Intrauterine growth retardation

Intrauterine growth retardation
A premature newborn Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: : Kalsang Dolma, M.B.B.S.[2]

Synonyms and keywords: Intrauterine growth restriction

Overview

Intrauterine growth retardation (IUGR) refers to poor growth of a baby while in the mother's womb during pregnancy.

Classification

Asymmetrical IUGR is more common. In asymmetrical IUGR, there is restriction of weight followed by length. The head continues to grow at normal or near-normal rates (head sparing). This is a protective mechanism that may have evolved to promote brain development. This type of IUGR is most commonly caused by extrinsic factors that affect the fetus at later gestational ages.

Symmetrical IUGR is less common and is more worrisome. This type of IUGR usually begins early in gestation. Since most neurons are developed by the 18th week of gestation, the fetus with symmetrical IUGR is more likely to have permanent neurological sequela

Pathophysiology

If the cause of IUGR is extrinsic to the fetus (maternal or uteroplacental), transfer of oxygen and nutrients to the fetus is decreased. This causes a reduction in the fetus’ stores of glycogen and lipids. This often leads to hypoglycemia at birth. Polycythemia can occur secondary to increased erythropoietin production caused by the chronic hypoxemia. Hypothermia, thrombocytopenia, leukopenia, hypocalcemia, and pulmonary hemorrhage are often results of IUGR.

If the cause of IUGR is intrinsic to the fetus, growth is restricted due to genetic factors or as a sequelae of infection.

Causes

Causes by Organ system

Cardiovascular	No underlying causes
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	No underlying causes

Causes by Alphabetical Order

Abnormal cord insertion Achondrogenesis type 1B Achondrogenesis, type 1A Acitretin Arthrogryposis IUGR thoracic dystrophy Aspartoacylase deficiency Atelosteogenesis type 1 Autoimmune disease Bloom's syndrome Bowen-Conradi syndrome BRESHECK syndrome Chagas' disease Chromosomal abnormality Chromosome 13 trisomy syndrome Chromosome 18 trisomy syndrome Chronic hypertension Class F or higher diabetes CODAS syndrome Coffin-Siris syndrome Confined placental mosaicism Congenital cytomegalovirus infection Congenital hyperinsulinism Congenital rubella infection Congenital syphilis Congenital toxoplasma infection Cord anomalies Cornelia de Lange syndrome Cyanotic heart disease De la Chapelle dysplasia Down syndrome Eclampsia Fetal akinesia-hypokinesia sequence Fryns syndrome 3 Gestational diabetes mellitus Gestational hypertension Gracile bone dysplasia GRACILE syndrome Haemoglobin Bart's Hemoglobinopathies Hutchinson-Gilford progeria syndrome IMAGE syndrome Immunoneurologic disorder, X-linked Incontinentia pigmenti Japanese encephalitis Langer-Saldino achondrogenesis Leprechaunism Lethal restrictive dermopathy Listeria monocytogenes Lowry-Wood syndrome Marden-Walker syndrome

Maternal kidney failure Maternal alcoholism Maternal anemia Maternal smoking Maternal collagen vascular disease Maternal infection Maternal kidney disease Maternal lung disease Maternal malnutrition Maturity onset diabetes of the young Meckel-Gruber syndrome Mullerian dysgenesis Multiple gestation Multiple pregnancy Neu-Laxova syndrome Osteogenesis imperfecta congenita Otopalatodigital syndrome type 2 Pallister-Hall syndrome Parvovirus B19 Phenylketonuria Phenytoin Pitt-Rogers-Danks syndrome Placenta abnormalities Placenta previa Placental abruptio Placental insufficiency Pre-eclampsia Pregnancy-associated hypertension Primordial dwarfism Prolonged high-altitude exposure Protein-calorie malnutrition Russell-Silver dwarfism SHORT syndrome Sickle-cell disease Substance abuse Taybi-Linder syndrome Thrombophilias TORCH infection Toxin Tuberculosis Twin-to-twin transfusion syndrome Urinary tract infection Uterine malformations Virchow-Seckel syndrome Williams syndrome Wolf-Hirschhorn syndrome Yunis-Varon syndrome Zinc deficiency 3M syndrome

Epidemiology and demographics

At least 60% of the 4 million neonatal deaths that occur worldwide every year are associated with low birth weight (LBW), caused by intrauterine growth restriction (IUGR), preterm delivery, and genetic/chromosomal abnormalities, demonstrating that under-nutrition is already a leading health problem at birth.

Risk factors

Risk factors in the mother that may contribute to IUGR include:

• Alcohol abuse
• Clotting disorders
• Drug addiction
• High blood pressure or heart disease
• Kidney disease
• Poor nutrition
• Smoking

Natural history, Complications and Prognosis

• After delivery, growth and development of the newborn depends on the severity and cause of IUGR.
• Depending on the specific cause, IUGR increases the risk for a variety of pregnancy and newborn complications.
• Infants may have a non-reassuring fetal heart rate during labor, requiring delivery by c-section.
• Perinatal mortality rates are 4-8 times higher for infants with IUGR, and morbidity is present in 50% of surviving infants.

History and Symptoms

• A pregnant woman may feel that her baby is not as big as it should be.

Physical Examination

• Uterine fundal height: Smaller than expected for the baby's gestational age.