Growth Restriction of the Fetus - FGR This is a condition of the fetus when it fails to reach the genetically determined, expected growth potential in the uterus. 

There is the concept of a small for gestational age (SGA) fetus. This may not be a pathology but rather a constitutional feature based on ethnic origin and the physical parameters of the parents. 

Causes of FGR may include: maternal, fetal and/or placental factors.  

Maternal risk factors include: age (under 16 or over 35), frequent deliveries, chronic diseases (arterial hypertension, chronic kidney disease, systemic lupus erythematosus, bronchial asthma, heart defects, diabetes mellitus, autoimmune diseases), gynecological diseases, developmental anomalies of the uterus, social factors (unsatisfactory living conditions, poor nutrition), and maternal harmful habits (alcohol or drug use, smoking).

Fetal causes include: genetic pathologies, developmental defects, and severe infections (syphilis, tuberculosis, cytomegalovirus, toxoplasmosis, etc.)

Placental causes include: abnormal development of the placenta, placental accreta, incorrect attachment of the umbilical cord, placental tumors, and placental damage due to preeclampsia-eclampsia, hypertensive diseases, diabetes mellitus. 

The risk is also high in multiple pregnancies, especially when the fetuses share a placenta.

Clinically manifested as: dry and flaky skin, reduced muscle mass and subcutaneous fat tissue, typical "old man's" appearance, thin umbilical cord, possibly meconium-stained, open skull sutures, etc. Such newborns often experience complications such as: premature birth, perinatal asphyxia, poor thermoregulation, hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia, decreased immune status, and feeding difficulties.

How should we manage such a newborn?

If it is known that the fetus has growth restriction, delivery should be planned in a center with experienced neonatal staff and appropriate resources. The neonatal team must consider potential complications' management needs, such as: respiratory dysfunction and hypoxemia, which may require ventilatory support and hypothermia, which can be prevented by promptly drying the newborn and placing them in a warming unit. Such newborns often end up in the Intensive Care Unit (NICU).

Babies born with FGR require continued growth and development monitoring, which should be managed multidisciplinary, as there is an increased risk of neurodevelopmental issues, including cognitive impairments, speech delays, learning disabilities, behavioral disorders, cerebral palsy, motor limitations, seizures, and visual or hearing impairments. Hypertension, cardiovascular and kidney diseases may also manifest in adulthood.

Author of the article:
Nino Kargadze - Head of the Neonatology and Newborn Intensive Care Department, Neonatologist