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intrauterine growth retardation Alternative Names low birth weight, small for gestational age, dysmaturity, intrauterine growth restriction Definition Intrauterine growth retardation, or IUGR, is a condition in which a fetus grows at a slower rate than expected. What is going on in the body? There are expected ranges of growth for a fetus at a given gestational age. The growth of a fetus depends on the health and nutrition of the mother and the health of the fetus. IUGR may occur if the health of the placenta or its blood supply is impaired. IUGR may also occur if the mother's nutrition, health, or lifestyle prevents a healthy pregnancy. What are the signs and symptoms of the disease? There are often no symptoms of IUGR. Symptoms that do occur may include the following: a uterus that is smaller than in previous pregnancies fewer fetal movements than expected What are the causes and risks of the disease? Women with certain conditions may be more likely to have a child with IUGR. These conditions include the following: placental insufficiency, which leads to poor nutrition of the fetus multiple pregnancies, such as twins IUGR in a previous pregnancy high blood pressure diabetes severe kidney disease heavy smoking poor weight gain in pregnancy preeclampsia or eclampsia, which are complications of pregnancy causing high blood pressure in the mother exposure to high altitudes drug abuse HIV infection severe inflammatory bowel disease or ulcerative colitis alcohol dependence or abuse TORCH infections, a set of infectious diseases that can harm the fetus if the mother is infected during her pregnancy poor nutrition in the mother congenital or chromosome abnormalities in the fetus recurrent bleeding, such as placenta previa, a condition in which the placenta implants over or near the opening of the cervix blood disorders, such as sickle cell anemia or thalassemia small stature in the mother placenta abruptio, which is a premature separation of the placenta from the uterine wall What can be done to prevent the disease? Most cases of IUGR cannot be prevented, especially if they are due to genetic causes. Some cases can be prevented by taking the following precautions: avoiding risk factors for the TORCH infections eliminating use of alcohol, tobacco, and illicit drugs careful monitoring and early treatment for high blood pressure and diabetes eating a diet high in folate before and during pregnancy to protect against certain birth defects How is the disease diagnosed? The diagnosis can be made with 2 tests: pregnancy ultrasound and the nonstress test. Ultrasound uses many measurements to evaluate expected fetal growth. The nonstress test measures the heart rate and the movement of the fetus. Other tests can be used to check for other conditions affecting the fetus. What are the long-term effects of the disease? Long-term effects in the fetus before or during delivery include the following: premature delivery poor tolerance of labor increased chances of a C-section, or delivery of the baby through an incision in the mother's abdomen increased risk of birth defects asphyxia, or too little oxygen, at birth, which may lead to cerebral palsy Long-term effects in the infant after delivery include the following: temperature instability hypoglycemia, or low blood sugar difficulty fighting infection death Complications later in childhood may include: learning disabilities mental retardation What are the risks to others? IUGR is not contagious, but it does pose a risk for the fetus. IUGR may also occur in future pregnancies. What are the treatments for the disease? Treatment of IUGR depends on the suspected cause and may include the following: stopping smoking stopping all drugs, such as cocaine and alcohol eating a good diet with proper amounts of folic acid and other vitamins increasing bed rest, lying on the left side as much as possible if prescribed, taking low-dose aspirin to prevent tiny clots from forming in the placenta monitoring fetal movements, contractions, or spontaneous rupture of membranes close monitoring by the healthcare provider using continuous internal fetal heart monitoring during labor to detect fetal distress using minimal anesthesia, although epidurals are safe having a C-section or forceps delivery if fetal distress is detected What are the side effects of the treatments? Treatments are intended to prevent serious complications in infants with IUGR. Side effects of surgery include bleeding, infection, and allergic reaction to anesthesia. What happens after treatment for the disease? Recovery from surgery may take a few days to several weeks, depending on the procedure used. The baby may be given oxygen, antibiotics, and intravenous fluids after delivery. An infant with cerebral palsy or seizures may need physical therapy. Other disabilities may require other treatments. How is the disease monitored? The following may be used to monitor the pregnancy: nonstress testing every week or two biophysical profile every week or two. This test uses ultrasound and a series of measurements to determine the health status of the developing fetus. pregnancy ultrasounds every 10 to 14 days Any new or worsening symptoms should be reported to the healthcare provider.

Author: Eva Martin, MD Date Written: 07/19/99 Reviewer: Eileen McLaughlin, RN, BSN Date Reviewed: 07/05/01 Potential conflict of interest information for reviewers available on request