Intrauterine Growth Restriction (Slow Growth of Baby during Pregnancy)

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KEY POINTS

• Intrauterine growth restriction (IUGR) means that a baby is growing more slowly than normal during a pregnancy and the baby's weight is lower than it should be.
• You may need to rest more often or stay in bed. You may also need to stop smoking or to talk to a dietitian about how you can improve your diet. You may need to stop working.
• Early and regular prenatal visits with your healthcare provider allow this problem to be found early. If your baby does not move very often, follow your healthcare provider’s instructions.

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What is intrauterine growth restriction?

Intrauterine growth restriction (IUGR) means that a baby is growing more slowly than normal during a pregnancy and the baby's weight is lower than it should be.

A baby's growth and weight are important. Small babies are more likely to have problems near the time of birth and after delivery.

What is the cause?

Some of the things that can slow the growth of your baby are:

• A placenta that does not give enough nourishment to the baby. The placenta is tissue inside the uterus that is attached to the baby by the umbilical cord. It carries oxygen and food from your blood to the baby’s blood.
• A baby who has a birth defect, like a heart or kidney problem, or a genetic problem. Genes are inside each cell of the body and contain the information that tells your baby’s body how to develop and work.
• High blood pressure during the pregnancy
• Infections in the baby
• Problems with the uterus
• Too little or too much fluid in the birth sac. The birth sac, also called the amniotic sac or bag of water, surrounds the baby and is filled with fluid. The fluid protects your baby and helps him grow.
• Exposure to chemicals or very high doses of radiation

Slowed growth is more likely to be problem if you (the mother):

• Are a smoker
• Do not have a healthy diet
• Drink alcohol during the pregnancy
• Are a teenager
• Are underweight
• Have had small babies in other pregnancies
• Take certain medicines or use illegal drugs
• Are pregnant with more than 1 baby, like twins or triplets
• Have other medical problems, such as high blood pressure, or heart, lung, or kidney disease

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 best way to check how a baby is growing is to have an ultrasound scan to estimate the size of the baby. Your provider can also use ultrasound to check the baby’s age. Sometimes the uterus is smaller because you are not as far along in your pregnancy as you thought.

You may have blood tests or tests of the amniotic fluid to see if there is a genetic problem, infection, or other medical problem that may be slowing your baby's growth.

You may have ultrasound scans once or twice a week during the last 2 months of the pregnancy. Tests using ultrasound can:

• Check the baby’s health
• See if your uterus has enough amniotic fluid
• See if blood flow through the placenta is normal

You may also have nonstress tests, which use a monitor attached with belts to your belly to record how your baby's heart rate changes when the baby moves.

How is it treated?

When IUGR is suspected:

• You may need to rest more often or stay in bed. You may also need to stop smoking or to talk to a dietitian about how you can improve your diet.
• You may need to work less or stop working.

Signs that a baby may have more serious problems include an abnormal heart rate and failure to grow in 2 or 3 weeks. In such cases, your healthcare provider may suggest delivering your baby right away or as soon as the baby is old enough to survive. Your baby may grow better outside the uterus in an intensive care nursery.

When it’s time for your baby to be delivered, your provider may start your labor by giving you medicine. If labor might be too stressful and risky for your baby, the baby may be delivered by C-section.

If your baby needs to be delivered early, your healthcare provider may give you a steroid shot to help your baby's lungs develop. This will help your baby breathe better after birth.

How can I take care of myself?

Early and regular prenatal visits with your healthcare provider allow this problem to be found early. Then you and your 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, follow your healthcare provider’s instructions.

Ask your healthcare provider:

• How and when you will get your test results
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent IUGR?

Some causes of IUGR cannot be controlled. However, you have control over things like diet, rest, and exercise. Follow your healthcare provider's instructions, which may include:

• Eat a healthy diet.
• Limit caffeine.
• If you smoke, try to quit. Talk to your healthcare provider about ways to quit smoking.
• Do not drink alcohol or abuse drugs.
• Learn ways to manage stress.
• Stay fit with the right kind of exercise for you. Exercise according to your healthcare provider's instructions.
• Avoid chemicals and radiation that are harmful to your baby. Ask your healthcare provider about this.
• Try to get at least 7 to 9 hours of sleep each night.

If you have had a previous pregnancy with a small baby or preeclampsia (high blood pressure), talk to your healthcare provider to see if there are ways to lower the chances of having a small baby or high blood pressure again.

If you have health problems, such as heart, lung, or kidney disease, see your healthcare provider if you are planning to get pregnant or as soon as you think you may be pregnant.