Fetal Growth Restriction Before and After Birth


Am Fam Physician. 2021 Nov ;104(5):486-492.

  Patient information: A handout on this topic is available at https://familydoctor.org/condition/intrauterine-growth-restriction.

Author disclosure: No relevant financial affiliations.

Fetal growth restriction, previously called intrauterine growth restriction, is a condition in which a fetus does not achieve its full growth potential during pregnancy. Early detection and management of fetal growth restriction are essential because it has significant clinical implications in childhood. It is diagnosed by estimated fetal weight or abdominal circumference below the 10th percentile on formal ultrasonography. Early-onset fetal growth restriction is diagnosed before 32 weeks' gestation and has a higher risk of adverse fetal outcomes. There are no evidence-based measures for preventing fetal growth restriction; however, aspirin used for the prevention of preeclampsia in high-risk pregnancies may reduce the likelihood of developing it. Timing of delivery for pregnancies affected by growth restriction must be adjusted based on the risks of premature birth and ongoing gestation, and it is best determined in consultation with maternal-fetal medicine specialists. Neonates affected by fetal growth restriction are at risk of feeding difficulties, glucose instability, temperature instability, and jaundice. As these children age, they are at risk of abnormal growth patterns, as well as later cardiac, metabolic, neurodevelopmental, reproductive, and psychiatric disorders.

Fetal growth restriction, previously called intrauterine growth restriction, is a condition in which a fetus does not achieve its optimal growth potential. It impacts up to 10% of pregnancies and has significant prenatal and postnatal consequences, including increased risk of perinatal death, neurodevelopmental abnormalities, metabolic syndrome, and cardiovascular disease.14 For fetuses affected by growth restriction, adverse outcomes such as intraventricular hemorrhage, hypoxic ischemic encephalopathy, necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis, and death are more common and severe when estimated fetal weight is below the third percentile, or the 10th percentile if uterine artery flow is abnormal.5

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Clinical recommendationEvidence ratingComments

Do not prescribe heparin or low-molecular-weight heparin solely for the prevention of fetal growth restriction.7,15


Expert clinical review of randomized controlled trials; evidence-based practice guideline

Do not use nutritional treatments or dietary supplements for the prevention of fetal growth restriction.1,7,1518


Consistent findings from randomized controlled trials; evidence-based practice guidelines

Prescribe low-dose aspirin to patients between 12 and 16 weeks' gestation at moderate or high risk of preeclampsia, but do not prescribe aspirin for the sole purpose of preventing fetal growth restriction.7,15,20,21


Consistent findings from randomized controlled trials; evidence-based practice guideline

Perform Level II comprehensive anatomy ultrasonography for pregnant patients diagnosed with early-onset fetal growth restriction.7


Consensus guideline based on observational studies

Obtain annual blood pressure measurements before three years of age for children who are born small for gestational age, for preterm birth before 32 weeks' gestation, or for complications requiring neonatal intensive care. Otherwise, start at three years of age as recommended for all children.45


Consensus guideline and expert opinion

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

The Authors

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ANDREA WESTBY, MD, FAAFP, is a faculty physician at the University of Minnesota North Memorial Family Medicine Residency Program, and an assistant professor in the Department of Family Medicine and Community Health at the University of Minnesota Medical School in Minneapolis....

LAURA MILLER, MD, MPH, FAAFP, is a faculty physician at the University of Minnesota North Memorial Family Medicine Residency Program, and an assistant professor in the Department of Family Medicine and Community Health at the University of Minnesota Medical School.

Address correspondence to Andrea Westby, MD, FAAFP, University of Minnesota Medical School, 1020 W. Broadway, Minneapolis, MN 55455 (email: westby@umn.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


show all references

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