Intrauterine growth restriction (IUGR) is a major public health problem and is the second leading cause of perinatal mortality and morbidity worldwide, behind preterm delivery.1 IUGR refers to a condition in which a fetus is unable to achieve its genetically determined potential growth. IUGR is commonly reported in cases of an estimated fetal weight below the 10th percentile in combination with ultrasonographic evidence of impaired placental function.2 This functional definition of IUGR seeks to identify a population of fetuses at risk for modifiable but otherwise poor outcomes. Uteroplacental insufficiency is the most common cause of IUGR, associated with maternal vascular malperfusion, which is characterized by reduced placental size, multifocal infarction, hemorrhage, and diseased spiral arteries.2 Fetuses with IUGR are at increased risk for significant perinatal morbidity and mortality after birth compared with infants with normal in utero growth.2 IUGR is associated with a 5- to 10-fold increased risk of stillbirth.2,3 Alteration in fetal growth may also be associated with developmental adaptation that permanently changes the child’s physiologic makeup and metabolism, consistent with the fetal origins of adult disease hypothesis.4 IUGR is associated with untoward long-term outcomes, including diabetes and cardiovascular diseases, and affects cognitive, socioemotional, and behavioral domains.1,4
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Guerby P, Bujold E. Early Detection and Prevention of Intrauterine Growth Restriction and Its Consequences. JAMA Pediatr. Published online May 26, 2020. doi:10.1001/jamapediatrics.2020.1106
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