Family Physician read more
2. Saleem T et al.(2011, September 07). Intrauterine growth retardation - small events, big consequences read more
3. Intrauterine growth restriction(2016, April 10). MedlinePlus 
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