Analysis of fetal growth restriction in pregnancy in subjects attending in an obstetric clinic of a tertiary care teaching hospital


  • Ashish Seal Department of Obstetrics and Gynecology, Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
  • Arup Dasgupta Department of Anaesthesiology, ICARE Institute of Medical Sciences and Research, Banbishnupur, Purba Medinipur, Haldia, West Bengal, India
  • Mousumi Sengupta Department of Radiology, Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
  • Rinini Dastider Department of Biochemistry, Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
  • Sukanta Sen Department of Pharmacology, ICARE Institute of Medical Sciences and Research, Banbishnupur, Purba Medinipur, Haldia, West Bengal, India



Fetal, Fetus, Intrauterine growth restriction, Outcomes, Pregnancy, Placenta, Small for gestational age


Background: Intrauterine growth restriction (IUGR) is defined as fetal growth less than the normal growth potential of a specific infant because of genetic or environmental factors. Fetal growth restriction or intrauterine growth restriction is one of the leading causes of perinatal mortality and morbidity in newborns. Fetal growth restriction is a complex multifactorial condition resulting from several fetal and maternal disorders. Objective of present study was to find out incidence of IUGR and assessment and evaluation of different important changes in IUGR.

Methods: Women who attended the Obstetric OPD in their 1st trimester of pregnancy and those who were thought would be able to visit the antenatal clinic for their fortnightly check-up regularly were screened for intrauterine foetal growth retardation. Women with irregular and uncertain menstrual history and where the 1st trimester USG foetal crown rump length did not corroborate with the menstrual gestational age were excluded from this study.

Results: Incidence of IUGR was 18.2% and 84% were found to be asymmetrical. IUGR was found to be double among primigravids and women above 30 years. It had been observed that IUGR was associated with certain conditions like short stature (52%), pregnancy induced hypertension (24%) and anaemia (12%).

Conclusions: Thus, early USG screening along with robust screening for maternal BMI, nutritional status, and anaemia can assist the obstetric team in providing early diagnosis, prompt intervention, and better outcome in pregnancy with fetal growth restriction.


Battaglia FC, Lubchenco LO. A practical classification of newborn infants by weight and gestational age. J Pediatr. 1967;71:159-63.

Lee PA, Chernausek SD, Hokken-Koelega AC, Czernichow P. International Small for Gestational Age Advisory Board (2003) International Small for Gestational Age Advisory Board consensus development conference statement: management of short children born small for gestational age. Pediatrics. 2001;111:1253-61.

Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol. 1996;87:163-8.

Sharma D, Shastri S, Sharma P. Intrauterine growth restriction: antenatal and postnatal aspects. Clinical Medicine Insights Pediatrics. 2016;10:67-83.

Murki S, Sharma D. Intrauterine growth retardation: a review article. J Neonatal Biol. 2014;3:135.

Saleem T, Sajjad N, Fatima S, Habib N, Ali SR, Qadir M. Intrauterine growth retardation-small events, big consequences. Ital J Pediatr. 2011 Sep;37:41.

Scott KE, Usher R. Fetal malnutrition: its incidence, causes, and effects. Am J Obstet Gynecol. 1966;94(7):951-63.

Imdad A, Yakoob MY, Siddiqui S, Bhutta ZA. Screening and triage of intrauterine growth restriction (IUGR) in general population and high risk pregnancies: a systematic review with a focus on reduction of IUGR related stillbirths. BMC Public Health. 2011 Apr;11 Suppl 3:S1.

Horta BL, Victora CG, Menezes AM, Halpern R, Barros FC. Low birth weight, preterm births and intrauterine growth retardation in relation to maternal smoking. Paediatr Perinat Epidemiol. 1997 Apr;11(2):140-51.

Ashworth A. Effects of intrauterine growth retardation on mortality and morbidity in infants and young children. Eur J Clin Nutr. 1998:52(suppl 1):S34-S42.

Leitner Y, Valevski FA, Geva R, Bassan H, Posner E, Kutai M, et al. Six year follow-up of children with intrauterine growth retardation: long-term, prospective study. J Child Neurol. 2000;15:781-6.

Barker DJ. Fetal origins of coronary heart disease. BMJ. 1995;311:171-4

de Onis M, Blossner M, Villar J. Levels and patterns of intrauterine growth retardation in developing countries. Eur J Clin Nutr 1998; 52 (suppl 1):S5-S15 5.

Barker DJ, Osmond C, Golding J, Kuh D, Wadsworth ME. Growth in utero, blood pressure in childhood and adult life and mortality from cardiovascular disease. BMJ. 1989;298:564-7.

Pillay P, Janaki S, Manjila C. A comparative study of gravidogram and ultrasound in detection of IUGR. J Obstet Gynaecol India. 2012;62(4):409-4128.

Shoham-Vardi I, Leiberman JR, Kopernik G. The association of primiparity with intrauterine growth retardation. Eur J Obstet Gynecol Reprod Biol. 1994;53(2):95-101.

Resnik R. Intrauterine growth restriction. Obstet Gynecol. 2002 Mar;99(3):490-6.

Torche F. The effect of maternal stress on birth outcomes: exploiting a natural experiment. Demography. 2011 Nov; 48(4):1473-91.

Pike K, Jane Pillow J, Lucas JS. Long term respiratory consequences of intrauterine growth restriction. Semin Fetal Neonatal Med. 2012 Apr;17(2):92-8.

Muthayya S. Maternal nutrition and low birth weight-what is really important? Indian J Med Res. 2009 Nov;130(5):600-8.

Bamfo JE, Odibo AO. Diagnosis and management of fetal growth restriction. J Pregnancy. 2011;2011:640715.

Ornoy A. Prenatal origin of obesity and their complications: gestational diabetes, maternal overweight and the paradoxical effects of fetal growth restriction and macrosomia. Reprod Toxicol. 2011 Sep; 32(2):205-12.

Sawant LD, Venkat S. Comparative Analysis of Normal versus Fetal Growth Restriction in Pregnancy: The Significance of Maternal Body Mass Index, Nutritional Status, Anemia, and Ultrasonography Screening. Int J Reprod Med. 2013;2013:671954.

Szentpéteri I, Rab A, Kornya L, Kovács P, Brubel R, et al. Placental gene expression patterns of endoglin (CD105) in intrauterine growth restriction. J Matern Fetal Neonatal Med. 2014;27:350-4.

Szentpéteri I, Rab A, Kornya L, Kovács P, Joó JG. Gene expression patterns of vascular endothelial growth factor (VEGF-A) in human placenta from pregnancies with intrauterine growth restriction. J Matern Fetal Neonatal Med. 2013;26:984-9.

Anderson MS, Hay WW. Intrauterine growth restriction and the small-for-gestational-age infant. In: Neonatology Pathophysiology and Management of the Newborn (5th Edtn). Lippincott Williams and Wilkins, Philadelphia;1999.

Katz J, Lee AC, Kozuki N, Lawn JE, Cousens S, Blencowe H et al. Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis. Lancet. 2013;382:417-25.

Kramer MS, Kakuma R. Energy and protein intake in pregnancy. Cochrane Database Syst Rev. 2003:CD000032.

Haider BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. 2012;11:CD004905.

Ghazi HA, Spielberger C, Kallen B. Delivery outcome after infertility: a registry study. Fertil Steril. 1991;55:726-32.

Sharma SR, Giri S, Timalsina U, Bhandari SS, Basyal B, Wagle K et al. Low birth weight at term and its determinants in a tertiary hospital of Nepal: a case-control study. PLoS ONE. 2015;10(4):e0123962.

Villar J, Belizan JM. The relative contribution of prematurity and fetal growth retardation to low birth weight in developing and developed societies. Am J Obstet Gynecol. 1982;143:793-8.

Mathai M, Thomas S, Peedicayil A, Regi A, Jasper P, Joseph R. Growth pattern of the Indian fetus. Int J Gynaecol Obstet. 1995;48:21-4.

Indira R, Oumachigui A, Narayan KA, Rajaram P, Ramalingam G. Symphysis-fundal height measurement--a reliable parameter for assessment of fetal growth. Int J Gynaecol Obstet. 1990 Sep;33(1):1-5.

Campbell S, Newman GB. Growth of the fetal biparietal diameter during normal pregnancy. J Obstet Gynaecol Br Commonw. 1971;78:513-9.

Chitty LS, Altman DG, Henderson A, Campbell S. Charts of fetal size: 3. Abdominal measurements. Br J Obstet Gynaecol. 1994;101:125-31.

Fox H. Invited review. A contemporary approach to placental pathology. Pathology. 1981 Apr;13(2):207-23.






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