NEWS

The PSMFM in cooperation with the PSMFM Fetal Growth Restriction Special Interest Group held an online webinar entitled “Fetal Growth Restriction: What’s the latest Marites? A Facts vs. Myths Webinar” last March 12, 2025 with 655 attendees via the zoom platform.

Maternal-Fetal Medicine Experts discussed the definition, classification, risk factors, etiologies, diagnosis, diagnostics, management, and mode of delivery.

The following are the highlights of the discussion:

✔ Fetal growth restriction (FGR) is a complex condition which may be due to an interplay of multiple factors. Fetuses with chromosomal abnormalities, congenital anomalies and intrauterine infections, as well as maternal demographics (age, BMI, nutritional status), and co-morbidities may contribute to the development of FGR.

✔ Assisted reproductive technology (ART) which includes In-vitro fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI) are considered risk factors for FGR due to potential placental abnormalities, multifetal pregnancies, and pre-existing medical conditions.

✔ Placental abnormalities with dysfunctional trophoblastic development, that limits nutrient and oxygen exchange, can cause FGR.

✔ During pregnancy, appropriate maternal weight gain is desired to assure that placental development is optimal for the unhindered transfer of nutrients to meet fetal nutritional needs for rapid development.

✔ Early detection, comprehensive prenatal care, and intensive neonatal management are key to ensuring the best possible outcome.

✔ Accurate pregnancy aging, fetal biometry, and fundic height measurement are key ways to detect and monitor fetal growth.

✔ Maternal-Fetal Doppler Velocimetry studies are integral in the evaluation of FGR.

✔ A small baby is not always a sign of FGR. A baby <10^th percentile with normal Doppler findings and absent feto-placental dysfunction is considered a constitutionally small baby and has a low risk for adverse perinatal outcomes. A growth restricted baby has a higher risk of adverse perinatal outcomes.

✔ Early-onset FGR is associated with higher perinatal morbidity and mortality rates versus the Late-onset FGR.

✔ Not all small babies will have long-term health problems. But growth restricted babies have an increased risk for adverse neurodevelopmental outcomes and future non-communicable diseases such as obesity, metabolic syndrome, diabetes, hypertension, cardiovascular disease and some malignancies.

✔ Maternal multivitamins intake are intended to supplement a proper balanced diet, and not as a replacement.

✔ Daily elemental iron and folic acid intake prevent maternal anemia, and prevent neural tube defects, accordingly.

✔ Calcium supplementation may prevent development of preeclampsia.

✔ Amino acid supplementation in pregnancies with FGR may be beneficial but does not ensure improved fetal growth.

✔ Low-dose Aspirin prophylaxis should only be considered for those at risk for the development of preeclampsia.

✔ The timing of delivery is individualized depending on the underlying etiology, as well as maternal and fetal status.

✔ The mode of delivery for constitutionally small babies and those with FGR are individualized. Pregnancies with FGR can safely undergo induction of labor and vaginal delivery provided the fetal status is reassuring with a normal biophysical profile scoring (BPS) ultrasound and negative contraction stress test (CST).