The baby’s growth retardation in utero

What is growth retardation in utero?

«My fetus is too small: is it stunted?»Be careful not to confuse a fetus a little smaller than the average (but which is doing perfectly well) and a real stunted growth. Stunted growth is suggested when a baby’s readings are below the 10th percentile. At birth, this results in a insufficient infant weight compared to the curves reference. the intrauterine growth retardation (RCIU) is from a pregnancy complication which results in an insufficient size fetus for the age of pregnancy. Growth curves during pregnancy are expressed in “percentiles”.

How to screen for fetal growth retardation?

It is often a fundal height too small for the term of the pregnancy that alerts the midwife or the doctor, and leads them to request an ultrasound. This exam can diagnose a large number of intrauterine growth delays (however, almost a third of IUGRs are not discovered until birth). The baby’s head, abdomen and femur are measured and compared to reference curves. When the measurements are between the 10th and 3rd percentile, the delay is said to be moderate. Below the 3rd, it is severe.

The ultrasound examination continues with the study of the placenta and amniotic fluid. A decrease in fluid volume is a severity factor that indicates fetal distress. The baby’s morphology is then studied to look for possible fetal malformations causing the growth problem. To control the exchanges between mother and baby, a fetal umbilical doppler is performed.

Are there many kinds of stunting?

Two categories of delay exist. In 20% of cases, it is said to be harmonious or symmetrical and concerns all growth parameters (head, abdomen and femur). This type of delay begins early in pregnancy and often raises concerns about genetic abnormality.

In 80% of cases, growth retardation appears late, in the 3rd trimester of pregnancy, and affects only the abdomen. This is called dysharmonious growth retardation. The prognosis is better, since 50% of children catch up with their weight loss within a year of birth.

What are the causes of growth retardation in utero?

They are multiple and come under various mechanisms. Harmonious IUGR are mainly due to genetic (chromosomal abnormalities), infectious (rubella, cytomegalovirus or toxoplasmosis), toxic (alcohol, tobacco, drugs) or medicinal (antiepileptic) factors.

The so-called RCIUs disharmonious are most often the consequence of placental lesions which lead to a decrease in nutritional exchanges and oxygen supply, essential to the fetus. As the baby is poorly “nourished”, he no longer grows and loses weight. This occurs in preeclampsia, but also when the mother suffers from certain chronic diseases: severe diabetes, lupus or kidney disease. Multiple pregnancy or abnormalities of the placenta or the cord can also cause stunted growth. Finally, if the mother is malnourished or suffers from severe anemia, it can disrupt the growth of the baby. However, for 30% of IUGRs, no cause is identified.

RCIU: are there women at risk?

Certain factors predispose to stunted growth: the fact that the mother-to-be is pregnant for the first time, that she suffers from a malformation of the uterus or is small (<1,50 m). Age also matters, since the RCIU is more frequent before 20 years or after 40 years. Poor socio-economic conditions also increase the risk. Finally, maternal disease (cardiovascular disease, for example), as well as insufficient nutrition or a history of IUGR can also increase its occurrence.

Stunted growth: what consequences for the baby?

The impact on the child depends on the cause, severity and date of onset of the growth retardation during pregnancy. It is all the more serious when the birth takes place prematurely. Among the most common complications are: biological disturbances, poorer resistance to infections, poor regulation of body temperature (babies warm up poorly) and an abnormal increase in the number of red blood cells. Mortality is also higher, especially in infants who have suffered from a lack of oxygen or have serious infections or deformities. If the majority of babies catch up with their growth retardation, the risk of permanent short stature is seven times higher in children born with intrauterine growth retardation.

How is stunting treated?

Unfortunately, there is no cure for IUGR. The first measure will be to put the mother to rest, lying on her left side, and in severe forms with the onset of fetal distress, to deliver the baby earlier.

What precautions for a future pregnancy?

The risk of a recurrence of IUGR is around 20%. To avoid it, some preventive measures are offered to the mother. Ultrasound monitoring of the baby’s growth or screening for hypertension will be strengthened. In case of toxic IUGR, the mother is recommended to stop using tobacco, alcohol or drugs. If the cause is nutritional, diet and vitamin supplementation will be prescribed. Genetic counseling is also undertaken in the event of a chromosomal abnormality. After birth, the mother will be vaccinated against rubella if she is not immune, in preparation for a new pregnancy.

Do you want to talk about it between parents? To give your opinion, to bring your testimony? We meet on https://forum.parents.fr.