Is your baby not as big as expected in the womb? Let's talk about Intrauterine Growth Restriction (IUGR)!

Most of the time, as a mother, you hope to bring a healthy, well-developed baby into the world. But sometimes, your little one in your womb doesn't grow as fast as you'd like. Doctors call this condition Intrauterine Growth Restriction (IUGR) , or sometimes Fetal Growth Restriction (FGR) . Simply put, a baby is small for its gestational age. This means that it weighs less than nine out of ten other babies (less than the 10th percentile) at the same gestational age.

Now, not all babies grow the same. Just because a baby is "small" doesn't mean they have IUGR. Just like us, some are tall and some are short. A 5'1" baby is no less healthy than a 6'4" baby. That's right, most babies who are born small are healthy. However, some mothers have certain health conditions that can limit their baby's growth.

What are the main types of IUGR?

Doctors divide IUGR into two main types:

1. Symmetric IUGR (Primary IUGR): This is where the baby's entire body – head, abdomen, limbs – is all the same size. This is seen in about 30% of babies with IUGR.

2. Asymmetric IUGR (secondary IUGR): Here, the baby's head and brain size are normal, but only the abdomen is small. This is the most common type, accounting for about 80% of babies with IUGR.

How common is this fetal growth restriction?

This IUGR condition can be seen in about 10% of pregnancies. However, the important thing is that even if the baby is smaller than normal, it does not always mean that it has IUGR. So, it's better not to be unnecessarily scared, right?

When is IUGR usually diagnosed?

IUGR is often suspected after 20 weeks of pregnancy. Every time you see your doctor, they will measure your fundal height – the distance from your pubic bone to the top of your uterus. If this measurement is lower than expected, your doctor may suspect IUGR and refer you for further testing.

How will this IUGR condition affect my pregnancy?

If you are diagnosed with IUGR, your pregnancy will need to be managed a little differently. Your doctor may order additional scans (ultrasounds) , other tests, and more frequent clinic visits to monitor your baby's development. If you have another medical condition that is causing your IUGR, your doctor may also start treating that condition. However, this all depends on your health and that of your baby.

Sometimes your doctor may consider your pregnancy to be "high-risk." However, many babies diagnosed with IUGR are healthy and just need a little extra attention during pregnancy.

What are the reasons for restricting a baby's growth?

There are several reasons why a baby's growth may be restricted in this way. Sometimes, this is due to a problem with the placenta or umbilical cord. This is because the baby receives the nutrients, oxygen, and blood it needs through these. So, if these things are not getting enough, the baby's growth may be reduced.

There are also reasons related to the mother:

• If you are expecting twins or triplets .
• If you have had a previous baby with IUGR .
• If you have conditions such as high blood pressure, heart disease, or low blood count .
• If you smoke, drink alcohol, or use other drugs . (These are definitely things you should stop doing!)
• If you have an autoimmune condition , such as lupus .
• If you have kidney disease .
• If you are taking certain medications (anti-seizure medications) to treat conditions such as epilepsy .
• If you have diabetes (Diabetes Mellitus) .
• If you develop an infection such as rubella, syphilis, cytomegalovirus (CMV), or toxoplasmosis during pregnancy.

Sometimes IUGR can also be caused by a congenital or genetic disorder in the baby, for example , Down syndrome (Trisomy 21) . It has also been found that babies born to mothers living at high altitudes may have lower birth weights.

What is the main cause of fetal growth restriction?

It's hard to say for sure what the cause of fetal growth restriction is. Sometimes there can be multiple causes, or no clear cause can be found. Your doctor will try to find the underlying cause (if any).

What are the symptoms of IUGR?

Most mothers don't experience any specific symptoms that indicate their baby is smaller than the number of weeks. Sometimes you may feel like your belly or baby isn't as big as expected. However, only your doctor can determine for sure whether you have IUGR.

How is this IUGR condition diagnosed?

To diagnose IUGR, you first need to know your due date, which is usually determined by the first day of your last menstrual period and a first-trimester ultrasound . Knowing this date gives your doctor a basis for diagnosing IUGR.

Then, the doctor will try to diagnose IUGR using several methods:

• Uterine fundal height: As mentioned earlier, your doctor will measure the height from your pubic bone to the top of your uterus (the size of your "baby bump") with a paper tape measure. After 20 weeks, this height should be approximately equal to the number of weeks you are pregnant in centimeters (cm). For example, if you are 32 weeks pregnant, your uterine height should be about 32 centimeters. If this measurement is even 4 centimeters lower than expected (i.e., 28 centimeters or less in this example), your doctor may suspect IUGR. Sometimes, your doctor will estimate the size of your baby by palpation.
• Your Weight: Your weight is checked at every clinic visit. If you are not gaining weight properly, it could be a sign that your baby is not gaining weight properly either.
• Ultrasound: If you are diagnosed with IUGR, you will need to have regular scans throughout your pregnancy to monitor your baby's growth. During this scan, your doctor will move a device (wand or probe) over your abdomen. The sound waves create an image of your baby. The doctor will use the image to measure your baby's weight and size. The scan may also be used to look at the blood flow from the placenta to the baby through the umbilical cord (called a Doppler flow test). Poor blood flow can be a sign of IUGR. The scan can also measure the amount of amniotic fluid around the baby. Low levels of this fluid (oligohydramnios) can also be a sign of IUGR.
• Fetal monitoring: Your doctor will attach a monitoring device to your uterus with a strap. You will need to lie down and wear this device for about 30 minutes. This will record the baby's heart rate. The doctor will use these results to check for any developmental problems.
• Amniocentesis: This test can help identify congenital causes of IUGR. Here, the doctor inserts a thin needle through your skin into your uterus and takes a small amount of the amniotic fluid that surrounds the baby and sends it to the lab for testing. This is not a routine test, and is only done if necessary.

Don't be afraid when the doctor asks you to do additional tests. Some babies are smaller than average, but they are healthy and active.

How is fetal growth restriction treated?

The treatment for IUGR depends on how far along you are in your pregnancy and the health of your baby. Unfortunately, there is no one-size-fits-all solution to fetal growth restriction. Your doctor will monitor you and your baby closely to make sure there are no complications. They will also treat any underlying medical conditions that may be causing the condition.

The following can be done as treatment:

• Increased monitoring: The doctor will monitor you and your baby more closely. The baby's development will be checked regularly with scans and other tests.
• Early delivery: If the pregnancy is not progressing well or the baby is at risk, your doctor may decide to induce labor early (before 37 weeks). Sometimes a cesarean section (C-section) may be recommended, as vaginal delivery can be stressful for a growth-restricted baby.
• Corticosteroid medication: If your doctor recommends delivering your baby early, you may be given a corticosteroid medication to help your baby's lungs develop.

In very rare, or severe cases, your doctor may decide to admit you to the hospital for closer observation.

Will babies with growth restriction eventually grow like other children?

Most of the time, yes! Most babies born with IUGR grow to the same size as other children their age by the time they are about 3 years old. However, it is important to remember that every child develops differently. Also, do not force-feed your child. Doing so can lead to other health problems, such as obesity or diabetes. Your child's pediatrician will advise you if your child's growth is not going as expected.

What should I do to increase my baby's growth?

There is no guarantee that eating certain foods will definitely increase your baby's weight. However, it is definitely recommended to eat a healthy diet during pregnancy. Foods rich in fruits, vegetables, healthy carbohydrates, and protein will provide you and your baby with all the nutrients they need during pregnancy. Don't forget to talk to your doctor before making any major changes to your diet during pregnancy.

What can I do to prevent IUGR?

There are some factors that increase the risk of IUGR, but we can change them:

• Using drugs, alcohol, or smoking. (These should be stopped completely!)
• Following an unhealthy diet.
• Not gaining enough weight during pregnancy.

What health conditions do I have that increase my risk for IUGR?

You may be at increased risk for FGR/IUGR if you have any of the following conditions:

• High blood pressure or heart disease.
• Diabetes.
• Anemia or sickle cell anemia.
• Immune system diseases such as lupus.

Is IUGR going away?

The baby may "grab" a little and grow. However, the diagnosis of IUGR does not go away. The doctor will carefully monitor the baby's development until the end of the pregnancy.

Is it possible to have an early baby due to fetal growth restriction?

FGR/IUGR usually doesn't cause an early delivery, but it can happen. If your baby is growing slowly, or if there are problems with your placenta or umbilical cord, your doctor may recommend an early delivery. As mentioned earlier, if the stress of a vaginal delivery is too high for your baby, a cesarean section (C-section) may be recommended.

What are the risks for a baby born with IUGR?

There are some conditions and problems associated with IUGR:

• There is a higher risk of having a baby by cesarean section (C-section) and premature birth.
• Breathing and feeding difficulties may occur immediately after birth.
• Lack of oxygen (hypoxia) at birth.
• Low blood sugar levels (hypoglycemia) at birth.
• Difficulty controlling body temperature.
• Meconium aspiration (the baby swallowing its first stool in the womb).
• Polycythemia (increased red blood cell count).
• Decreased resistance to infections.

Some babies who are born prematurely or small may need to stay in the hospital longer or receive special care in the Neonatal Intensive Care Unit (NICU) .

IUGR can have long-term effects, depending on the following factors:

• The underlying medical condition that caused it.
• How limited the baby's growth is.
• How many weeks into the pregnancy have passed when the baby is delivered.

Your baby may be at higher risk for cognitive or developmental problems like hyperactivity, cerebral palsy , poor test scores at school, and may also be at higher risk for obesity and cardiovascular disease later in life.

What do I do if my baby has IUGR?

First of all, don't panic. Most of the time, this is not something you did. Here are some things you can do to help:

• Be sure to attend all of your prenatal appointments and baby checkups (like scans).
• If you use drugs, smoke, or drink alcohol, stop doing those things right now.
• Eat a healthy diet and get the required amount of calories per day.
• Get enough rest, sleep at least eight hours a night.
• If you feel like your baby's movements are decreasing, keep an eye on it. (There are ways to count how many kicks your baby makes in a day, ask your doctor.)
• Tell your doctor honestly about any medication you take.

Work with your doctor to fully understand this diagnosis, possible complications, and changes you can make to your lifestyle.

Should I be worried if my baby is small in size?

Most of the time, no. Babies grow at different rates. However, there is a difference between being diagnosed with small for gestational age and being diagnosed with fetal growth restriction (FGR/IUGR). FGR/IUGR is diagnosed when a baby is smaller than nine out of ten other babies of the same age. It is entirely possible for a baby to be small for gestational age to be healthy and not at increased risk of complications. Talk to your doctor about any concerns you may have.

What questions should I ask my doctor?

It's common to have questions about the diagnosis of intrauterine growth restriction (IUGR). Here are some questions you can ask your doctor:

• Do you know what causes IUGR?
• How often will I have to come to the antenatal clinics?
• Is there anything I can do to help my baby's development?
• Is my baby at risk of any health conditions?
• Will my baby have to stay in the hospital for a long time after birth?
• Could my baby develop any health conditions later on?

There are many reasons why a baby may be small before birth. Your doctor will determine if there is an underlying problem that is hindering the baby's growth. Sometimes, for no apparent reason, a baby may be born smaller than normal. If your baby is diagnosed with IUGR, your medical team will closely monitor your baby's development throughout the pregnancy. Their priority is to make sure you and your baby receive the care and treatment they need. Most babies born with IUGR do not have any health complications.

Take-Home Message

It's normal to feel scared and anxious when you find out that your baby is not growing as expected in the womb, or that he has IUGR. But please remember, many babies are born healthy, well, and grow well in these situations.

The most important thing is:

• See your doctor regularly and follow his instructions exactly.
• To complete all scheduled tests on time.
• Living a healthy lifestyle – eating well, avoiding smoking and alcohol.
• Any questions or fears you have in mind should be discussed with the doctor and clarified.

You are not alone, there are doctors and family members to help you. Think positively, take good care of yourself and your little one.

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