Fetal growth and size at birth

Question 1

> 4000g

Answer 1

macrosomic

Question 2

2500g - 4000g

Answer 2

normal birth weight

Question 3

1500g- 24999g

Answer 3

low birth weight (LBW)

Question 4

1000g- 1499g

Answer 4

very low birth weight (VLBW)

Question 5

<1000g

Answer 5

Extremely
Low Birth
Weight
(ELBW)

Question 6

four categories that affect birth weight

Answer 6

genetics
gestational age
fetal nutrition and placental function
environmental factors

Question 7

genetics

Answer 7

Some infants are constitutionally destined to be larger than others

Question 8

gestational age

Answer 8

Fetuses normally grow with age

Question 9

environmental factors

Answer 9

alcohol
chronic infections

Question 10

if an infant has a low birth weight they may be

Answer 10

1. Constitutionally small.
2. Preterm.
3. Suffering from poor fetal nutrition.
4. Damaged by environmental factors.

Question 11

One can describe the weight with respect to the gestational age in terms of whether
the child is:

Answer 11

• Large (overweight) for Gestational Age (LGA): >90th centile on Intergrowth charts.
• Appropriate for Gestational Age (AGA) (10th to 90th centile).
• Small (underweight)for Gestational Age (SGA) <10th centile.

Question 12

What does the term IUGR describe in relation to a fetus?

Answer 12

The term Intra-Uterine Growth Restriction (IUGR) describes a fetus who grows slower than normal, often from early pregnancy.

Question 13

Aetiology of underweight for gestational age: Maternal

Answer 13

. Maternal
* Teenager/Advanced Maternal Age.
* Short birth interval.
* Maternal undernutrition.
* Maternal diseases including hypertension, diabetes, cardiac and renal disease,
malaria, TB and advanced HIV.

Question 14

Aetiology of underweight for gestational age: Uterovascular inadequacy

Answer 14

• Abruption.
• Pre-eclampsia.
• Multiple Pregnancy.

Question 15

Aetiology of underweight for gestational age: Environmental

Answer 15

• Cigarettes.
• Alcohol.
• Illicit drugs.
• Licit drugs

Question 16

Aetiology of underweight for gestational age: Fetal

Answer 16

• Chromosomal abnormalities.
• Genetic diseases.
• Intrauterine infections (TORCH).
• Inborn errors of Metabolism (IEM).
• Twin to twin transfusion.

Question 17

What is Intra-Uterine Growth Restriction (IUGR)?

Answer 17

IUGR describes a fetus who grows slower than normal, often from early pregnancy.

Question 18

What is the characteristic growth pattern of infants affected by a late insult, such as pre-eclampsia?

Answer 18

Infants affected by a late insult experience acute starvation, leading to wasting and a small abdominal circumference.

Question 19

What is the term used for a fetus who has been growing well but suffers a late insult, like pre-eclampsia?

Answer 19

Such fetuses are termed acutely starved and may exhibit asymmetrical growth patterns.

Question 20

What happens to infants affected by a late insult, resembling those with Severe Acute Malnutrition (SAM)?

Answer 20

They become wasted with a small abdominal circumference due to depleted fat and glycogen stores.

Question 21

Why do these infants appear asymmetrical at birth?

Answer 21

Their head and length remain appropriate, but their body appears relatively smaller due to wasting.

Question 22

What is the potential outcome for these infants if fed appropriately after delivery?

Answer 22

They may experience good “catch-up growth” after birth.

Question 23

What characterizes infants affected by growth restriction that starts early in fetal life?

Answer 23

They exhibit symmetrical growth restriction, affecting all organs, and are typically small at birth.

Question 24

What distinguishes these infants from constitutionally small infants?

Answer 24

They may have severe concomitant pathology, such as chromosomal abnormalities or intra-uterine infections.

Question 25

What is the long-term prognosis for infants affected by early fetal growth restriction?

Answer 25

They do not typically experience good catch-up growth and tend to have worse long-term outcomes compared to constitutionally small infants.

Question 26

Complications of being underweight for gestational age

Answer 26

Some of the problems these infants face include:
* Hypoxic Ishaemic Encephalopathy.
* Meconium aspiration.
* Persistent Pulmonary Hypertension of the Newborn.
* Hypothermia.
* Hypoglycaemia.
* NEC
* Polycythaemia and jaundice.
* Cerebral Palsy, IVH and adverse neuro-developmental outcomes.

Question 27

What is the Barker’s hypothesis, also known as the Fetal Origins Hypothesis?

Answer 27

It suggests that being growth restricted as an infant has lifelong effects on health.

Question 28

What are some of the long-term health risks associated with being growth restricted as a fetus?

Answer 28

Growth-restricted fetuses have an increased risk of hypertension, diabetes, dyslipidemia, obesity, and ischemic heart disease when they reach adulthood.