What is (IUGR) intrauterine growth restriction?
Babies are diagnosed
with intrauterine growth restriction (IUGR) if they appear to be
smaller than expected specifically, if an ultrasound indicates that
their weight is below the 10th percentile for their gestational age.
There
are lots of reasons that a baby appears small. In many cases, a baby
who's diagnosed with IUGR just happens to be small (perhaps like one of
his parents). In other cases, a baby who seems small in the womb turns
out to be a normal size at birth. But in some cases, something is
keeping the baby from growing properly, and the prenatal caregiver will
try to figure out what the problem is.
How can my caregiver tell how big my baby is?
Your
caregiver assesses the size of your uterus during a pelvic exam in your
first trimester. After that, she checks your baby's growth by measuring
your belly at every prenatal visit. If the measurement is smaller than
your due date indicates it should be (this is called "small for dates"),
she'll follow up with an ultrasound to pinpoint your baby's size and
weight.
If you're in the first half of pregnancy and this is your
first ultrasound, you may measure small because your due date (based on
your last period) is wrong. This can happen if you remembered the first
day of your last period incorrectly or ovulated later than usual in your
last cycle.
If the ultrasound confirms your due date, however,
you'll have another ultrasound in several weeks to check on your baby's
growth. If the second ultrasound indicates that it's lagging, your baby
may be diagnosed with IUGR.
What could be causing problems with my baby's growth?
A
baby may not be growing properly if he's not getting the oxygen and
nutrients he needs to thrive. Less commonly, a genetic defect interferes
with his growth. Here's a list of the most common causes of IUGR:
- Abnormalities in the placenta, the organ that delivers oxygen and nutrients to your baby in the womb. The placenta may not be functioning properly if it's too small, improperly formed, or starting to detach from the uterus (placental abruption). A placenta that's too low in the uterus (placenta previa) may slightly increase the risk of IUGR.
- Medical conditions you may have, such as chronic hypertension or preeclampsia (particularly if the preeclampsia is severe and diagnosed in your second trimester or if you have both chronic hypertension and preeclampsia), kidney or heart disease, certain anemias (like sickle cell disease), advanced diabetes, blood clotting disorders, antiphospholipid antibody syndrome, or serious lung disease.
- Chromosomal abnormalities, such as Down syndrome, or structural birth defects, such as anencephaly (in which part of the brain is missing) or defects in the kidneys or abdominal wall.
- Carrying twins or higher multiples.
- Smoking, drinking, or abusing drugs.
- Certain infections your baby may get from you, such as toxoplasmosis, CMV, syphilis, or rubella.
- Certain medications, such as some anticonvulsants.
- Severe malnutrition.
In
addition, women who are underweight before pregnancy and don't gain
enough weight gain during pregnancy, and women who live at very high
altitudes, are more likely to have somewhat smaller babies.
If you
have any of the conditions listed above, you'll have ultrasounds to
check your baby's growth, even if your belly measurements during your
prenatal visits are normal.
Also, if you've previously had a
stillbirth or a baby with IUGR, you can expect at least one ultrasound
in your late second or early third trimester to check on your baby's
growth. Finally, your caregiver may suspect IUGR and check your baby's
growth by ultrasound if your multiple marker test shows an elevated level of AFP in your blood for which there's no apparent reason.
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