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Be aware of risk factors for fetal growth restriction

Be aware of risk factors for fetal growth restriction

Fetal growth restriction, also called intrauterine growth restriction (IUGR), is the term used to designate a fetus that has not reached its growth potential due to genetic or environmental factors. It can be caused by fetal, placental and / or maternal factors, but we are not always able to perform such identification. This term should not be used to describe a constitutionally small fetus that is healthy.

Fetal Factors

1. Genetic - studies have revealed that genetic factors influence between 30 and 50% in the variation of the birth weight. The rest is due to environmental factors. Maternal genes influence birth weight more than paternal genes, but both have their share.

Women who give birth to a restricted growth fetus are more at risk of this in the next pregnancy and the risk increases the greater the number of children with restricted growth has.

The presence of a chromosomal abnormality usually results in restriction of fetal growth already in early pregnancy.

Mild degrees of nutritional deficiency also have an effect on the baby's birth weight .

Chromosomal abnormalities associated with intrauterine growth restriction include trisomy 18 or 13, Turner's syndrome, among others.

2. Multiple gestation - fetal growth in multiple gestations is directly related to the number of fetuses present and whether or not they are identical. The lower weight of multiple gestation fetuses is due to the inability of the environment to meet the nutritional needs of multiple fetuses, as well as pregnancy complications most common in multiple gestations, such as maternal malnutrition, preeclampsia, and congenital anomalies.

3. Infection - infections that develop in early pregnancy have a greater effect on the growth of the baby, but account for less than 5% of all cases of fetal growth restriction (FHR). Viruses and parasites, such as rubella, toxoplasmosis, cytomegalovirus, varicella-zoster, malaria, syphilis and herpes, may have access to the fetus through the placenta or through intact fetal membranes, impairing fetal growth by a variety of mechanisms, from cell death to vascular failure.

High-altitude residents also suffer from chronic hypoxemia and generate children with low birth weight.

Placental factors

Many cases of particularly recurrent FHR are result of ischemic placental disease. This term refers to a process of placental disease which, clinically, manifests itself as preeclampsia, restriction of fetal growth, placental abruption or the combination of these disorders. All of these disorders may be associated with preterm birth or fetal loss and represent late manifestations of abnormal placental development.

1. Macroscopic and histological lesions - any mismatch between nutritional or respiratory fetal requirements and placental delivery may result in impaired fetal growth.

Maternal factors

1. Reduced blood flow to the uterus - may be decreased by defective development, obstruction, or rupture of utero-placental vessels. Maternal medical disorders such as hypertension, renal insufficiency, diabetes, collagen vascular disease, systemic lupus erythematosus and antiphospholipid syndrome; and obstetric complications, such as pre-eclampsia, decrease satisfactory blood delivery to the utero-placental combo and result in RFL.

2. Impaired caloric intake - Pre-gestational weight and weight gain during pregnancy are generally responsible for about 10% of fetal weight variation. However, severe maternal hunger during pregnancy can have a major impact on fetal growth.

Premature baby - Photo Getty Images

The Dutch population, for example, suffered great hunger during the winter of 1944, making the caloric intake maternal fall to a value between 450 and 750 kcal per day. As a result of this deprivation, the mean infant birth weight during this period decreased by 250 grams. Similarly, in Leningrad during World War II, longer and deeper hunger periods (below 300 kcal) made the average weight of babies fall by more than 500 grams.

Mild degrees of nutritional deficiency also have effect on the birth weight. Women who are underweight in early pregnancy or who have impaired weight gain during pregnancy are at greater risk of giving birth to a baby weighing less than 2,500 grams.

Poor absorption of nutrients in pregnant women with celiac disease (gluten intolerance) has also been associated with intrauterine growth restriction.

Smoking during the third trimester appears to have a greater impact on birth weight.

3. Hypoxemia? Hypoxemia (less oxygen to the tissues) Chronic maternal due to lung disease, heart disease and severe anemia are associated with decreased fetal growth. As an example, a study of 96 pregnancies of women with congenital heart disease reported that the average birth weight of babies at term was only 2,575 grams, which is significantly lower than the mean birth weight of 3,500 grams in the High - altitude residents also suffer from chronic hypoxemia and low birth weight.

4. Hematological and immunological diseases -

Hematologic diseases, such as sickle cell anemia, can cause placental thrombosis. Autoimmune diseases can cause chronic inflammation of the placenta and this can cause fetal malnutrition and hypoxia. 5. Drug use and smoking -

Smoking, alcohol consumption and the use of illicit drugs may cause intrauterine growth restriction, either by a direct or indirect toxic effect from related variables such as inadequate feeding. Smoking during the third trimester seems to have a greater impact on birth weight. Women who quit smoking in the third trimester may have birth weights similar to those of nonsmokers. Caffeine consumption may have a small negative effect on fetal growth.

Numerous studies have attempted to determine the relationship between exposure of pregnant women to environmental tobacco smoke and passive smoking with the birth weight of the baby. Results were discordant, although most show an increased risk of low weight in women with secondhand smoke. These studies are limited by the difficulty in accurately quantifying maternal exposure and adjusting for multiple factors affecting birth weight.

6. Toxins -

Toxic substances, including various medicinal products, such as anticonvulsants and antineoplastics, may produce growth restriction. It is unclear whether growth restriction in hypertensive women is only a result of the disease or in part a side effect of antihypertensive drugs. Caffeine consumption may have a small negative effect on fetal growth.

7. Assisted Reproductive Technologies

- Pregnancy designed through assisted reproductive technologies increase the risk of low fetal weight. 8. Other -

growth restriction is more common among pregnant women at the extremes of reproductive life, therefore adolescents and women over 40. Chronic maternal stress may also be a factor and is an active area of ​​research. Chronic stress is associated with high levels of hormones which, in turn, may be associated with impaired fetal growth and premature delivery.In some cases, the reason for restricting fetal growth, often severe, is still uncertain. But good prenatal care can make the mother and baby reach the end of healthy pregnancy.


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