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Intrauterine Growth Restriction: Intervention Strategies

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Neonatology

Abstract

Intrauterine growth restriction (IUGR) or fetal growth restriction (FGR) is defined as a pregnancy in which the fetus fails to achieve his/her genetically determined growth potential or optimal growth. Optimal fetal growth is defined as birth weight achieved in the absence of fetal, maternal or placental factors that can exert a pathological effect on growth [1]. Clinically, whether the fetus or newborn has achieved appropriate growth for gestation is inferred from gender-specific standardized growth charts. IUGR is diagnosed if the weight is below the 10th percentile for a given gestational age. During pregnancy, the diagnosis is made if the estimated fetal weight (EFW) has either fallen below the 10th percentile or if it is on a downward trajectory on consecutive measurements indicating that IUGR can be diagnosed even if the EFW is within the normal percentiles.

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References

  1. Blair EM, Liu Y, de Klerk NH, Lawrence DM (2005) Optimal fetal growth for the Caucasian singleton and assessment of appropriateness of fetal growth: an analysis of total population perinatal database. BMC Pediatr 5:13–25

    Article  PubMed  Google Scholar 

  2. WHO Department of Nutrition for Health and Development (2009) WHO Child Growth Standards. http://www.who.int/childgrowth/publications/technical_report_velocity/en/index.html

  3. Garite TJ, Clark R, Thorp JA (2004) Intrauterine growth restriction increases morbidity and mortality among premature neonates. Am J Obstet Gynecol 191:481–487

    Article  PubMed  Google Scholar 

  4. Barker DJP (2004) The developmental origins of adult disease. Am J Nutrition 23:588S–595

    CAS  Google Scholar 

  5. Hanson M, Gluckman P, Bier D et al (2004) Report on the 2nd World Congress on Fetal Origins of Adult Disease. Pediatr Res 55:894–897

    Article  PubMed  Google Scholar 

  6. Sibley C (2009) Understanding placental nutrient transfer-why bother? New biomarkers of fetal growth. J Physiol 14:3431–3440

    Article  Google Scholar 

  7. Desforges M, Sibley CP (2010) Placental nutrient supply and fetal growth. Int J Dev Biol 54:377–390

    Article  PubMed  CAS  Google Scholar 

  8. Rodenhiser D, Mann M (2006) Epigenetics and human disease: translating basic biology into clinical applications. CMAJ 174:341–348

    Article  PubMed  Google Scholar 

  9. Meaney MJ, Szyf M, Seckl JR (2007) Epigenetic mechanisms of perinatal programming of hypothalamic-pituitary-adrenal function and health. Trends Mol Med. 13:269–277

    Article  PubMed  CAS  Google Scholar 

  10. Murphy VE, Smith R, Giles WB, Clifton VL (2006) Endocrine regulation of human fetal growth: the role of the mother, placenta, and fetus. Endocr Rev 27:141–169

    Article  PubMed  Google Scholar 

  11. Japaraj RP, Ho JJ, Valliapan J, Sivasangari S (2009) Symphysial fundal height measurement (SFH) in pregnancy for detecting abnormal fetal growth. Cochrane Pregnancy and Childbirth Group. Cochrane Database Syst Rev 4:CD008136

    Google Scholar 

  12. Nabhan AF, Abdelmoula YA (2008) Amniotic fluid index versus single deepest vertical pocket as a screening test for preventing adverse pregnancy outcomes. Cochrane Pregnancy and Childbirth Group, Cochrane Database Syst Rev 3:CD006593

    Google Scholar 

  13. Baschat AA (2004) Pathophysiology of fetal growth restriction: Implications for diagnosis and surveillance. Obstet Gynecol Surv 59:617–627

    Article  PubMed  Google Scholar 

  14. Lalor JG, Fawole B, Alfirevic Z, Devane D (2008) Biophysical profile for fetal assessment in high risk pregnancies. Cochrane Pregnancy and Childbirth Group, Cochrane Database of Sys Rev 1:CD000038

    Google Scholar 

  15. Alberry M, Soothill P (2007) Management of fetal growth restriction. Arch Dis Child Fetal Neonatal Ed 92:F62–67

    Article  PubMed  CAS  Google Scholar 

  16. Gupta MB, Seferovic MD, Liu S et al (2007) Altered proteome profiles in maternal plasma in pregnancies with fetal growth restriction: Differential haptoglobin α2 isoforms as a potential biomarker. Clinical Proteomics 2:169–184

    Article  Google Scholar 

  17. Abu Shehab M, Inoue S, Han VKM, Gupta MB (2009) Site-specific phosphorylation of insulin-like growth factor binding protein-1 (IGFBP-1) for evaluating clinical relevancy in fetal growth restriction. J Proteome Res 8:5325–5335

    Article  PubMed  CAS  Google Scholar 

  18. Albion C, Dixon S, Nygard K et al (2009) Effects of maternal nutrient restriction on placental phenotype and insulin-like growth factor system and glucocorticoid metabolism system expression The Endocrine Society’s Annual Meeting, Washington DC, June 10–13, 2009

    Google Scholar 

  19. Say L, Gülmezoglu AM, Hofmeyr GJ (2003) Maternal nutrient supplementation for suspected impaired fetal growth. Cochrane Pregnancy and Childbirth Group, Cochrane Database Sys Rev 1:CD000148

    Google Scholar 

  20. Kramer MS, Kakuma R (2003) Energy and protein intake in pregnancy. Cochrane Pregnancy and Childbirth Group, Cochrane Database Syst Rev 4:CD000032

    Google Scholar 

  21. Rozance PJ, Limesand SW, Barry JS et al (2009) Glucose replacement to euglycemia causes hypoxia, acidosis, and decreased insulin secretion in fetal sheep with intrauterine growth restriction. Pediatr Res 65:72–78

    Article  PubMed  CAS  Google Scholar 

  22. Makrides M, Duley L, Olsen SF (2006) Marine oil, and other prostaglandin precursor, supplementation for pregnancy uncomplicated by preeclampsia or intrauterine growth restriction. Cochrane Pregnancy and Childbirth Group, Cochrane Database Syst Rev 3:CD003402

    CAS  Google Scholar 

  23. Say L, Gülmezoglu AM, Hofmeyr GJ (2003) Maternal oxygen administration for suspected impaired fetal growth. Cochrane Pregnancy and Childbirth Group, Cochrane Database Sys Rev 1:CD000137

    Google Scholar 

  24. Eremia SC, de Boo HA, Bloomfield FH et al (2007) Fetal and amniotic insulin-like growth factor-I supplements improve growth rate in intrauterine growth restriction fetal sheep. Endocrinology 148:2963–2972

    Article  PubMed  CAS  Google Scholar 

  25. Leitich H, Egarter C, Husslein P et al (1997) A meta-analysis of low dose aspirin for the prevention of intrauterine growth retardation. Br J Obstet Gynaecol 104:450–459

    Article  PubMed  CAS  Google Scholar 

  26. Kozer E, Costei AM, Boskovic R et al (2003) Effects of aspirin consumption during pregnancy on pregnancy outcomes: metaanalysis. Birth Defects Res B Dev Reprod Toxicol 68:70–84

    Article  PubMed  CAS  Google Scholar 

  27. Sieroszewski P, Suzin J, Karowicz-Bilińska A (2004) Ultrasound evaluation of intrauterine growth restriction therapy by a nitric oxide donor (L-arginine). J Matern Fetal Neonatal Med 15:363–366

    Article  PubMed  CAS  Google Scholar 

  28. Say L, Gülmezoglu AM, Hofmeyr GJ (1995) Bed rest in hospital for suspected impaired fetal growth. Cochrane Pregnancy and Childbirth Group, Cochrane Database Sys Rev 1:CD000034

    Google Scholar 

  29. Kramer MS, MacDonald SW (2006) Aerobic exercise for women during pregnancy. Cochrane Pregnancy and Childbirth Group, Cochrane Database Sys Rev 3:CD000180

    CAS  Google Scholar 

  30. Meher S, Duley L (2006) Exercise or other physical activity for preventing pre-eclampsia and its complications. Cochrane Pregnancy and Childbirth Group, Cochrane Database Sys Rev 2:CD005942

    Google Scholar 

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Han, V.K.M., Seferovic, M.D., Albion, C.D., Gupta, M.B. (2012). Intrauterine Growth Restriction: Intervention Strategies. In: Buonocore, G., Bracci, R., Weindling, M. (eds) Neonatology. Springer, Milano. https://doi.org/10.1007/978-88-470-1405-3_13

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  • DOI: https://doi.org/10.1007/978-88-470-1405-3_13

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-1404-6

  • Online ISBN: 978-88-470-1405-3

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