What is fetal growth restriction and how does it differ from a small baby? Causes, monitoring, birth planning and what to watch in your baby's movements.
Fetal growth restriction means the baby is not achieving the expected growth in the womb, and it is considered on the basis of measurements taken by ultrasound. A baby being found "small" on ultrasound does not always mean growth restriction; many small babies are healthy. The doctor investigates the cause and seriousness, the baby is monitored closely, and the timing and place of birth are planned accordingly.
What is fetal growth restriction?
When the baby's measurements on ultrasound come out smaller than average, this finding is called a "small baby". Most babies found to be small are healthy and are simply smaller than average; in some there is true growth restriction, and the smaller the baby, the more likely this is.
Are a "small baby" and growth restriction the same thing?
No. "Small" is a measurement label; growth restriction is the baby not meeting its own growth potential. Not every small baby has growth restriction, and not every baby with growth restriction may look small by the criteria. The doctor looks at additional information to assess this distinction.
What can cause growth restriction, and which factors can raise the risk?
The main causes of fetal growth restriction can include problems related to the placenta, some infections during pregnancy and genetic or developmental conditions of the baby; however, a cause cannot always be found. Some factors can affect the likelihood: smoking and substance use, high caffeine intake, low body weight, older age, high blood pressure, diabetes, kidney or autoimmune diseases, and a history of a small baby, pre-eclampsia or stillbirth in a previous pregnancy. Some of these factors are not in the person's hands; for those that can be changed, such as smoking or substance use, support can be sought. Having a risk factor does not mean growth restriction will happen.
How is it detected and monitored?
In a low-risk pregnancy, monitoring relies on measuring the fundal height; if there is concern, an extra ultrasound is done. In a high-risk pregnancy, extra growth ultrasounds and assessment of the uterine artery with Doppler may be planned. When concern about growth arises, umbilical cord Doppler, more frequent growth ultrasounds and monitoring of the baby's heartbeat (cardiotocography) may be considered; genetic or infection tests may also be requested if needed. When the baby is found to be very small, when it is noticed early or when the Doppler result is abnormal, referral to a fetal medicine specialist may be made. Checking the mother's blood pressure and urine is also part of monitoring, because these findings may be linked with pre-eclampsia. The frequency and extent of monitoring are planned by the doctor according to the condition of the baby and the placenta.
What can be done?
Stopping smoking, not using substances, limiting caffeine and keeping a healthy body weight are among the recommended steps; getting support to stop smoking can be helpful. In some people at risk, the doctor may recommend preventive treatment. There is no medicine shown to speed up the baby's growth in the womb, and bed rest is not recommended. Do not use medicines, supplements or herbal products on your own; these should not be added without talking to your doctor.
How is birth planned?
The timing and mode of birth are planned individually according to the seriousness of the situation. When Doppler results are normal, vaginal birth may be an option; when results are abnormal, a caesarean may be considered. It is recommended that birth takes place in a hospital with a newborn care unit, and a meeting with the newborn team may be planned before birth. Exactly when and how the birth will happen is decided together with you.
What does it mean for the baby and for future pregnancies?
The earlier the condition starts and the more severe it is, the less favourable the possible outcomes for the baby can be; close monitoring is important for this reason. This is a likelihood, not a definite outcome; your doctor assesses what it means for your situation. Having given birth to a small baby may raise the likelihood of the condition being seen again in a later pregnancy; for this reason, when planning a new pregnancy, sharing your previous pregnancy with your doctor can help an early plan of precautions to be made.
How can you cope emotionally?
News of this kind can be very stressful; it is recommended that you share your anxiety with your health team. Experiencing this is not a sign that you or your baby did something; most of the causes are factors outside a person's control. You may want to get help from support organisations or a mental health professional.
What can you ask your doctor about monitoring and the birth plan?
- Ask which causes are being investigated and what the results mean.
- Find out what the monitoring plan (ultrasound, Doppler, heartbeat monitoring) will be.
- Ask what your options are and the balance of benefit and harm of each.
- Talk about where and when the birth will be planned.
- Ask how you can get support in the decision-making process.
Frequently Asked Questions
Did my baby being small happen because of me?
Often a single cause cannot be found; problems related to the placenta and genetic factors are not in the person's control. Support can be sought for factors that can be changed, such as smoking, but experiencing this does not mean a mistake or neglect.
My fundal height measurement came out small; what does this mean?
One small measurement does not on its own mean a result; what matters is how this measurement changes over the course of monitoring and what picture it forms together with other findings, if any (for example Doppler results). Your doctor assesses this whole and decides whether further investigation is needed.
Can the birth be normal (vaginal)?
This decision is not made according to a single ultrasound result but takes shape over time according to all the results gathered during monitoring; it generally becomes clear as the due date approaches and the monitoring findings are reviewed. The team following you will share this process with you step by step.
How should I keep track of my baby's movements?
No particular counting method is recommended; what matters is that you know your baby's usual pattern of movement and that you report without delay when you notice a decrease or change in this pattern.
Will this happen again in my next pregnancy?
This likelihood is higher in the next pregnancy; a review meeting after birth is recommended. In this meeting, what played a part in this pregnancy is discussed; planning the meeting right after birth, while the information is fresh, helps to determine more clearly which steps will come in and when for the next pregnancy.
Does every baby that looks small on ultrasound have growth restriction?
No. Many small babies are healthy. A small measurement and a baby not meeting its own growth potential are not the same thing.
Does having a risk factor make growth restriction certain?
No. Some illnesses and pregnancy history can affect the likelihood; they do not tell the outcome. A cause may not always be found.
Does monitoring look only at the baby's measurements?
No. Depending on the situation, Doppler, heartbeat monitoring and other assessments may also be done. Checking the mother's blood pressure and urine is also part of monitoring.
Should I start a medicine or supplement myself to speed up growth?
No. There is no medicine shown to speed up growth in the womb and no recommendation for bed rest. Do not add medicines, supplements or herbal products without talking to your doctor.
Do Doppler results affect the birth plan?
Yes. If the results are normal, vaginal birth may be an option; if they are abnormal, a caesarean may be considered. The decision is made individually, with all the monitoring findings together.
Is the hospital where the birth will take place planned separately?
Yes. Birth in a hospital with a newborn care unit is recommended, and a meeting with the newborn team may be planned before birth.
Should I use a particular counting method for the baby's movements?
No particular counting method is recommended. Report to your health team without delay any decrease or change in the usual pattern of movement.
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