IUGR: problems with your baby's growth in the womb

Intrauterine growth restriction (IUGR), also known as fetal growth restriction (FGR) is a condition in which a baby's growth slows or stops when they are in the womb.

Intrauterine growth restriction (IUGR) occurs in around 3 in every 100 pregnancies. Unborn babies with IUGR can grow so slowly in the womb that they are at risk of health problems. If the growth restriction is severe, the baby may have to be delivered, so it is also a cause of premature birth.

Causes of Intrauterine Growth Restriction

The majority of cases of IUGR are caused by failure of the placenta but there are also several other factors that could cause a baby's growth to be restricted:

  • multiple pregnancy
  • infection
  • Antiphospholid Syndrome
  • genetic problems or a congenital anomaly in the baby
  • pre-existing medical problems in the mother such as high blood pressure, kidney disease, diabetes, heart disease, lung disease, chronic anaemia
  • certain prescribed medications such as warfarin, some but not all anticonvulsants, and some anticancer drugs
  • low pregnancy weight
  • smoking or using drugs during pregnancy
  • drinking alcohol during pregnancy.

Around 10 in every 100 babies are small for gestational age. Most of these are small for normal reasons, such as the mother’s size and ethnicity, but around a third will be due to intrauterine growth restriction. 

Signs and symptoms of Intrauterine Growth Restriction

IUGR is normally diagnosed during routine antenatal appointments. Your baby’s size is monitored throughout your pregnancy in your routine appointments. The midwife will palpate your stomach gently to feel the baby’s size, and they will measure the fundal height. The measure is then put on a chart that plots the growth. If there are any concerns the midwife will refer you for a scan. This does not necessarily mean something is wrong, but it is important to have the scan as more accurate way of assessing the baby's growth.

Management of Intrauterine Growth Restriction

There is no 'treatment' for IUGR. Instead you will have a management plan. If IUGR is suspected, you will have regular scans to look at the baby’s growth. The blood flow through the placenta will be checked with a uterine artery doppler test. If there is concern about growth then a plan will be implemented including regular scans, CTG monitoring and consultant appointments in antenatal clinic at the unit.

You will be told to closely monitor your baby’s movements.

If the growth restriction is severe, your healthcare team will recommend additional scans for monitoring of growth and baby well-being. They may recommend delivering the baby early.

Fetal movements

It is very important to be aware of your baby’s pattern of movements and monitor this for change if you have been diagnosed with suspected IUGR.

More on growth restriction

  • My baby does not seem to be getting any bigger

    My baby is not growing in pregnancy

    A growing bump is the sign of a growing baby. Your midwife should start measuring your growing baby at antenatal appointments from 24 weeks to make sure they are growing at the right rate for your stage of pregnancy.

Sources

  1. NICE (2008) Antenatal care: routine care for the  healthy pregnant woman. National Institute for Health and Clinical Excellence.
  2. NICE (2011) CG129 Multiple pregnancy: The management of twin and triplet pregnancies in the antenatal period, National Institute for Health and Clinical Excellence.
  3. Norman J (2011) Preterm labour, managing risk in clinical practice. Cambridge: Cambridge University Press.
  4. RCOG (2013) The Investigation and Management of the Small–for–Gestational–Age Fetus. The Royal College of Obstetricians and Gynaecologists.
  5. James D, Steer P (2011) High risk pregnancy, management options. Fourth ed, Elsevier Saunders.
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Last reviewed on October 3rd, 2016. Next review date October 3rd, 2019.

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Comments

  • By Anonymous (not verified) on 10 Oct 2017 - 18:00

    Hi, I’m 31 weeks pregnant and my fundal height has been measuring at 27cm since I was 26 weeks. Had 2 growth scans and baby is on 23rd percentile and growing but midwife has booked me in for another scan to be on the safe side. Should I be worried about IGUR or is it ok if the baby isn’t measuring small for dates?

  • By Midwife @Tommys on 11 Oct 2017 - 14:29

    Hi, It is good that the baby is growing. Around 10% of babies are measured as small with only approx. 3% diagnosed as IUGR. The next scan will help to confirm whether your baby is growing well or not. Please be vigilant in monitoring the fetal movements and let your midwife or maternity unit know if you are concerned. Best wishes

  • By Anonymous (not verified) on 9 Oct 2017 - 02:02

    Hi, I'm currently at 40 weeks and 2 days. My baby was growing almost perfectly in the middle of the 10th percentile lines all the way through out the pregnancy whenever checked.
    I went for my antenatal appointment at exactly 40 weeks (because I missed mine at 37 weeks and my last one before that was at 35 weeks) and was asked if I wanted a membrane sweep which my midwife was quite jokey about and saying she didn't recommend me having one. Then they started the check ups and she completely changed her mind after my measurement, recommending I had the sweep. My baby's growth dropped to just below the 10th percentile. They said she is SGA in my notes. I need to go for an assessment but am worried that it is something I have done or am doing which has affected my baby. What are the problems that cause that to happen later in pregnancy?

  • By Midwife @Tommys on 9 Oct 2017 - 16:16

    Hi
    There are many risk factors for SGA as you have read on this page. Some of them are within your control like smoking, but others are related to conditions that you cannot change or affect. The most important thing is to ensure that you attend your appointments and that you are aware of baby's movement patterns. I have no doubt that your baby will be born very soon x

  • By Anonymous (not verified) on 7 Oct 2017 - 15:26

    Hi please help. I had my 2nd scan done today and was told my sac hasn't grown since the last week and no heart beat was showing. Am I too early. I am 6 weeks and 6 days pregnant today. PLEASE help

  • By Midwife @Tommys on 9 Oct 2017 - 16:04

    It is usually possible to see a heart beat at 7 weeks. Unfortunately I can't comment on your scan having not seen it but if you would like to contact us you can call 0800 0147 800 to speak to a midwife. Best wishes x

  • By Anonymous (not verified) on 20 Sep 2017 - 13:48

    Hi. I previously had an IUGR baby. He weighed 3lb15, this was 2 years ago now. He is healthy and growing now. I am looking at trying for another baby and the consultant has suggested baby aspirin (75mg) from finding out about pregnancy until 13 weeks, in the hope that this will prevent IUGR again. They didn't also send my placenta off in previous pregnancy and found to be diagnosed in that pregnancy with maternal vascular underperfusion syndrome. I was just wondering have you got any evidence/stories of someone taking aspirin in the first 12 weeks to prevent IUGR. Thank you

  • By Midwife @Tommys on 21 Sep 2017 - 12:42

    Hi, Thank you for your comment.

    There are on going studies looking into the effectiveness of aspirin and what benefits it has on the outcome of a pregnancy. Some consultants do recommend aspirin for certain pregnancies depending on medical history. Some women may take aspirin if they have had pre-eclampsia in the past, having this condition may result in having smaller babies. If you would like to email [email protected] then we can try and give you more information and advice about this. Take Care Tommy's Midwives x

  • By Anonymous (not verified) on 29 Aug 2017 - 15:50

    Hi, we paid for a private scan to get some ore pictures of our baby (20 week scan had no photos). As part of the scan we discovered than he is measuring below average on all of his growth measurements, but particularly his femur length (55cm). I have of course been googling like mad, which isn't helpful, but is there anything I can and should be doing to help him grow a bit more? I have increased my calorie intake, with dairy/ calcium rich foods in particular, but I am having to wait a while for follow up appointments as I am being seen at a tertiary centre and am understandably quite worried and concerned. I am 5ft 1 so not big, but I am so worried there is something wrong with him.

  • By Midwife @Tommys on 30 Aug 2017 - 13:27

    Hi Penny
    It is great that they picked up the femur length was below average growth as they can now keep a close eye on the babies rate of growth. If both you and your partner are small, then it is unlikely that you will have a very large baby. However, it is safe for you to be offered more frequent growth scans to keep an eye on this.
    There is nothing that you can do to increase the baby's growth rate. The doctors and sonographers will be scanning you more frequently to ensure that the placenta is functioning at its absolute best . If they are concerned that the placenta is not functioning at its absolute best, they they may suggest an induction of labour to deliver baby earlier.
    You are best to get an urgent midwife or obstetric appointment to go through your options with them and what might be best for you and your baby. If you are concerned about baby's movements in the meantime though, i would suggest that you take yourself into your local hospital to be reviewed by a midwife and obstetric doctor. Please don't panic about this, you have plenty of options and your carers should help go through this with you asap.
    Please feel free to call us if you need further advice.

  • By Anonymous (not verified) on 27 Aug 2017 - 21:39

    Hi..,I am 32yrs old lady & going through second pregnancy with 10 weeks. During my first pregnancy, I came to know I have double uterus. By God's grace my first baby born through C-section with a weight of 2.5 kg. After 3 yrs of first baby, I am pregnant again. from the scanning, I came to know my baby is not growing till 10 weeks of pregnancy. And I am also supposed to have twins both not growing totally (according to the report) . What am I supposed to expect now - meaning am I going to have successful pregnancy even with this complications in growth or is there chances for miscarriages?

  • By Midwife @Tommys on 30 Aug 2017 - 13:10

    Hi Zenifer
    It is difficult to know exactly how to answer your question as i do not have access to your medical and obstetric history. Your midwife and doctor will be best placed to answer your questions- as they are quite difficult to answer with the information you have given me. Please do go to seek medical review/advice from your GP, midwife or obstetric asap to go through these with them. I do not want to give you the wrong advise as i do not know your full history. Please take good care of yourself.

  • By Anonymous (not verified) on 22 Jul 2017 - 18:26

    Hi, I'm 13 weeks and 2 days pregnant. I lost my first at 8 weeks and my second at 16 weeks found out at 20 weeks. All pregnancies I have suffered with hg sickness so I thought was a good sign of a healthy pregnancy. I have started getting a lot of uncomfortable pain all around my lower and upper belly do you think this could be stretching pains? I had a scan recently on Wednesday due to brown spotting last weekend . Kind regards, Veronica

  • By Midwife @Tommys on 24 Jul 2017 - 15:09

    Hi Veronica. You must be very anxious after your last pregnancy. Was the scan last week reassuring? Mild cramping and stitch like pains are common in early pregnancy but if the pain in your abdomen persists or if you have any signs of bleeding, you should contact your doctor or midwife. Best wishes to you x

  • By Anonymous (not verified) on 22 Jun 2017 - 09:51

    Hi I would like to know I'm 30 weeks. On my last appointment (2weeks ago ). My doc said the baby is very under weight. And his pulse was No Accurate my belly isn't growing much I'm trying a lot of healthy foods and healthy m resting my self alot please advise me what more can I do.

  • By Midwife @Tommys on 22 Jun 2017 - 12:20

    Hi, It can be a shock when you go to your hospital appointment and receive news like you have, that your baby's isn't growing as much as it should. This can be for a number of reasons, some of which you don't have any control over but what is most important is that now your doctors are aware that your baby is small, they can monitor you as closely as possible. It sounds like you are doing all the rights things that we would advice for your baby, you are eating well and resting when you can. Keep monitoring your baby's movements and if you feel like they have changed at all then please call your maternity day assessment unit so that the midwives can check you over. You should expect to been seen at the hospital more regularly now, so that your baby's growth and development can be monitored, so please attend all you appointments. You should have a follow up appointment at the hospital soon if your last one was 2 weeks ago, if you haven't, then please call the antenatal clinic at your local maternity unit and explain your circumstances, they should be able to book you in to see your Obstetrician as soon as they can. Hope this has helped, take care Tommy's Midwives x

  • By Midwife @Tommys on 13 Jun 2017 - 12:47

    Hi, thank you for your comment and I am so sorry to hear that you have lost three babies. It would be great to speak or if you could email us here at Tommy's with more information we might be able to help.
    Our number is 0800 0147 800 and there are midwives available weekdays 9-5 pm or email us [email protected]
    We hope to be in touch again soon
    Anna-Tommy's Midwives Team

  • By Anonymous (not verified) on 13 Jun 2017 - 08:05

    I have lost 3baby "not growing in my womb what I do plesss help me

  • By Anonymous (not verified) on 1 Apr 2017 - 18:39

    Hello Sir/Mam, my name is Arun Biradar. We are staying in chennai from last three years. We are facing problem in my wife pregnancy. On first pregnancy we found fetal growth is too small as compared to current weeks and finally doctor adviced us to do abortion. We lost our child in first pregnancy. The same thing happened in next pregnancy exactly after 1 year. Now we are in a situation to do medical abortion again..please let me know the reason for low fetal growth during pregnancy and what should we have to do to avoid this in future..?

  • By Midwife @Tommys on 3 Apr 2017 - 10:00

    Hi Arun,
    it is very difficult to comment on the care that you are receiving in Chennai as we are a U.K based charity. I am ever so sorry to hear about the loss of one of your babies, and now the prospect of a second loss too.
    The majority of cases of IUGR are caused by failure of the placenta but there are also several other factors that could cause a baby's growth to be restricted-multiple pregnancy/infection/Antiphospholid Syndrome/genetic problems or a congenital anomaly in the baby.
    Some Pre-existing medical problems in the mother can also contribute to this, such as high blood pressure, kidney disease, diabetes, heart disease, lung disease, chronic anaemia
    certain prescribed medications such as warfarin, some but not all anticonvulsants, and some anticancer drugs.
    Having alow pregnancy weight/smoking or using drugs during pregnancy/drinking alcohol during pregnancy can also contribute.
    Around 10 in every 100 babies are small for gestational age. Most of these are small for normal reasons, such as the mother’s size and ethnicity, but around a third will be due to intrauterine growth restriction.
    Make sure you discuss all of your possible options with your wife's doctor before you both go ahead with any procedures. Please take good care of yourselves!

  • By Anonymous (not verified) on 26 Mar 2017 - 00:46

    Hi, my son was born via emergency c-section due to my severe preeclampsia at 31+4 on 1/1/17. He weighed 2lbs 13oz at birth and I was told the placenta was 1/3 of the size it should be.

    After the 20week scan of pregancy I had to go for regular growth scans- 2 to 3 weekly as he was measuring small, My question is..
    No one has ever mentioned IUGR to me but it seems to be exactly what me and my son went through. Would this affect him in his life outside the womb? and is it something I should bring up with the GP? Thanks

  • By Midwife @Tommys on 27 Mar 2017 - 10:13

    Hi Emma,
    This is outside our remit as midwives so I don't really know the full answer to your question I am afraid.
    I would certainly tell your GP and Health Visitor about the IUGR you and your son experienced during pregnancy so that they can keep a closer eye on his progress as he grows and develops.
    Take good care of yourself and your little man, Emma!

  • By Anonymous (not verified) on 19 Mar 2017 - 10:52

    hello there...my name is Themba and I'm worried since me and my girlfriend are expecting a baby.She is 9 months pregnant now and the baby is too small so she cant deliver since the child is small.So id like to know what is it that oftenly happens when the baby isn't growing and what can we do in order for our baby to grow because at hospital they give her medication and injection to help the baby to grow but my concern is its now the 9th month

  • By Midwife @Tommys on 20 Mar 2017 - 09:41

    Hi Themba.
    Without knowing your girlfriends full medical history it is a little difficult to fully understand your case. Your baby needs to be closely monitored by the midwife and obstetric dr's caring for your girlfriend. It would be sensible to visit your doctor/midwife as soon as possible if you are concerned about either of their health. Please take care of yourself.

  • By Midwife @Tommys on 22 Sep 2016 - 10:21

    We are very sorry to hear about William and hope our information can give you some understanding of what happened. Thank you for your feedback. Best wishes from all at Tommy's.

  • By Anonymous (not verified) on 21 Sep 2016 - 17:06

    I found this page informative and easy to follow. I wish I had known about it when I was diagnosed with placenta problems which
    led to William being growth restricted and eventually stillborn. I feel it was never fully explained to me at the time and I was told all it meant was I needed more monitoring and that I would not be going to term.

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