Is Your Baby At Risk Of Growth Retardation?

What Is Growth Retardation?

According to Stanford Children’s Health, Intrauterine Growth Restriction (IUGR) is a term used to describe a condition in which the fetus is smaller than expected for the number of weeks of pregnancy [1]. This condition is also called as “fetal growth restriction” where the newborn baby is comparatively much smaller in size for the gestational age. Fetuses with IUGR are born as either as preterm babies – after 37 weeks of pregnancy or prematurely – before 37 weeks.

Physical Symptoms Of Fetus With IUGR

Diagnosis for IUGR is done via two methods: Ultrasound tests and Non-stress testing (monitoring of fetal heartbeat).

When the fetus is diagnosed with IUGR, its weight is “less than the 10th percentile” – this means that it weighs 90 percent less than all other fetuses that are of the same gestational age.

Fetal Growth Restriction manifests itself in two ways:

• Symmetric or primary growth restriction occurs when all the internal organs are reduced in size. Usually, this condition accounts for 20% to 25% of all cases of growth restriction.
• Asymmetric or secondary growth restriction is characterized by the head and brain being normal in size. However, the abdomen of the fetus is smaller. The condition is not evident until the third trimester of the pregnancy [2].

Newborn babies diagnosed with IUGR are usually pale and and have loose, dry skin. The umbilical cord is thinner and dull-looking rather than shiny and fat. However, some babies do not display these physical symptoms, but are physically smaller in size compared to other babies.

Risk Factors For Growth Retardation

Maternal Risk Factors

The following risk factors are related to the mother’s physical profile, lifestyle and medical history [3]:

1. Age less than 17 years or greater than 30 years
2. Smoking
3. Alcohol consumption
4. Drugs
5. Short in stature
6. Low weight
7. Low weight gain during pregnancy
8. Anemia
9. Previous preterm delivery
10. Previous abortion [4]
11. Stress and Distress [5]
12. Pollution (exposures to sulfur dioxide (SO2) and total suspended particles (TSP) during the third trimester of pregnancy) [6]
13. Consumption of Fatty Fish (a known route of exposure to persistent organic pollutants) [7]
14. Snoring [8]
15. Consumption of antibiotics
16. Kidney disease, advanced diabetes, high blood pressure, heart/respiratory issues and other chronic infections

While caffeine consumption has been perceived as a risk factor, studies seem to indicate that moderate caffeine consumption does not increase IUGR risk [9].

Uteroplacental Factors

Some risk factors are external to the fetus but localized in the uterus and placenta:

1. Decreased uterine blood flow
2. Reduced blood flow in the placenta
3. Infections in the tissues surrounding the fetus
4. Placenta previa – a condition where the placenta attaches itself quite low to the uterus

Fetal Factors

While maternal and intrauterine factors originate outside the fetus, some risk factors are intrinsic to the fetus (more likely to lead to symmetric IUGR):

1. Multiple Gestation
2. Birth/ Genetic defects
3. Chromosomal abnormality
4. Vertical Infections

What Can IUGR Lead To?

IUGR has been linked to a variety of neurodevelopmental disorders.

• Learning and memory deficiencies [10]
• An increased risk for schizophrenia was found in boys who were small for their gestational age at birth (odds ratio 3.2) [11]
• Many human fetuses have to adapt to a limited supply of nutrients. In doing so they permanently change their structure and metabolism. These programmed changes may be the origins of a number of diseases in later life, including coronary heart disease, hypertension, and noninsulin- dependent diabetes. [12]
• Restricted fetal growth and teenage motherhood were associated with both suicide completion and attempt in offspring. [13]

References

1. Intrauterine Growth Restriction (IUGR). Stanford Children’s Health.
2. Intrauterine Growth Restriction (IUGR); Small For Gestational Age. American Pregnancy Association.
3. Wen, Shi Wu, et al. “Intrauterine growth retardation and preterm delivery: prenatal risk factors in an indigent population.” American journal of obstetrics and gynecology 162.1 (1990): 213-218.
4. Basso, Olga, Jørn Olsen, and Kaare Christensen. “Risk of preterm delivery, low birthweight and growth retardation following spontaneous abortion: a registry-based study in Denmark.” International journal of epidemiology 27.4 (1998): 642-646.
5. Rondo, P. H. C., et al. “Maternal psychological stress and distress as predictors of low birth weight, prematurity and intrauterine growth retardation.” European Journal of Clinical Nutrition 57.2 (2003): 266-272.
6. Wang, Xiaobin, et al. “Association between air pollution and low birth weight: a community-based study.” Environmental Health Perspectives 105.5 (1997): 514.
7. Halldorsson, Th I., et al. “Is high consumption of fatty fish during pregnancy a risk factor for fetal growth retardation? A study of 44,824 Danish pregnant women.” American journal of epidemiology 166.6 (2007): 687-696.
8. Franklin, Karl A., et al. “Snoring, pregnancy-induced hypertension, and growth retardation of the fetus.” CHEST Journal 117.1 (2000): 137-141.
9. Mills, James L., et al. “Moderate caffeine use and the risk of spontaneous abortion and intrauterine growth retardation.” Jama 269.5 (1993): 593-597.
10. Geva, Ronny, et al. “Neuropsychological outcome of children with intrauterine growth restriction: a 9-year prospective study.” Pediatrics 118.1 (2006): 91-100.
11. Hultman, Christina M., et al. “PapersPrenatal and perinatal risk factors for schizophrenia, affective psychosis, and reactive psychosis of early onset: case-control studyPrenatal and perinatal risk factors for early onset schizophrenia, affective psychosis, and reactive psychosis.” Bmj 318.7181 (1999): 421-426.
12. Osmond, Clive, and D. J. Barker. “Fetal, infant, and childhood growth are predictors of coronary heart disease, diabetes, and hypertension in adult men and women.” Environmental Health Perspectives 108.Suppl 3 (2000): 545.
13. Mittendorfer-Rutz, Ellenor, Finn Rasmussen, and Danuta Wasserman. “Restricted fetal growth and adverse maternal psychosocial and socioeconomic conditions as risk factors for suicidal behaviour of offspring: a cohort study.” The Lancet 364.9440 (2004): 1135-1140.