Your Pregnancy After 35 : How Your Baby Grows and Develops (part 4) - Intrauterine-Growth Restriction

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12. Intrauterine-Growth Restriction (IUGR)

Intrauterine-growth restriction (IUGR) indicates a fetus is small for its gestational age. Weight is below the tenth percentile (in the lowest 10%) for the baby’s gestational age. This means 9 out of 10 babies of normal growth are larger.

When gestational age is appropriate—meaning dates are correct and the pregnancy is as far along as expected—and weight falls below the tenth percentile, it’s a cause for concern. Growth-restricted fetuses have a higher rate of problems than infants in the normal-weight range.

Diagnosing IUGR can be difficult. Your doctor measures you at each visit to see how your uterus and baby are growing. A problem is usually found by measuring the uterus over a period of time and finding no change. If you measured 10¾ inches (27cm) at 27 weeks gestation and at 31 weeks you measure only 11 inches (28cm), your doctor might become concerned about IUGR and may order tests.

Diagnosing this problem is one important reason to keep all your prenatal appointments. You may not like being measured and weighed at every appointment, but it helps your doctor see if your pregnancy is growing and baby is getting bigger.

IUGR can be diagnosed or confirmed by ultrasound. Ultrasound may also be used to assure baby is healthy and no malformations exist that must be taken care of at birth.

When IUGR is diagnosed, avoid doing anything that could make it worse. Bed rest is another treatment.

An infant with IUGR is at risk of dying before delivery. Avoiding this may involve delivering the baby before it is full term. Infants with IUGR may not tolerate labor; a Cesarean delivery is more likely because of fetal stress. The baby may be safer outside the uterus than inside of it.

Becky said she weighed 9 pounds at birth, and all her brothers and sisters were also big. She was worried her baby would be so big she’d need a Cesarean delivery. I reassured her that her pregnancy growth had been normal and told her it was difficult to estimate the size of the baby. She laughed and relaxed a little when I told her if 100 healthcare providers tried to guess the weight of her baby, the guesses would range from 6 to 8 pounds. When she delivered the baby, it weighed 8 pounds, and Becky did fine.

Causes of IUGR

What causes IUGR? Many conditions can increase the chance of intrauterine-growth restriction or a small fetus. Research shows a woman who has delivered a growth-restricted infant may be more likely to do so again in sub sequent pregnancies.

Lifestyle choices can cause IUGR. Smoking can inhibit a baby’s growth. The more cigarettes smoked, the smaller the baby. Alcohol and drug use can also restrict growth. Anything that causes baby to receive less nutrition can be a factor.

How Often Birth Defects Actually Occur

Birth defects aren’t as common as you might think. Below is a chart showing how often they occur in North America.

Cleft lip/cleft palate 1 in 730 births
Clubfoot 1 in 1000 births
Congenital heart defects 1 in 125 births
Dislocated hips 1 in 400 births
Down syndrome 1 in 900 births
Neural-tube defects 1 in 1600 births
Pyloric stenosis 1 in 250 births
Sickle-cell disease 1 in 400 births of Black/African-American babies

A woman who doesn’t gain enough weight may have a growth-restricted baby. Research indicates when you eat fewer than 1500 calories a day for an extended time, IUGR may result, so practice good nutrition and eat a healthful diet during pregnancy. Don’t restrict normal pregnancy weight gain.

Pre-eclampsia and high blood pressure (hypertension) can have a marked effect on fetal growth. Cytomegalovirus, rubella, kidney disease and other infections may also restrict fetal growth. Maternal anemia may be a cause.

Women who live at high altitudes are more likely to have babies who weigh less. Carrying more than one baby may also be causes of a smaller-than-normal baby.

Other reasons for a small baby, unrelated to IUGR, include the fact that a woman who is small might have a small baby. In addition, an overdue pregnancy can lead to an undernourished, smaller baby. A malformed or abnormal fetus may also be smaller, especially when chromosomal abnormalities are present.

Ways to Deal with IUGR

The greatest risk associated with IUGR is stillbirth (the baby dies before delivery). Delivery of the baby before full term may be required to avoid this serious problem. The following advice may help you avoid giving birth to a low-birthweight baby.

Gain enough weight during pregnancy. This may mean changing your body image and your eating habits.

Quit smoking before pregnancy, and avoid second-hand and third-hand smoke.

Get prenatal care as soon as you find out you’re pregnant. Keep all your prenatal appointments.

Follow your healthcare provider’s suggestions and instructions during your pregnancy.

If you’re considering fertility treatment, understand the risks as well as the benefits of ART and multiple births (multiple births often deliver early or prematurely).

Ask your healthcare provider about screening for lower-genital-tract infections early in pregnancy.

Wait at least 18 months between delivery of one baby and conception of the next.

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