Coping with fetal growth restriction can be worrisome for expecting parents. In this article, we’ll explore what FGR signifies and how it affects pregnancy, providing valuable information to help you understand and navigate this challenging situation.
When I was 20 weeks pregnant, my unborn child was diagnosed with fetal growth restriction (FGR), also known as intrauterine growth restriction (IUGR). It indicated that my child was not growing at the expected rate. The diagnosis was confusing and frightening, and my pregnancy left a lot to be desired.
With a lively kid bouncing on my lap, I can guarantee you that my story ends happily. Yet FGR was a lot to grasp, especially when the reasons and outcomes can be so variable.
Here’s what it means to receive a FGR diagnosis and how it may affect pregnancy.
What Is Fetal Growth Restriction?
FGR indicates that a fetus is not developing normally in the womb for its gestational age. It’s when the fetus has a weight or belly circumference less than the 10th percentile for gestational age.
FGR occurs in ten percent or more of pregnancies1. Despite being reasonably frequent, FGR is rarely discussed, particularly in parent groups.
A little infant is not always a problem; some infants may just be small by nature. “About 20% of [fetuses with FGR] will be fundamentally tiny fetuses that will be healthy at birth with a normal outcome,” says Lynn L. Simpson, M.D., chief of maternal-fetal medicine and professor of women’s health at Columbia University Irving Medical Center. Nonetheless, FGR can indicate problems for some fetuses.
The condition may manifest early or late, be symmetric (when all of the fetuses are of comparable size) or asymmetric (when some sections are smaller than others), and be minor or severe. Dr. Simpson says, “FGR is a complex topic that is only unified by its definition.”
What FGR May Signify for Your Pregnancy
I was informed of various hazards when I was diagnosed with FGR. My maternal fetal medicine (MFM) specialist informed me that I had a 1 in 3 probability of miscarriage, a 1 in 3 possibility of my child being born with a serious impairment, or a 1 in 3 chance that my child would be born healthy. At that point, it was too early to tell.
FGR has been associated with a number of problems, including perinatal morbidity and mortality. In addition, it increases the risk of low birth weight, delivery complications, decreased oxygen levels, infection, low blood sugar, and breathing problems. Some research implies that FGR can contribute to subsequent cognitive development difficulties or persistent growth limits.
This can all be frightening to hear. Yet, it is essential to remember that consequences will rely on the cause, although this is not always straightforward. It also doesn’t indicate your kid will encounter such complications by virtue of their FGR diagnosis. That is merely an indicator.
Dr. Simpson states, “Each situation is unique, and most importantly, excellent outcomes are attainable.” Following the advice of one’s obstetrician and MFM specialist can improve the prognosis of FGR-affected pregnancies.
FGR Antenatal Symptoms
My FGR was diagnosed at my 20-week ultrasound. After 20 weeks of pregnancy, when a healthcare provider begins measuring the fundal height or distance from the pubic bone to the top of the uterus, FGR is often detected. Simply said, it is the height in millimeters of an individual’s bump. By around 20 weeks, the fundal height of a pregnant woman should be roughly equivalent to the weeks of pregnancy. If a woman is 25 weeks pregnant, her fundal height should be approximately 25 cm.
In many cases, the only physical indication of FGR will be a little bump, although this is not always symptomatic of the illness. Before my 20-week ultrasound, there were no signs that my baby’s growth was impeded, despite my baby bump being quite modest. This was something I attributed to being a first-time mother, and medical specialists had not yet noticed it.
Sometimes FGR simply occurs, and the cause and mechanism are unknown. Nonetheless, several risk factors have been associated with the illness. Dr. Simpson says that FGR can be caused by maternal sickness, fetal problems, or placental failure.
These can include lifestyle decisions such as smoking or drug misuse, the health of the pregnant woman, diseases such as toxoplasmosis or CMV, or placental issues such as placental malfunction or abruption that prevent the fetus from receiving enough nutrition. In addition to chromosomal abnormalities and genetic disorders, FGR can also be caused by hereditary diseases.
Angela M. Patterson, M.D., FAAP, a specialist in neonatal and perinatal medicine and member of the National Perinatal Association’s board of directors, asserts that professionals can treat FGR by piecing together these factors. She believes that identifying a cause as soon as feasible is advantageous. She continues, “You may not be able to enhance the development by itself, but you may be able to do something.”
Fetuses with FGR will be directed to an MFM specialist whose role it is to determine why growth is restricted and what, if any, impact this has or could have on the infant. Once FGR is diagnosed, regardless of the underlying signs or reason, the fetus will be continuously monitored for the remainder of the pregnancy.
Prenatal studies may involve continual fetal monitoring to gauge growth, tracking heart rate and blood flow, screening for infections, and amniocentesis to identify or rule out a genetic reason. Moreover, parental testing may be performed to screen for high blood pressure and other conditions that may influence the birthing parent. Unfortunately, often these tests yield little further information, and the impact may never be fully understood or may not become apparent until the kid is born or develops.
Even with regular checkups, physicians may determine that a kid with FGR may flourish better abroad, where the environment will be less hostile. Dr. Patterson explains that this is why certain FGR infants may be induced early and spend time in the neonatal intensive care unit (NICU). She continues, “Sometimes we have no control over the interior environment of the uterus, but we have more influence over the external environment.”
Delivering a Child With FGR
My water broke at 31+6 weeks, prompting an emergency C-section to deliver our child eight weeks prematurely. My physicians never confirmed the cause of my FGR, however, there were concerns that either my placenta did not implant properly or became partially detached during pregnancy. When he was born below the 3rd percentile, my son spent five weeks in NICU, primarily to gain strength. Expecting this was helpful, and I’m grateful to my medical staff for prepping me for such outcomes.
Babies diagnosed with FGR may experience additional difficulties following birth. After NICU, for example, my son suffered some feeding challenges. That’s not unusual for infants with FGR, as they may have difficulty tolerating standard feeding quantities once they’re born, says Cuyler Romeo, M.O.T., OTR/L, SCFES, IBCLC, a feeding specialist at Feeding Matters.
My son also had slight delays with gross motor skills, like crawling and walking, because he needed a bit longer to establish his core muscles. Nonetheless, his pediatric experts repeatedly assured me that he was “bright as a button” and that there was no cause for developmental concern.
By 12 months, he had reached the 9th percentile for weight and the enormous 50th for length, making him tall but slender and very obviously healthy. He continues to follow his growth curve, which is significant. This is a far cry from the scenarios we prepared for during our pregnancy, but hopefully, it can provide some solace to those who, like myself, are perplexed by their diagnosis.
Romeo says although many children who were diagnosed with FGR catch up by the time they are two years old, some may need specific help in certain areas to ensure they realize their growth and developmental potential.
She continues, “This is not an indicator of a problem or delay in the future, but rather a reason for families to seek support so they can make educated decisions regarding their child’s care.” “They will acquire new talents and reach their milestones at the optimal rate for their body.”
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