intrauterine growth restriction

子宮内胎児発育遅延

WordNet

1. cultivate by growing, often involving improvements by means of agricultural techniques; "The Bordeaux region produces great red wines"; "They produce good ham in Parma"; "We grow wheat here"; "We raise hogs here" (同)raise, farm, produce
2. come to have or undergo a change of (physical features and attributes); "He grew a beard"; "The patient developed abdominal pains"; "I got funny spots all over my body"; "Well-developed breasts" (同)develop, produce, get, acquire
3. become attached by or as if by the process of growth; "The tree trunks had grown together"
4. become larger, greater, or bigger; expand or gain; "The problem grew too large for me"; "Her business grew fast"
5. cause to grow or develop; "He grows vegetables in his backyard"
6. increase in size by natural process; "Corn doesnt grow here"; "In these forests, mushrooms grow under the trees"; "her hair doesnt grow much anymore"
7. (biology) the process of an individual organism growing organically; a purely biological unfolding of events involved in an organism changing gradually from a simple to a more complex level; "he proposed an indicator of osseous development in children" (同)growing, maturation, development, ontogeny, ontogenesis
8. (pathology) an abnormal proliferation of tissue (as in a tumor)
9. a progression from simpler to more complex forms; "the growth of culture"
10. something grown or growing; "a growth of hair"
11. vegetation that has grown; "a growth of trees"; "the only growth was some salt grass"
12. the act of keeping something within specified bounds (by force if necessary); "the restriction of the infection to a focal area" (同)confinement
13. a principle that limits the extent of something; "I am willing to accept certain restrictions on my movements" (同)limitation
14. within the womb

PrepTutorEJDIC

1. 『成長する』,育つ,〈植物が〉生える,茂る / (類・量・程などにおいて)『増大する』,大きくなる / 『しだいになる』 / …‘を'成長させる,大きくする,育てる / …から生じる(起こる)
2. 〈U〉(…の)『成長』,発育;『発達』,発展《+『of』+『名』》 / 〈U〉(数・量,重要性・力などの)『増加』,増大,拡張《+『of』+『名』》 / 〈U〉《修飾語[句]を伴って》栽培,生産,…産 / 〈C〉成育した物,(草,木,髪,ひげなどの)生えたもの / 〈C〉腫瘍(しゅよう)
3. (…を)『制限』(『限定』)『すること』《+『of』+『名』》,制限(限定)されていること / 〈C〉(…に対する)制限事項,制約《+『on』(『against』)+『名』》
4. 子宮内の,子宮内で起こる

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/11/19 00:12:18」(JST)

wiki en

[Wiki en表示]

Intrauterine growth restriction
Classification and external resources
Micrograph of villitis of unknown etiology, a placental pathology associated with IUGR. H&E stain.
ICD-10	P05.9
ICD-9	764.9
DiseasesDB	6895
MedlinePlus	001500
eMedicine	article/261226
MeSH	D005317

Intrauterine growth restriction (IUGR) refers to poor growth of a baby while in the mother's womb during pregnancy. The causes can be many, but most often involve poor maternal nutrition or lack of adequate oxygen supply to the fetus.

At least 60% of the 4 million neonatal deaths that occur worldwide every year are associated with low birth weight (LBW), caused by intrauterine growth restriction (IUGR), preterm delivery, and genetic/chromosomal abnormalities, demonstrating that under-nutrition is already a leading health problem at birth.

Terminology

The term IUGR is not synonymous with Small for Gestational Age (SGA). SGA refers to a birth weight that is below the 10th percentile for gestational age. Not all fetuses with IUGR are classified as SGA, and vice versa. IUGR is used to describe a pattern of intrauterine fetal growth that deviates from expected norms, whereas SGA is a category assigned based on birth weight.

Symmetrical vs. asymmetrical

There are 2 major categories of IUGR: symmetrical and asymmetrical.

Asymmetrical IUGR is more common. In asymmetrical IUGR, there is restriction of weight followed by length. The head continues to grow at normal or near-normal rates (head sparing). This is a protective mechanism that may have evolved to promote brain development. This type of IUGR is most commonly caused by extrinsic factors that affect the fetus at later gestational ages.

Symmetrical IUGR is less common and is more worrisome. This type of IUGR usually begins early in gestation. Since most neurons are developed by the 18th week of gestation, the fetus with symmetrical IUGR is more likely to have permanent neurological sequela.

Causes

Maternal

• pre-pregnancy weight and nutritional status
• poor weight gain during pregnancy
• poor nutrition
• anemia
• alcohol and/or drug use
• maternal smoking
• recent pregnancy
• pre-gestational diabetes
• gestational diabetes
• pulmonary disease
• cardiovascular disease
• renal disease
• hypertension

Uteroplacental

• preeclampsia
• multiple gestation
• uterine malformations

Fetal

• chromosomal abnormalities
• intrauterine infection

Pathophysiology

If the cause of IUGR is extrinsic to the fetus (maternal or uteroplacental), transfer of oxygen and nutrients to the fetus is decreased. This causes a reduction in the fetus’ stores of glycogen and lipids. This often leads to hypoglycemia at birth. Polycythemia can occur secondary to increased erythropoietin production caused by the chronic hypoxemia. Hypothermia, thrombocytopenia, leukopenia, hypocalcemia, and pulmonary hemorrhage are often results of IUGR.

If the cause of IUGR is intrinsic to the fetus, growth is restricted due to genetic factors or as a sequela of infection.

Neurological Development Postpartum

IUGR is associated with a wide range of short- and long-term neurodevelopmental disorders

Cerebral Changes

white matter effects – In postpartum studies of infants, it was shown that there was a decrease of the fractal dimension of the white matter in IUGR infants at one year corrected age. This was compared to at term and preterm infants at one year adjusted corrected age.

grey matter effects – Grey matter was also shown to be decreased in infants with IUGR at one year corrected age.

Neural Circuitry and Brain Networks

Children with IUGR are often found to exhibit brain reorganization including neural circuitry. Reorganization has been linked to learning and memory differences between children born at term and those born with IUGR.

Studies have shown that children born with IUGR had lower IQ. They also exhibit other deficits that point to [frontal lobe] dysfunction.

IUGR infants with brain-sparing show accelerated maturation of the hippocampus which is responsible for memory. This accelerated maturation can often lead to uncharacteristic development that may compromise other networks and lead to memory and learning deficiencies.

Outcomes and clinical significance

IUGR affects 3-10% of pregnancies. 20% of stillborn infants have IUGR. Perinatal mortality rates are 4-8 times higher for infants with IUGR, and morbidity is present in 50% of surviving infants.

Sheep

In sheep, intrauterine growth restriction can be caused by heat stress in early to mid pregnancy. The effect is attributed to reduced placental development causing reduced fetal growth. Hormonal effects appear implicated in the reduced placental development. Although early reduction of placental development is not accompanied by concurrent reduction of fetal growth; it tends to limit fetal growth later in gestation. Normally, ovine placental mass increases until about day 70 of gestation, but high demand on the placenta for fetal growth occurs later. (For example, research results suggest that a normal average singleton Suffolk x Targhee sheep fetus has a mass of about 0.15 kg at day 70, and growth rates of about 31 g/day at day 80, 129 g/day at day 120 and 199 g/day at day 140 of gestation, reaching a mass of about 6.21 kg at day 140, a few days before parturition.)

In adolescent ewes (i.e. ewe hoggets), overfeeding during pregnancy can also cause intrauterine growth restriction, by altering nutrient partitioning between dam and conceptus. Fetal growth restriction in adolescent ewes overnourished during early to mid pregnancy is not avoided by switching to lower nutrient intake after day 90 of gestation; whereas such switching at day 50 does result in greater placental growth and enhanced pregnancy outcome. Practical implications include the importance of estimating a threshold for "overnutrition" in management of pregnant ewe hoggets. In a study of Romney and Coopworth ewe hoggets bred to Perendale rams, feeding to approximate a conceptus-free live mass gain of 0.15 kg/day (i.e. in addition to conceptus mass), commencing 13 days after the midpoint of a synchronized breeding period, yielded no reduction in lamb birth mass, where compared with feeding treatments yielding conceptus-free live mass gains of about 0 and 0.075 kg/day.

In both of the above models of IUGR in sheep, the absolute magnitude of uterine blood flow is reduced. Evidence of substantial reduction of placental glucose transport capacity has been observed in pregnant ewes that had been heat-stressed during placental development.

References

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 胎児の発育遅延：評価およびマネージメント fetal growth restriction evaluation and management
• 2. 胎児（子宮内）発育遅延が認められる胎児 infants with fetal intrauterine growth restriction
• 3. 胎児発育遅延：診断 fetal growth restriction diagnosis
• 4. 妊娠月齢に比して小さい小児に対する成長ホルモン治療 growth hormone treatment for children born small for gestational age
• 5. 新生児低血糖の病因、スクリーニング、および診断 pathogenesis screening and diagnosis of neonatal hypoglycemia

English Journal

• [Hyperthyroidism in pregnancy, less common disorder of the thyroid gland complicating the pregnancy].

• Prajka L, Binder T.
• Ceská gynekologie / Ceská lékarská spolecnost J. Ev. Purkyne.Ceska Gynekol.2016 Dec;80(6):444-6.
• The case report focuses on the case of heavy Graves - Basedow thyreotoxicosis in 33 years old secundipara who was transferred to our departement from regional hospital for decompensation of gestational hypertension, oligohydramnios and the suspition on intrauterine growth restriction (IUGR). In our
• PMID 26741159

• Protein expression in the brain of rat offspring in relation to prenatal caloric restriction.

• Aravidou E1,2, Eleftheriades M1,3, Malamitsi-Puchner A4, Anagnostopoulos AK5, Aravantinos L2, Dontas I6, Aravidis C7, Creatsas G2, Tsangaris G5, Chrousos GP1,8.
• The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.J Matern Fetal Neonatal Med.2016 Aug;29(16):2707-14. doi: 10.3109/14767058.2015.1102222. Epub 2015 Oct 30.
• OBJECTIVE: Intrauterine growth restriction (IUGR) has been associated with decreased supply of crucial substrates to the fetus and affects its growth and development by temporarily or permanently modifying gene expression and function. However, not all neonates born by calorie restricted mothers are
• PMID 26515516

• Adropin concentrations in term pregnancies with normal, restricted and increased fetal growth.

• Baka S1, Malamitsi-Puchner A1, Briana DD1, Boutsikou M1, Marmarinos A2, Gourgiotis D2, Boutsikou T1.
• The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.J Matern Fetal Neonatal Med.2016 Aug;29(15):2403-7. doi: 10.3109/14767058.2015.1089861. Epub 2015 Oct 22.
• OBJECTIVE: To determine levels of adropin (implicated in insulin resistance and endothelial dysfunction) in intrauterine growth restricted (IUGR), large (LGA) and appropriate for gestational age (AGA) pregnancies.METHODS: Cord-blood (UC) adropin and insulin concentrations were measured in 30 IUGR, 3
• PMID 26490387

Japanese Journal

• 母体CMV-IgMが陰性であった先天性サイトメガロウイルス感染症の1例

• 超音波医学 43(3), 505-508, 2016
• NAID 130005151407

• 母体CMV-IgMが陰性であった先天性サイトメガロウイルス感染症の1例

• 超音波医学 advpub(0), 2016
• NAID 130005144179

• 妊娠中のヨガ（マタニティ・ヨガ）の有効性に関する文献的考察（システマティック・レビュー）

• 日本公衆衛生雑誌 62(5), 221-231, 2015
• NAID 130005084360

Related Links

• Intrauterine growth restriction - Wikipedia, the free encyclopedia

Intrauterine growth restriction (IUGR) refers to poor growth of a baby while in the mother's womb during pregnancy. The causes can be many, but most often involve poor maternal nutrition or lack of adequate oxygen supply to the fetus. At least ...

• Intrauterine Growth Restriction: Identification and Management ...

1 Aug 1998 ... Intrauterine growth restriction (IUGR) is a common diagnosis in obstetrics and carries an increased risk of perinatal mortality and morbidity. Identification of IUGR is crucial because proper evaluation and management can ...

Related Pictures

---

★リンクテーブル★

リンク元	「子宮内胎児発育遅延」
関連記事	「restriction」「grow」「intrauterine」「growth」

「子宮内胎児発育遅延」

　　[★]

英

intrauterine growth retardation, IUGR, intrauterine growth restriction？？？

関

胎児発育遅延, 子宮内発育遅延, 胎内発育遅延, 子宮内胎児発育不全

[show details]

子宮内胎児成長遅延 : 10 件
子宮内胎児成長不全 : 1 件
子宮内胎児発育遅延 : 約 92,500 件
子宮内胎児発育不全 : 約 133,000 件

定義

• 胎児の推定体重、妊娠週数に相当する推定体重の10%タイル未満、あるいは-1.5SD未満の時にIUGRと診断する(G10M.124)

分類

NGY.491

• 均衡型子宮内胎児発育遅延 均衡型IUGR, symmetrical IUGR, type I IUGR。胎児障害型

• 体重、身長、頭囲が一様に在胎週数相当の発育をしていない。妊娠20週以前から発生。細胞自体の大きさは正常であるが、細胞数が少ない。
• 原因：妊娠初期の器官形成期の放射線照射、多量の薬剤、感染(風疹ウイルスｍヘルペスウイルス、サイトメガロウイルス、トキソプラズマ、梅毒など)、染色体異常、先天奇形、嗜好品(タバコ、アルコール、麻薬)

• 不均衡型子宮内胎児発育遅延 不均衡型IUGR, asymmetrical IUGR, type II IUGR。栄養障害型

• 頭囲は在胎週数の範囲内であるが体重は小さい。
• 妊娠中期までは正常であるが、後期から発育が遅延。細胞数は減少していないが、細胞の大きさが減少。
• 原因：胎盤機能の低下。異常妊娠や母体合併症　←　妊娠高血圧症候群、心疾患・腎疾患、甲状腺機能亢進症、高度の貧血

管理

• 胎児の成長の評価と胎児well-beingの評価を行う。
• 不均衡型IUGRでは低酸素血症により血流再分配により腎血流が減少し乏尿・羊水過少を呈する事があるために、羊水量のチェックを行う。

「restriction」

　　[★]

• n.

• 制限、限定

関

circumscription、confine、confinement、define、definite、definition、limit、limitation、qualify、restrain、restraint、restrict

　 　 　

「grow」

　　[★]

• v.

(過去: grew-過去分詞: grown)

• 成長する、生育する、伸びる

関

extend、growth、outgrow、outgrowth、stretch

　 　 　 　 　 　 　

「intrauterine」

　　[★]

• adj.

• 子宮内の

関

in utero

　 　

「growth」

　　[★]

• n.

• 成長