You are expecting a child. Nothing can be more wonderful - or stressful! There are so many things to worry about, but you take it all in stride. You make conscious decisions to eat right and get plenty of rest to remain fit and healthy during your pregnancy.
You are happy your weight gain is steady but minimal, but then your doctor throws you a curve ball. He tells you your fetus is smaller than average and may not be growing normally inside your uterus. Suddenly all these technical terms start flying around and you begin to doubt your baby will be delivered healthy and hearty.
What is IUGR?
IUGR or Intrauterine Growth Restriction, also known as Small-For-Gestational-Age and Dysmaturity, is defined as a fetus whose weight is below the tenth percentile of their gestational age; it is also defined by the abdominal circumference of the mother. If your protruding abdomen is below the 2.5 percentile, you may be at risk for IUGR.
What does that mean? Basically, your baby is smaller than normal during pregnancy, which may mean a decrease in normal growth inside the uterus. This declined growth can have a negative effect on the brain leading to mental developmental difficulties, such as attention or performance deficits.
If your baby is demonstrating asymmetric growth, he may be undernourished (usually due to placental insufficiencies). These babies have normal a size head with a small abdomen, scrawny limbs and thin skin because most of the energy must go to the maintenance of his heart and brain - the two most vital organs.
What Causes IUGR?
IUGR can be the result of a variety of different causes. Most commonly, there is a problem with the placenta - your baby's lifeline, supplying blood and nutrients to growing life. Some placental problems are unexplained, meaning there is no clearly defined reason for the problem. Other causes, such as pre-eclampsia or a "poisoning of the pregnancy", is characterized by high blood pressure, headaches and swelling of the extremities of the mother. Birth defects and genetic disorders may also play a role in IUGR. Risks increase if you have a history of infections, diseases such as hypertension (high blood pressure), diabetes or cardiovascular disease or if you continue habits such as smoking and consuming alcohol or drugs.
Should I Worry?
Just because your baby is small does not mean there is a problem as long as they are well proportioned and developing normally. However, IUGR is not something that should be taken lightly, since growth restrictions is the second leading cause of sickness, disease or death followed only by premature birth.
What Now? What Should I Do?
It is estimated that only around 30% of small babies have IUGR. But to assure the health and welfare of your unborn baby, regular checkups are necessary. Constant monitoring from a qualified physician is crucial for delivering a healthy baby!
You need to be aware of you and your baby's health. Make sure your baby moves everyday. A significant decrease or absence of movement necessitates a call or consultation with your doctor. This may be a sign something is wrong.
Get plenty of rest. Try to get at least eight hours of sleep every night and nap when possible. If this is impossible, your doctor may recommend bed rest for the duration of the pregnancy as this may maximize blood flow to the uterus. Assuring adequate blood flow allows proper blood and nutrition to your baby.
Keep to a sensible diet. Just because you may be eating for two does not give you full rein to eat anything and everything in sight! Growing babies need nutritious foods for proper growth and development.
Abstain from smoking, alcohol and drugs. Smoking and alcohol consumption during pregnancy have long been a taboo. Cessation of smoking and alcohol only increases the chances of a normal, healthy delivery. Drug use, whether prescription, over-the-counter or illegal drugs may have an adverse effect on your baby, so take heed and discuss all medications with your physician.
What Can I Expect?
Accurate dating of the pregnancy early on can determine if IUGR is a consideration. Typically, an ultrasound between the weeks of eight and thirteen is the best determinant of gestational age.
If your doctor considers you at risk for IUGR, he will begin to keep a closer eye on your pregnancy. Often, additional ultrasound images will be taken to assure your baby is proportioned and developing normally. Fetal monitoring is also a typical step to ensure your baby is under no unnecessary stress. Occasionally, amniocentesis is necessary to rule out infections or genetic problems. Amniocentesis is a procedure where a small amount of amniotic fluid is taken from your uterus and analyzed.
Early delivery is only necessary if the baby is not growing at all or if there are other complications. Most of the time, a normal vaginal delivery can be expected unless the baby is too weak or experiences other problems during delivery.
Some complications can arise with delivery of any baby. Birth asphyxia is a concern if IUGR is due to placental insufficiency. With each uterine contraction, placental perfusion or flow is slowed or stopped. This may cause excessive stress on the baby and can result in an insufficient intake of oxygen. Constant monitoring during labor can determine if a cesarean section is necessary.
During delivery some meconium or the first feces of the baby may be passed into the amniotic sac. Babies experiencing birth asphyxia may begin deep, gasping movements, which increases the risk of meconium aspiration or intake of the feces through breathing or swallowing. This can lead to pneumonitis (inflammation of the lungs) or an obstruction of the bronchi, the main air passages leading to the lungs. If the blockage is partial, hyperinflation of the lungs may be seen with air leaks. With a complete obstruction the baby's lungs will not expand, thus allowing no air into the lungs.
After delivery, many IUGR infants are prone to hypoglycemia, a condition of a sugar deficiency in the blood. This typically lasts the first few hours or days of life.
Your baby usually will only have to stay in the hospital if there are medical complications. Generally, if the baby is able to breathe on his own and takes regular feedings without significant weight loss, he is well enough to go home. Most hospitals use five pounds as a safe measurement before leaving. But always leave those decisions to your doctor!
Most small babies catch up to their normal size around the age of two. But keep in mind, the lower the birth rate and the earlier the gestational age, the lower chance your child has to catch up. Does that mean your baby will have problems all throughout his life? Not necessarily, but regular monitoring of his progress is suggested so any problems that may arise can be quickly treated.
Generally IUGR does not occur in future pregnancies, but it remains a possibility. Gaining control over your own medical conditions and habits before attempting to get pregnant again will also decrease the risks.
Though IUGR is a cause for concern, regular checkups and close monitoring can mean the difference between a small healthy baby and a small sickly baby!