Origins of fetal growth restriction

Regulation of growth of the fetus and its placenta begins before pregnancy. Early in pregnancy the mother sets the rate of growth of the fetus on a tr ajectory, which may be modified by events later in pregnancy. Low maternal weight for height, history of previous small babies, maternal undernutrition, pregnancy disorders, e.g. pre-eclampsia, are associated wit h low birthweight. Maternal smoking is a major factor in developed countrie s; infections and undernutrition in developing countries. Recently, there has been emphasis on adverse long-term outcomes including i schaemic heart disease, hypertension and diabetes associated with poor feta l growth. Experimental studies in animals show that some of these outcomes can readily be induced by restriction of fetal growth. Progress in determining successful treatments to improve the growth of the fetus has lagged behind these epidemiological and experimental findings. Ho wever, nutrient supplements improve growth in undernourished women and smok ing cessation also improves fetal size and outcome. (C) 2000 Elsevier Scien ce Ireland Ltd. All rights reserved.