Growth Retardation also known as intrauterine growth restrictions (IUGR) refer to the poor growth and development of the fetus inside a mother’s womb. At least 60 per cent of the 4 million neonatal deaths occurring worldwide each year are due to low birth weight caused by intrauterine growth restriction, preterm delivery and genetic/chromosomal abnormalities. Therefore, fetuses with IUGR are much smaller compared to other fetuses of the same gestational age.
There are two forms of growth retardation – asymmetrical and symmetrical. In asymmetrical IUGR, the head of the fetus is of normal size but the size of the body is much smaller and thinner. Generally the embryo/fetus grows to a normal size in the first two trimesters but have difficulties in the third trimesters due to secondary complications like pre-eclampsia. Therefore, babies having asymmetrical IUGR may develop hypoxia (low availability of oxygen in the blood that may be localized or generalized) and hypoglacaemia (low blood sugar level). It is more common than symmetrical IUGR. It is mainly caused by chronic high blood pressure, severe malnutrition and genetic mutations. In symmetrical IUGR, the size of the body and head are proportional but they are just smaller compared to other fetus of their age. It is cause by early intrauterine infections (cytomegalovirus, rubella), chromosomal abnormalities, anemia and maternal substance abuse.
The cause of IUGR can be categorized into maternal, fetal and uterine/placental factors. Maternal causes include chronic diseases (diabetes, kidney problems, heart disease or respiratory disease), hypertension, malnutrition, anemia, infections, substance abuse and smoking. Infection, birth defects and chromosomal abnormalities are termed as fetal causes. Intrauterine causes mainly arise due to placental abruption or other disease like pre-eclampsia (occurring due to gestational hypertension) and multiple gestations. It should be noted that placenta previa, a condition where the placenta attaches too low in your uterus also causes IUGR. Therefore, treatment will generally depend on the cause of IUGR.
Treatment and diagnosis goes hand in hand for IUGR as there is no definite way of preventing or treating IUGR. In most cases doctors or gynecologists will monitor you if you have one of the conditions (diabetes, smoking, and hypertension) that can lead to IUGR. However, an ultrasound screening during your monthly prenatal check-up will help your gynecologist in identifying IUGR in your fetus. If it is detected, then a combination monitoring and management strategy is used by the doctor to protect you and your baby.
One of the monitoring techniques is an umbilical artery Doppler which is a method used and shown to decrease morbidity and mortality before and after childbirth in cases of IUGR. Time of delivery is also a management strategy and is based on the Doppler artery scan. The test measures pulsatility index, resistance index and end-diastolic velocities to measure fetal circulation in the womb. Based on which your doctor will suggest an induced labour to protect you and your baby.
It is very difficult to diagnose IUGR as most babies born now a days have low birth weight which is a sign of worry among doctors and mother alike. However, during your monthly prenatal check-up, when you undergo ultrasound and it shows smaller fetus size compared to normal gestational age, then your baby might have IUGR and you will need to consult with your doctor or gynecologist to go for the best possible treatment available.
As there is no definite treatment for IUGR, any women who have a normal pregnancy with no indication of IUGR in their ultrasound have no cause of worry.
There are no possible side effects of IUGR treatment. However, severe IUGR generally leads to stillbirth and low infant mortality. Moreover, babies born with IUGR have various health complications like low oxygen level, low blood sugar, increased red blood cells, failure to maintain a normal body temperature, problems in breastfeeding or consumption of food, learning disabilities, delayed motor and social development, infections and neurological problems. They also have low Apgar score which is a measure of their health at birth.
There are no post-treatment guidelines for IUGR. However, it can be prevented by following a better maternal dietary plan which is one of the most important factors determining low birth weight of babies. Try to include healthier food options like home-cooked meals. Don’t eat junk or street foods and also processed foods that has zero nutrition and minerals. Take folic acid and zinc supplements as prescribed by your doctor as they form an important part of prenatal vitamins. Folic acid is vital as it prevent neural tube defects in fetus and megaloblastic anemia in the mother. Don’t smoke or drink alcohol during your pregnancy as it can be fatal for the fetus and the mother and lead to increased risk of developing IUGR.
Recovery period usually is the same as a normal pregnacy ranging from one week to a moth depending upon the type of delivery you had. However,babies born with IUGR needs extra care and support to maintain their weight and improve their health.
The cost for treating IUGR is similar to a normal childbirth and will depend on the type of delivery, normal or C-section. If you have a normal delivery, then the price usually starts at Rs.10,000 and go up to Rs.50,000. If you have a C-section, then price usually starts at Rs.80,000 and go up to Rs.10,00,000.
As there is no proper treatment for IUGR, the results of treatment is niether permanant nor semi-permanent. Having an induced childbirth will result in a baby having IUGR.
There are no alternative treatment for Growth Retardation.