Intrauterine Growth Restriction and Cerebral Palsy

Fact Checked

Intrauterine growth restriction, or IUGR, means that a baby is not growing well in the womb. Risk factors for IUGR include maternal health conditions and substance use. Not every baby who is small for its gestational age will develop cerebral palsy, but it does increase the risk.

What Is IUGR?

IUGR occurs when a fetus does not develop and grow as it should. Doctors can use ultrasound images to determine a fetus’s size and approximate weight and determine if it is growing appropriately or has IUGR.[1]

If the weight of a baby is lower than the tenth percentile for its gestational age, the baby is not growing as it should.

There are two basic types of IUGR. Primary, or symmetric, IUGR occurs when all the organs in the developing fetus are too small.

In asymmetric, or secondary, IUGR, the head and brain develop to average size, but the abdomen is too small. This is more common than symmetric IUGR. Symmetric IUGR is more commonly associated with adverse neurological outcomes.

Does IUGR Cause Cerebral Palsy?

Cerebral palsy is associated with poor intrauterine growth and low birth weight. This doesn’t mean that IUGR always causes cerebral palsy, but it is an important risk factor.[2]

IUGR, compared to appropriate growth for gestational babies, may lead to a small head size, which is associated with a five to ten times increased risk of neurological complications. Another significant potential complication of IUGR is a lack of oxygen to the baby as it is being born.

This, in turn, can cause brain damage and cerebral palsy. Not all babies born with a small size will experience brain damage and develop cerebral palsy, but it is an increased risk.

Backing up the evidence that IUGR can put a baby at risk for cerebral palsy is the opposite statistic: babies a little bit larger than average for their gestational age are less likely to have cerebral palsy.

Research also suggests that the lower the baby’s weight or size due to IUGR, the greater the risk of developing more severe cerebral palsy. Male babies also seem to be at a greater risk of having cerebral palsy as a result of IUGR. In some cases, there is a question of whether slow growth causes brain damage and cerebral palsy or whether some brain damage has occurred that results in IUGR.

Causes and Risk Factors

Why IUGR happens is not always known. A baby may grow poorly, but doctors may be unable to pinpoint the exact reason. There are many potential causes as well as risk factors that make it more likely a baby will struggle to grow and develop.

Risk factors that may contribute to poor growth include smoking, drug use, or alcohol abuse by the mother. Other health problems in the mother that may contribute to IUGR include heart disease, high blood pressure, gestational diabetes, rubella, and kidney disease.[1] Cytomegalovirus can also be a cause of restricted fetal growth.[3]

A documented cause of IUGR is when the fetus does not get adequate nutrition or oxygen from the placenta. This may be from maternal health conditions such as diabetes, poor weight gain, or drug and alcohol use.

It can be caused by multiple births, placental complications, or preeclampsia. It can also occur due to the mother having low oxygen levels due to being at a high altitude or having a low blood count (anemia). Infections in the mother may also cause IUGR, especially rubella, syphilis, toxoplasmosis, and cytomegalovirus.

There may also be chromosome abnormalities or birth defects that cause a baby to fail to develop normally in the womb.

Treating IUGR

If a doctor determines that a baby is not developing or growing enough, treating it depends on the gestational age and the cause. If low oxygen is an issue, the doctor will try to treat that.

If placental factors are present, a mother may need to increase her fluid and nutrient intake. According to a study, injecting nutrients into a developing fetus can improve placental perfusion and metabolism and reduce the risk of poor growth.[4]

A fetus that is 34 weeks or more may be a good candidate for early delivery.

The mother can be induced to start labor, or a Cesarean section may be performed. If the fetus is less than 34 weeks, the doctor is most likely to continue to monitor the situation and decide at 34 weeks if early delivery is necessary.

Complications of IUGR

IUGR must be taken seriously because a fetus not growing normally could end up with serious health complications. IUGR can even lead to the baby’s death either in the womb or shortly after birth.

Babies that are IUGR are at a greater risk of having low blood sugar at the time of birth, having a lower resistance to infections, being able to maintain adequate body temperature, being able to cope with the stress of vaginal delivery, and having a high red blood cell count.

Preventing IUGR and Cerebral Palsy

It is important to understand the risk factors and causes of IUGR to take appropriate steps to prevent it and, in turn, prevent cerebral palsy. Even with preventative measures, a fetus may not develop normally, but the more risk factors can be eliminated, the better.

This means a mother should maintain her own health as much as possible, avoiding drugs, cigarettes, and alcohol, getting good nutrition, and seeing her doctor regularly. Regular checkups include screenings and treatments for health problems that may contribute to IUGR, like preeclampsia.

It is also crucial to monitor the fetus during pregnancy. If the doctor can pinpoint a problem in growth before it proceeds too rapidly, steps may be taken that reverse the risks and help the fetus grow and develop.

Negligence may be involved in cases in which a doctor fails to monitor the developing fetus and does not notice that it is not growing normally.

There are instances in which a fetus does not develop normally, and it is no one’s fault. The mother and her medical team may have done everything right, and yet the baby does not grow normally.

On the other hand, enough is known about IUGR and its risk factors and causes and how to monitor it that doctors should be able to screen a mother for the average growth of her fetus.

If you believe your baby did not develop normally, was too small for its gestational age, and your child now has cerebral palsy because your doctor did not make the right choices during your pregnancy and labor, you may have a case for medical malpractice. Contact an experienced cerebral palsy lawyer to learn more about your legal options.