13 Things to Know about an IUGR Diagnosis

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. 

IUGR Baby

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.

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:

IUGR.

I knew babies were born small sometimes, but I always just assumed that was because they were premature. 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 something bad was going to happen.

Fortunately, Oliver was born at exactly 39 weeks, 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. Even more, I feel like a lot of the doctor’s we’ve talked with aren’t even sure what to say. 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, etc. (which IUGR babies are more at risk for anyways.)

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.

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 Other’s 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.

Find Support

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:

IUGR Support Group on Facebook
IUGR Pregnancy and Beyond

Don’t Blame Yourself

While there are some things that can cause an IUGR baby, often, it is ideopathic…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:

What is IUGR?

It 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.)

Can IUGR Recur? 

Yes. If you had one IUGR baby, you have a heightned risk in anther pregnancy. However, it may not happen again, and the risk depends on why IUGR happend in the first place. It is important to follow-up with your doctor after your pregnancy to discuss this.

Can IUGR babies be normal?

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.) It’s not a death sentence. Many babies who were IUGR at birth have no lasting consequences.

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. 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. While any literature you read will mention things like smoking, alcohol, etc., there are many other reasons. Some women never know!

  • Placental abnormalities
  • Congenital defects
  • Smoking during pregnancy
  • Poor nutrition
  • Pregnancy induced hypertension
  • Clotting disorders
  • Gestational Diabetes
  • Low amniotic fluid
  • Cord issues

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. 

IUGR Baby / What is IUGR / IUGR

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14 Comments

    • I hadn't either! I felt like I knew a lot about pregnancy and different complications, but it was a totally new diagnosis to me. I hope this can help others!
  • Very good article. Thank you for bringing awareness to IUGR. We had our baby girl 9 months ago. I was concerned at a 21 week scan that she was measuring 8 days behind, but the doctors weren't. I felt uneasy after that. After severe decrease in movement. They finally did another scan. My heart sank when at 27+6 she was barely the size of a 24-weeker. I am here to give moms hope!! She was diagnosed with SYMMETRICAL IUGR and NO FLUID. She was born the next day via emergency csec. 1lb. 7oz. Fast forward to last week. She just had her 6 month NICU follow up. She scored at a 6 month level on all test and was in the 18-20% for weight, heights & head. She is happy and healthy and almost crawling. Even though she was Symmetrical IUGR, her neonatologist says she is perfect and requires no therapy. We are so blessed. These babies are fighters.
    • Thank you so much for sharing your story and giving other moms hope - especially those in the situation you were in! I'm so glad she's doing so well now. They truly are fighters!
  • Thanks for sharing your story. My IUGR baby is now 5. She has stayed small but is on her own growth curve. She has been on medicine for GERD since she was 5 days old. She is now a very typical 5 year old but she was considered delayed in gross motor skills and cognitively until she was 2. And she definitely gets LOTS of wear out of all of her clothes and shoes.
  • My Cadee girl was dx. With IUGR, but not until AFTER she was delivered via c-section. I had never head of the dx. Either, and like any new mom, I Googled and read everything I could get my hands on.(some info. Helped, some did not) although I never found out why.. she was considered asymmetrical iugr and is 14mo. And weighing a whopping 22lbs lol so I get a lot of "omg, let that baby comes to my house, I'll fatten her up" I cringe at that comment! (Mainly because it makes me feel like a failure) But educating people about the dx. And whyyy she is so small and whyyy "fattening her up" would only increase her risk for type 2 diabetes, usually gets them to change their tune and are more cautious about their comments. Thank you for the blog! Everything you said I felt! ?
    • I totally agree with everything you said! My Oliver is about 21 months, and he is only 23 pounds - so we definitely get those comments, too. I think it's important that people realize these kiddos are at an increased risk of Type 2 Diabetes and Obesity, which is why loading them up with calories isn't always ideal. I hope more recognition will come to this diagnosis - I certainly had no idea what was going on when I first heard it!
  • At my 19th week ultrasound it was discovered that my baby is measuring small. I'm currently 31 weeks pregnant and the baby is still measuring small at a little over 2.5 lb , somedays I cry thinking the worst could happen, my husband is much stronger then me and has faith that everything will be alright. I just want to say Thank you for writing this article it deffinetly puts a better perspective into this diagnostic, and helped me to keep positive about this and is helping me to keep faith that my babygirl is most likely going to be okay.
    • Thanks for comment, Jolaine! I'm glad that you were able to find some comfort in this post. I hope everything will be okay. Keep me updated <3
  • I love your post.... i am at a risk of assymeterical iugr..... i am 32 weeks and ac is measuring 29 weeks... so a few weeks back.... i am going crazy and am super scared as to what will happen next... i have an other ultrasound tomorrow lets hopes things look up for the better.... in my case too the head is measuring 32 weeks so seems like olivers case....this post gives me hope that everything will be fine..... i really want to know if the doctor says i would go full term is there a way to put on weight though supplement or medicine till the baby is in the womb
    • Thank you for sharing your situation! Try and relax. I hope things are looking better for you. But it definitely sounds like your child is like Oliver - make sure you push for answers if you aren't getting them (like I should have pushed harder when the doctor said everything was fine just because his head was large, even though the rest of his body was so far behind!).I have heard that sometimes extra protein can help with infant weight gain, however, it would really depend on what your child is IUGR. In my case, the placenta had an issue, and no amount of food would have helped that.
  • Thank you thank you thank you. I can’t thank you enough for being the absolute voice of reason I needed so badly right now. I will remind myself to keep referring back to this post when I get all caught up in my emotions and negative thinking.

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