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Micrograph of villitis of unknown etiology, aplacental pathology associated with IUGR. H&E stain. ICD-10 ICD-9 DiseasesDB MedlinePlus eMedicine MeSH P05.9 764.9 6895 001500 article/261226 D005317
Intrauterine growth restriction (IUGR) refers to poor growth of a baby while in the mother's womb during pregnancy. The causes can be many, but most often involve poor maternal nutrition or lack of adequate oxygen supply to the fetus.
At least 60% of the 4 million neonatal deaths that occur worldwide every year are associated with low birth weight (LBW), caused by intrauterine growth restriction (IUGR), preterm delivery, and genetic/chromosomal abnormalities,[1] demonstrating that under-nutrition is already a leading health problem at birth. Intrauterine growth restriction can result in baby being Small for Gestational Age(SGA), which is most commonly defined as a weight below the 10th percentile for thegestational age.[2] At the end of pregnancy, it can result in a low birth weight.
Chronic high blood pressure Severe malnutrition Genetic mutations, EhlersDanlos syndrome
Symmetrical IUGR is less common and is more worrisome. It is less commonly known as global growth restriction, and indicates that the fetus has developed slowly throughout the duration of the pregnancy and was thus affected from a very early stage. The head circumference of such a newborn is in proportion to the rest of the body. Since most neurons are developed by the 18th week of gestation, the fetus with symmetrical IUGR is more likely to have permanent neurological sequela. Common causes include:
Early intrauterine infections, such as cytomegalovirus, rubella or toxoplasmosis Chromosomal abnormalities Anemia Maternal substance abuse (prenatal alcohol use can result in Fetal alcohol syndrome)
Causes[edit]
Maternal[edit]
pre-pregnancy weight and nutritional status poor weight gain during pregnancy poor nutrition anemia alcohol and/or drug use maternal smoking recent pregnancy pre-gestational diabetes gestational diabetes pulmonary disease
Uteroplacental[edit]
Fetal[edit]
Pathophysiology[edit]
If the cause of IUGR is extrinsic to the fetus (maternal or uteroplacental), transfer of oxygen and nutrients to the fetus is decreased. This causes a reduction in the fetus stores of glycogen and lipids. This often leads to hypoglycemia at birth. Polycythemia can occur secondary to increased erythropoietin production caused by the chronic hypoxemia. Hypothermia, thrombocytopenia, leukopenia,hypocalce mia, and pulmonary hemorrhage are often results of IUGR. If the cause of IUGR is intrinsic to the fetus, growth is restricted due to genetic factors or as a sequela of infection.
Cerebral Changes[edit]
white matter effects In postpartum studies of infants, it was shown that there was a decrease of the fractal dimension of the white matter in IUGR
infants at one year corrected age. This was compared to at term and preterm infants at one year adjusted corrected age. grey matter effects Grey matter was also shown to be decreased in infants with IUGR at one year corrected age.