What is IUGR? What happens when you have an IUGR baby? In this post, I share my experience with having a child who was IUGR while I was pregnant – and I hope to offer hope to those dealing with this diagnosis.
What to know about your IUGR baby
“Still birth. Disabilities. NICU.”
Those are the words I kept coming across as I lay in a hospital bed, waiting to hear if I was going to be induced.
I generally maintain prenatal visits. A few weeks prior, I had gone in for my 36-week appointment (even though I was just a day shy of 37 weeks.) They did a presentation scan – where they discovered Oliver was breech. I noticed that his measurements seemed a bit small for almost 37 weeks (just about 4 1/2 pounds). The doctor brushed aside my concerns and just jumped into my options for my breech baby.
While I was concerned about him being breech, I was even more concerned about his size.
The next week, I went to meet with another OBGYN in the area. While he confirmed that Oliver was no longer breech, he was very concerned about his size. He took measurements and determined that he was in the 1% – he was measuring 31-32 weeks in his femur and humerus, his abdomen was about 33 weeks, and his head was right on track. He started saying that he couldn’t believe my other doctors hadn’t paid much attention to this, and that I needed to be delivered ASAP. He noted that my placenta seemed to have infarctions and was quite small. And then he mentioned a term I’d never heard before – head-sparing growth restricted.
He called my doctor’s office and insisted that they admit me to the hospital – which they did (and apologized profusely for not sending me to a specialist earlier. Apparently I had been measuring behind for awhile, and the doctor who did the presentation scan should not have dismissed his small measurements.)
And of course, as we drove to the hospital and as I waited to meet with an maternal fetal medicine doctor, I started googling what in the world head-sparing growth restricted was. That’s when I first saw the term:
I knew babies could be born small, have a low birth weight, or have a growth problem but I always just assumed that was because they were premature – born in the 20th week or so. For whatever reason, I didn’t realize that sometimes babies stopped or slowed growth while in the womb (and if they did, that it might be a problem.)
That night in the hospital was scary. I had no idea what to think – was my baby okay? Would I be welcoming him a little earlier than expected? Would I have to have a c-section – something a few hours earlier I had thought was off the table since he was no longer breech? I became well-acquainted with the term intrauterine growth restriction.
When I met with the MFM, his cord flow was okay, so delivery wasn’t required (despite his abdomen and limbs still being below the 2%. His head was so big it brought up the rest of the percentile, haha), but I would have to go in weekly until I delivered. I delivered less than a week later on my own, so I didn’t see him again, but that was a stressful week. I was so worried about how big he would be, if he’d be able to breathe on his own, and I was scared to death that something bad was going to happen.
Fortunately, Oliver was born at exactly 39 weeks so it was not an early delivery,, weighing 5 lb 7.7 ounces. He went home at about 5 lbs. Despite having a little trouble regulating his blood sugar at first (which fortunately, frequent nursing helped with), he was sent home two days later with me. He has had different issues over the last few months (mainly in regards to jaundice, weight gain and eating, reflux, and some breathing issues – all of which are common with IUGR babies), but I’m grateful he’s here and growing.
Sunday is IUGR Awareness Day, so I thought I would write a post for it. Like I said, before Oliver, I had no idea what IUGR was. I felt scared and kind of alone! So if you are out there Googling like I was, I hope this post will bring you some hope and support!
What is IUGR?
They Grow Differently
There’s not a ton of research out there about IUGR babies, and some of it seems to be conflicting. The underlying cause is vague. Even more, I feel like a lot of the doctors we’ve talked with aren’t even sure what to say. However, IUGR can not be considered as a birth defect because it is only related to the weight and physical growth of a child. Our old pediatrician said she expected Oliver to gain over an ounce a day so he could have “catch-up growth”. However, some recent data suggests that fast catch-up growth isn’t necessarily good, and it can be linked to type 2 diabetes, obesity in adulthood, and other high risk of high blood pressure, heart disease, etc. (which IUGR babies are more at risk for anyways.). The baby who has IUGR generally has less than the estimated weight, generating some inevitable risk factors on both short-term and long-term basis. If the growth is slow, the babies can have low blood sugar and a weak body.
IUGR babies just grow differently – some of them will catch up faster, and others will just have slower weight and height gains. The important thing to watch is that they are following their own curve – some babies will need medical assistance to help them gain weight or height. But it’s important to know that they do grow differently and may always be small! And that’s okay. In general, they are expected to catch up to their genetic potential by about age two (and if they don’t, there are other options you can look into.)
Comparison Doesn’t Do Any Good
This one is hard, especially if you are around other babies that are the same age as your child. While most of the time I just focus on Oliver, and what he has accomplished, sometimes I see other babies his age doing things he isn’t or weighing a lot more, and I feel like I’ve failed him.
Remember that your baby is perfect the way they are. Even if they weren’t an IUGR baby, they might be growing at a different pace! Your baby doesn’t have to be in the 100th percentile and walking at seven months to be doing well.
Listen to your Instincts
I believe very strongly in the power of mother’s intuition. You know your baby best. While you should definitely have a medical team that you feel has your child’s best interest at mind, if you have a feeling that they aren’t taking the best approach, listen to that feeling. Be an advocate for your child and make sure they are getting the best care you can get. You are with your baby all the time – not your doctor. You understand your baby’s medical conditions and their needs more than their doctor to some point.
With Oliver, he’s had some different issues, mainly in regards to severe GERD and weight gain. Our old pediatrician just wasn’t on the same page as us, and she really tried to push switching to formula. While there’s definitely nothing wrong with formula, I felt that switching to formula would not solve the problem. I felt the real issue was his reflux, and once we got that under control, his weight gain improved. Until it was under control, I worked with an IBCLC who taught me how to skim the fat off of pumped breastmilk to feed him twice a day to help increase his caloric intake. And it worked!
Doctor’s Don’t Know Everything
Okay, I love doctors. There are some amazing ones out there. However, they aren’t all experts in every topic. And I’ve found that not all doctors understand IUGR. In a group I’m in, some people were basically told to terminate their pregnancy because their baby’s IUGR started early on, and they would likely not survive – and then they went on to deliver their babies. Our old pediatrician, as I mentioned above, just didn’t seem to have the latest information. Research the doctors in your area, and don’t be afraid to search for a specialist.
I recommend joining the MAGIC Foundation, which is a foundation dedicated to giving support to families who have children with growth disorders, including IUGR and SGA. They have a lot of great resources so you can be equipped with the best information regarding your baby!
Size Doesn’t Matter
These babies are fighters. I’m in a Facebook IUGR support group, and I am constantly amazed by the strength of these tiny babies. Some of them are born at l pound! But something I sometimes have to remind myself of is that size does not matter. I have a small baby, and that’s okay! Being in the 100th percentile doesn’t make a baby better than one in the 0 percentile. It’s just different!
A person’s a person no matter how small!
Ignore Others’ Comments
There are sometimes comments I get like, “Wow, he DOES NOT look such and such age” or “Are you feeding that baby?!” or “He is SOOOOO small!” and those comments can sting every now and then. Now that he’s getting a little bit more fat on his bones, it happens less (particularly the – is he eating enough comment). But try not to let it get to you. People just say things (and most of the time, without an mean intent), and it doesn’t change the perfect baby that you have!
Ignore people who seem to think your baby is underfed or malnourished. Or, better yet, educate them on why your baby is smaller. They might just be concerned.
Google is Not Your Friend
Okay, I have gotten some good information from Google. However, I’ve also scared myself a lot – especially before Oliver was born. I just about convinced myself that something horrible was wrong with him, and I was terrified of stillbirth. While I believe it’s important to be equipped with the best information possible, and the Internet can give you that, it can also give you some scary stories and statistics.
Remember this – the stories online are not yours. Just because something happened to another child doesn’t mean it will happen to yours! Search things cautiously.
As soon as I found out that Oliver was IUGR, I immediately tried to learn about other’s experiences. In this, I stumbled upon a BabyCenter board all about IUGR/SGA babies, and it was actually relieving to hear a lot of experiences.
For me, I didn’t know Oliver was IUGR until the end of my pregnancy was nearing, so I didn’t really join any support groups until afterward. However, I’ve found these groups to be invaluable as he’s grown. I’ve found that many other babies have had similar issues to Oliver, and it’s been so helpful to hear things that have worked for others, vented frustrations, and just connected with other moms of these tiny warriors! Here are two groups I think are really helpful:
Don’t Blame Yourself
While there are some things that can cause an IUGR baby, often, it is idiopathic…as in, there’s not much you could have done to prevent it. Sometimes genetic anomalies cause it, other times pre-eclampsia, and other times, it’s just bad luck.
For me, my placenta was just messed up. It was about 1/3 the size it should have been, there were multiple infarctions (dead tissue), as well as clotting, along with a very short cord. It’s important to have your placenta sent to pathology, especially if there isn’t an apparent cause for it. For me, I still need to meet with an OBGYN to go over the report, as it may impact future pregnancies (particularly the clotting.)
But don’t blame yourself for your baby being small or the issues they may have. Most of us wish we had answers, but many times, we don’t get them.
Sometimes the tiniest things take up the most room in your heart.
Clothes last longer!
Oliver still fits into his newborn pants and just wears 0-3 months clothes…and he’s almost 6 months! We really have gotten a lot of use out of those smaller clothes. Plus, I always say I don’t like my babies to grow up…In some ways, I feel like I can enjoy him being little a little bit longer.
Someone in one of my groups mentioned that dog collars make for great belts – that made me laugh a little bit!
It’s Okay to Be Sad
A lot of women I’ve interacted with seem to have feelings of sadness at one time or another – whether it’s because they didn’t have their ideal birthing experience, their baby ended up in the NICU or with other health issues, they had trouble breastfeeding, or even guilt. While it’s good to try and not dwell on sad thoughts, it’s okay to mourn a little bit and be sad. It’s hard when things don’t go as planned. I know there have been times where I think, “Well if only my placenta hadn’t been so bad, maybe x and x wouldn’t have happened.” And I start to feel sad. But I have to remind myself of all the good things that have happened, and how my baby is perfect the way he is…which brings me to my final point…
It will be okay
IUGR can mean so many things. Some babies will have to be delivered early. Others will be able to delivered at term. When your doctor catches it, they will monitor you closely. Yes, sometimes bad things happen – that’s the reality of it with ANY pregnancies. However, it’s important to realize there’s not a lot you can do – just hope for the best and let go of the things you can’t control.
Love the Child You Have
I believe our children are sent to us for a reason. Love the child you have, and not the one you thought you might have. Some IUGR babies will have no complications and will grow completely normally – others may not. And that’s okay. Try and cherish all of their milestones and enjoy the time while they are little. They eventually will grow up, and you might find yourself crying when you find an old preemie size outfit or a picture and wish for one more day with that tiny babe (especially when they make a big mess in the play room!)
FAQs about IUGR
And just in case you have some general questions, here are some commonly Google questions:
IUGR is a common problem of the general population, but many people cannot identify IUGR. IUGR stands for Intrauterine Growth Restriction, and in the most basic of terms, it means that an unborn baby has slowed growth and is not at the optimal size for its gestational age. It can happen for many reasons, and the severity varies. It is generally determined by being below the 10th percentile for estimated fetal weight (or the abdominal circumference and limb measurements are below that, it can still indicate IUGR.)
Yes. If you had one IUGR baby, you have a heightened risk in another pregnancy. However, it may not happen again, and the risk depends on why IUGR happened in the first place. It is important to follow-up with your doctor after your pregnancy to discuss this.
What’s your definition of normal? Is it all it’s hyped to be? IUGR babies are all different – just like all children are. Some of them may have more difficulties than others, but isn’t that the truth with a lot of babies? But short answer, yes, IUGR babies can be ‘normal’ (height, intelligence, appetite, etc.)
A baby’s weight does not make them abnormal. And in the case of IUGR, the baby is not a normal size at birth. It’s not a death sentence. Many babies who were IUGR at birth have no lasting consequences. An IUGR baby’s growth can change drastically over time. The good news is there is no problem with the internal organs of those babies. A systematic review and care of your baby’s health can help over time.
IUGR baby not gaining weight
Digestive disorders seem to be more common with IUGR babies. They are at a heightened risk of GERD (acid reflux) or delayed gastric emptying, which can result in slower or stalled weight gain. If this is the case for your child, it’s important to find a specialist to help come up with the best plan to help your child gain. A healthy diet will help. While fortifying milk can help some babies, it’s not an end-all solution. Some IUGR babies have to be fed through a G-tube.
For us, the key to helping Oliver gain weight was giving him extra “cream” from breastmilk a few times a day, as well as getting his reflux under control. After that, it took off (at his two-month appointment, he had gained barely two pounds since birth. After we resolved his issues, he gained two pounds in a month!)
Types of Intrauterine Growth Restriction
There are two types of IUGR – asymmetrical and symmetrical. In general, asymmetrical is typically thought to be a more “positive” diagnosis. It means that the head is growing at a normal rate for gestation, but the rest of the body is lagging behind. The doctor I saw referred to it as head sparing, as in, the placenta was sending all the nutrients it could to the baby’s head, which is one of the more vital organs to be nourished. The placenta is a pretty amazing thing. Asymmetrical IUGR is often related to placental issues, though there can be other causes. This is what Oliver was. His head was actually a little larger than his gestational age, but the rest of his body was behind quite a few weeks. It often isn’t noted until the third trimester.
Symmetrical means that the body is behind in growth proportionally. 20-25% of IUGR cases are considered symmetrical, so it is a little more rare. However, when an IUGR diagnosis is given earlier in pregnancy (like at the 20-week ultrasound), it is often symmetrical.
What causes IUGR?
There are many different things that can cause IUGR – many of them are idiopathic. That means there is no precise cause of IUGR. While any literature you read will mention things like smoking, alcohol, etc., there are many other reasons. Some women never know!
- Placental abnormalities or placental insufficiency
- Congenital defects
- Smoking during pregnancy
- Substance abuse
- Lack of growth potential of a pregnant woman
- Poor nutrition
- Pregnancy induced hypertension
- Clotting disorders
- Gestational Diabetes
- Low amniotic fluid
- Cord issues
- Small fetal size or fetal growth restriction
I am not a doctor. This information should not be taken as medical advice. Always consult with your medical team when making decisions regarding your pregnancy and baby.
Katie is a Colorado-native, BYU graduated, and most importantly, wife to one and mother to three beautiful boys. She is passionate about sharing her experiences with others – especially about pregnancy, breastfeeding, cooking, and crafts. She is an International Board Certified Lactation Consultant. She loves spending time with her family and helping others find joy in family life.