Intrauterine growth retardation refers to a prenatal disorder of development. Synonyms for intrauterine growth retardation are prenatal dystrophy and fetal hypertrophy.
What is intrauterine growth retardation?
Intrauterine growth retardation is a pathologic delay in the growth of an unborn child in the uterus (womb). Affected infants are referred to as SGA infants. SGA stands for “small for gestational age.” Intrauterine growth retardation, or IUGR for short, is when the weight and height of the unborn child are below the 10th percentile. The causes of IUGR can be genetic or influenced by environmental factors. The cause can be on the part of the child or can originate from the mother. Intrauterine growth retardation is usually discovered during prenatal care in the first or second trimester. About a quarter of all stillbirths are due to intrauterine growth retardation. Growth retardation can lead to metabolic changes in the fetuses, so affected infants have a higher risk of lethality.
Causes
One fetal cause of IUGR is chromosomal aberration. A chromosomal aberration is a chromosomal abnormality that affects a genome. The best known aberration is trisomy 21, also known as Down syndrome. Malformations such as agenesia or aplasia can also result in growth retardation. When viruses are transmitted from mother to child, they can affect fetal development and growth. Transmission occurs through the placenta. Infections of the mother with rubella, toxoplasma or genital herpes pose a particularly high risk of disease for the child. However, intrauterine growth retardation can also originate in the placenta. A common cause of retarded growth is a multiple pregnancy. Place-related growth deficits may occur in one or more children. Placental insufficiency also affects the growth of the baby. Acute placental insufficiency results from acute circulatory problems. Chronic placental insufficiency is caused by chronic diseases of the expectant mother. If hypertension and proteinuria occur during pregnancy, preeclampsia is usually present. A fetal complication of preeclampsia is intrauterine growth retardation. Maternal causes of growth retardation are autoimmune diseases and renal diseases. Gestational diabetes in the mother can also have a negative effect on the growth of the unborn child. The fetus also grows delayed if it receives too little oxygen. Such hypoxia can be caused by anemia, cardiovascular disease, or lung disease. Hypertension, alcohol abuse, and smoking during pregnancy also harm the unborn and cause delayed growth. Because of the risk of intrauterine growth retardation, some drugs are contraindicated during pregnancy.
Symptoms, complaints, and signs
Two forms of IUGR can be distinguished. The asymmetric form occurs in 70 percent of cases. Here, only the body weight is initially affected by the developmental disorder. The height is normal, but the abdominal girth is reduced. The children have too little subcutaneous fatty tissue and thus develop a very small and thin body, the proportion of which does not fit the head. In the symmetrical form of intrauterine growth retardation, the body weight and body length of the unborn child are reduced. The head circumference is in correct proportion to the rest of the body, but the overall body growth does not correspond to the normal values. Intrauterine growth retardation can cause drastic changes in the child’s metabolism. These metabolic abnormalities can expand and worsen after birth and increase the risk for certain chronic diseases later in life. These conditions include coronary artery disease (CAD), for example. This phenomenon is also known as fetal programming. Suboptimal conditions during pregnancy lead to irreversible susceptibility to disease in the unborn child.Intrauterine growth retardation results in structural changes in organs, altered cell number, altered blood supply and altered number of cell receptors. Children are initially able to compensate well for these changes, but as they grow older, they are more likely to develop diseases than children who were not affected by IUGR.
Diagnosis and disease progression
Intrauterine growth retardation is usually detected during prenatal care in the second or third trimester during ultrasound examination. Ultrasound-assisted fetometry, as it is called, is performed. This involves measuring the unborn child in the womb. Routine parameters include head circumference, biparietal diameter, circumference of the fetal abdomen and length of the femur. If abnormalities are detected, additional examinations are performed. These examinations include Doppler sonography and fetal blood gas analysis. Fetal blood gas analysis checks the oxygen level in the baby’s blood vessels. Cardiototography is used to record and monitor fetal heart activity. An amniocentesis may be performed. Here, amniotic fluid is extracted from the embryonic blastocyst by puncturing the amniotic sac. Special examinations of the amniotic fluid can clarify genetic diseases of the embryo. If an infection of the mother is suspected, a TORCH serology is performed. The TORCH complex refers to various infectious diseases that can pass to the unborn child during pregnancy. In the laboratory, the mother’s blood is tested for toxoplasma, coxsackie virus, syphilis, HIV, parvovirus B19, listeriosis, rubella, cytomegalovirus, and herpes simplex virus.
Complications
In this disease, growth retardation occurs in the womb. Usually, this disease leads to extreme sequelae after birth, resulting in a significant reduction in life expectancy. First and foremost, patients suffer from a greatly reduced body weight. Likewise, various lengths on the body may be deformed and damage to the internal organs occurs. Metabolic disorders can also occur as a result of growth retardation, leading to various complications in adulthood. In most cases, the symptoms of this disease cannot be completely controlled, resulting in reduced life expectancy and increased susceptibility to infections after the patient is born. In some cases, the patient’s mental development is also limited or severely slowed by this disease. Malformations of the heart may also occur. After birth, growth retardation cannot be treated causally. If the symptoms are detected before birth, the expectant mother should avoid drugs and follow a healthy lifestyle. This can limit further damage. If the growth retardation has arisen due to another disease, a premature birth may have to be induced. This may result in various complications.
When should you see a doctor?
An expectant mother should, in principle, participate in all preventive and control examinations offered during pregnancy. With these examinations, delays in the development of the embryo can be detected and diagnosed by the doctor in imaging procedures several months before the expected date of birth. If the expectant mother has a diffuse feeling that something might be wrong with the fetus or the general development during pregnancy, she should consult a doctor. If the pregnancy belly grows unusually little or if the pregnant woman’s weight gain is very low, these abnormalities should be discussed with a doctor. If the expectant mother notices any peculiarity of metabolism, it is necessary to consult a doctor. In case of disturbances of the heart rhythm, changes in blood pressure or palpitations, a doctor should be consulted. If there are sleep disturbances, fears or insecurities, it is advisable to consult a doctor. If there are genetic diseases in the family, these should be discussed with a doctor and specifically clarified.
Treatment and therapy
Therapy is given depending on the cause. Alcohol and nicotine use must be stopped immediately. One goal of therapy is to improve placental perfusion.Pregnant women often need to be on bed rest after diagnosis. Inpatient admission may be required. In severe cases, birth is also induced before the 37th week of pregnancy.
Outlook and prognosis
Intrauterine growth retardation is inconsequential to the health of the mother but has severe effects on the health of the unborn child. First, changes occur in the metabolism of the fetus, which ensure that physical functions cannot develop as they should for the child’s age. As a result, the child may be born with physical and mental developmental disorders. At best, the baby is underweight at birth and its development can be promoted by appropriate nutrition after birth so that it no longer suffers from intrauterine growth retardation later in life. At worst, the consequences result in an increased risk of certain chronic diseases that only appear later in life. For example, the risk of affected children developing coronary heart disease later in life is increased by intrauterine growth retardation. If the problem is caused by an underlying disease in the fetus, the prognosis for the baby’s future life depends heavily on this underlying disease. Because it is likely to be born underweight and very small, it has hardly any energy reserves to cope well with stresses caused by its underlying disease. Affected babies must receive medical care and be examined early after birth, because only in this way can physical and psychological damage be detected early and its consequences for health be contained in time.
Aftercare
Intrauterine growth retardation requires intensive medical care during and after pregnancy. Immediate treatment followed by follow-up care can contain the infant’s physical damage. This is very important for the health condition of the child. For the affected women, it is important to strictly follow the medical recommendations after the diagnosis. Here, the consistent bed rest is in the foreground. The expectant mother needs a lot of sleep and rest. This rest has a positive effect on the course of the disease and affects both the mother and the unborn child. The stress level should be lowered as much as possible. At the same time, physical exertion is a taboo for affected women. Depending on the situation, only short walks are allowed. The fresh air and light exercise stabilize the physical condition and also improve the mood. This has a positive effect on the psyche and the overall condition. Nutrition also plays a role. Together with the doctor, the patient should make adjustments to her diet in order to provide the body with sufficient nutrients. With balanced meals, plenty of vegetables and fresh fruit, the organism gets the necessary strength. Too few calories, on the other hand, can have a harmful effect on the further course of pregnancy.
This is what you can do yourself
In everyday life, there are some methods that affected people can use to help themselves. The most important thing to remember is that bed rest should be observed. This refers specifically to cases in which it has been prescribed by a doctor. In the context of bed rest, attention should be paid to the quality and quantity of sleep. Sufficient sleep is indispensable for the protection of the patient and the unborn child even without prescribed bed rest. General lifestyle also plays a role. If there is any stress level, it should be reduced to a minimum, if possible. In this way, the greatest possible protection of the sufferer can be achieved. Affected persons should keep any exertion to a minimum and avoid vigorous physical activity. However, this does not apply to short walks in the fresh air. These can have a positive effect on the psyche and body and thus contribute to an improvement of the condition. Furthermore, the diet of the patient should be monitored. If this is too one-sided, the diet should be changed. A suitable diet should include a balanced diet and plenty of fresh fruit and vegetables. Too little calorie intake can also be harmful. Therefore, care should be taken to ensure sufficient nutrient intake. Any nicotine or alcohol consumption should be stopped immediately after diagnosis.
