Growth Retardation | Causes of IUGR and Treatment | Nutrition

Growth retardation

What is growth retardation?

Growth retardation occurs when your fetus is not developing at a normal rate. This is called intrauterine growth control (IUGR). The term intrauterine growth retardation is also used.

IUGR embryos are much smaller than other fetuses of the same gestational age. The term is also used for babies weighing less than 5 pounds 8 ounces at birth.

There are two forms of stunting: symmetric and asymmetric. Babies with symmetrical IUGR usually have a proportionate body, which is younger than most children in their gestational age. Children with an asymmetric IUGR have a normal-sized head. However, her body is much smaller than that. On ultrasound, your head appears much larger than your body.

Symptoms of growth retardation

The main feature of IUGR is that the gestational age is shorter for the baby. During a prenatal checkup, a doctor measures the height of the uterus from the pubic bone to estimate the size of the fetus. After about week 20, the height of the cervical fundus in centimetres is usually equal to the number of weeks of pregnancy. A record with a fundus height of 4 cm or more with gestational age indicates IUGR and requires additional tests to confirm the diagnosis.

During the ultrasound, the estimated weight of the IUGR baby is less than 10% or less than 90% of babies of the same gestational age. Literally, birth weight less than 2500 g (5 lb, 8 ora) is considered IUGR. Not all babies born small have IUGR. In the most severe cases, IUGR can cause labour.

At birth, the symptoms of IUGR are:

  • The baby is small or malnourished.
  • Thin, pale, loose, and dry skin
  • The umbilical cord is thin and is often stained with meconium.

Causes of growth retardation

IUGR has many causes related to the mother, the fetus, and the placenta (the part where the mother and fetus meet). Summary of various risk factors for IUGR-

Maternal causes

Before pregnancy:

  • Prenatal weight and small maternal height
  • Nutritional status of poor preconception, such as anaemia, folate deficiency
  • Low socioeconomic status
  • Equality: none and more than 5 births
  • Recent pregnancy

During pregnancy:

  • Weight loss during pregnancy, especially in the last part.
  • Moderate to intense physical activity
  • Chronic disease, such as malabsorption, diabetes, kidney disease
  • Some drugs, smoking, and alcohol use
  • Pregnancy-induced hypertension
  • At higher altitudes, the availability of oxygen decreases, such as severe maternal anaemia.

Cervical and placental factors:

  • Placental abruption is not enough
  • Cervical deformities
  • Decreased cervical blood flow (such as toxaemia of pregnancy, diabetic vasculopathy)
  • Multiple pregnancies

Symmetric or primary IUGR is due to genetic or chromosomal causes, intrauterine infections of early pregnancy (TORCH), and maternal alcoholism.

Asymmetric IUGR is high due to external influences affecting the fetus during pregnancy such as pre-eclampsia, chronic hypertension, and cervical disorders. 

Diagnosis of growth retardation

The most important thing when diagnosing IUGR is knowing the exact gestational age of the baby. Gestational age can be calculated using the first day of the last trimester (LMP) and by early ultrasound calculations. The following methods can be used to diagnose IUGR once the gestational age is known.

Fundal height: This is a straightforward and simple method of diagnosing IUGR. The height of the uterine fundus is the size of the uterus, measured in centimetres from the pubic bone to the top of the uterus. After the 20th week of pregnancy, the measurement in centimetres usually corresponds to the number of weeks of pregnancy. A record with a bottom height of 4 cm or more indicates IUGR.

Weight checks: Doctors routinely check and record the mother’s weight at each prenatal checkup. If a mother does not gain weight properly, it indicates a growth problem in her baby.

Ultrasound: Used to measure the baby’s head and abdomen and is compared with growth charts to estimate the baby’s weight Ultrasound can also be used to determine amniotic fluid.

Doppler evaluation: A technique that uses sound waves to measure the volume and speed of blood flow through blood vessels. Doctors can use this test to check the blood flow in the umbilical cord and the vessels in the baby’s brain. Abnormal Doppler tests are the diagnosis of IUGR.

Treatment of growth retardation

Depending on the cause, IUGR may be reversible.

Before treatment, your doctor may monitor your fetus by:

  • Ultrasound, to see how your organs are developing and to check normal movements.
  • By monitoring your heart rate, your heart rate increases as you move.
  • Doppler flow studies, to make sure your blood is flowing properly.
  • Treatment focuses on resolving the root cause of IUGR. Depending on the cause, one of the following treatment options may be helpful:
  • Increase your nutrient intake

This will ensure that your fetus receives adequate nutrition. If you don’t eat enough, your baby may not have enough nutrients.

Bed rest

You can put it on bed rest to help improve the circulation of your fetus.

Induced labour

In severe cases, early delivery may be necessary. This allows your doctor to intervene before the IUGR damage worsens. Induced labour is necessary only if your fetus has stopped growing completely or has serious medical problems. Generally, your doctor will prefer to allow it to grow as long as possible before delivery.

Key point

Placental abruption: Premature separation of the placenta from the uterine wall. It occurs late in pregnancy and may not constitute a maternity emergency.

Circulatory placenta: The presence of a thick, rounded, white, opaque ring around the edge of the placenta that restricts the expansion of the fetal vessels

Background: Inside an organ. In the eye, the fundus represents the posterior region visible with the ophthalmoscope.

Hemoglobinopathies: Abnormal levels of haemoglobin in the blood, that is, sickle cell anaemia, thalassemia.

Hyperplasia: A condition in which the cells that make up the prostate gland divide abnormally quickly, causing the organ to expand.

Hypertrophy: An increase in the size of a tissue or organ due to the proliferation of its cells instead of cell multiplication.

Hypoplasia: Underdeveloped or incomplete tissue or organ due to a decrease in the number of cells.

The placenta: The organ that provides oxygen and nutrition from the mother to the fetus during pregnancy. The placenta attaches itself to the wall of the uterus and carries the fetus through the umbilical cord.

Placenta previa: The placenta totally or partially covers the uterus, preventing vaginal delivery.

Placental infarction: An area of ​​dead tissue in the placenta that interferes with circulation in that area.

Preeclampsia: Develops after the 20th week of pregnancy and causes high blood pressure, fluid retention, and large amounts of protein in the urine. Without treatment, it can lead to a dangerous condition called eclampsia, in which a woman falls into a coma.

It indicates a lack of blood flow from the uterus to the placenta, resulting in a decrease in nutrition and oxygen to the fetus.

Velamentous insertion of the umbilical cord: close to the membranes (water sac) or layers of the umbilical cord.

Complications

Growth retardation can cause many health problems during pregnancy, delivery, and after birth. In addition to:

  • Difficulties during vaginal delivery
  • Low Apgar scores (test performed immediately after birth to assess the physical condition of the newborn and determine the need for specialized medical care)
  • Meconium aspiration (inhalation of stool while in utero), which can lead to breathing problems
  • Low birth weight
  • Hypoglycemia (low blood sugar)
  • High red blood cell count
  • Low resistance to infection.
  • Difficulty maintaining body temperature.

Prevention

Growth retardation occurs even when the mother is perfectly healthy, although some steps can be taken to reduce the risk of IUGR and increase the chances of a healthy pregnancy and baby.

Precautions during pregnancy:

  • Providing care for preschool and middle-aged women (care between conceptions) improves the chances that mothers and children will be healthy.
  • Prescribe a healthy diet and physical activity in their daily routine so that women improve weight and heart condition before pregnancy.
  • Diagnosis and management of chronic diseases such as hypertension and diabetes before pregnancy.
  • Correction of anaemia/replacement of folic acid before pregnancy.

Care during pregnancy:

  • Pregnant mothers should only take medications prescribed by a doctor.
  • A healthy diet should be prescribed for pregnant women with behavioural changes to promote healthy eating habits during pregnancy. A nutritious diet with nutrients can be provided to pregnant women.
  • Pregnant women are advised to get enough rest at night with adequate sleep and an hour or two of rest in the afternoon.
  • Pregnant women must follow healthy lifestyle habits. Tobacco, smoking, and alcohol consumption should be avoided during pregnancy.
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