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The article presents data on the clinical and pathogenetic variants of fetal growth restriction (FGR). FGR is one of the typical clinical manifestations of large obstetric syndromes, is associated with a high perinatal morbidity and has a significant impact on the quality and duration of human life. The emphasis is made on the differences in pathogenesis, the features of prediction, diagnosis, obstetric management and the assessment of perinatal outcomes in the early and late phenotype of the FGR. The review includes materials from domestic and foreign scientific literature that found in eLibrary and PubMed on this topic and published for the last 10 years. This article discusses the role of the formation of the embryo(feto)placental system under the influence of existing periconceptional risk factors in the implementation of various phenotypes of FGR. An analysis of the literature shows that the fetal growth potential, which genetically and epigenetically determined, changes during pregnancydepending on maternal, placental and fetal factors, which ultimately determine the final weight-growth parameters of the newborn. The issues of informativeness of clinical, laboratory and instrumental predictors, diagnostic criteria, the choice of rational obstetric management in case of FGR of various periods of manifestation are discussed in this article. Convincing data on the perinatal and long-term consequences of intrauterine growth restriction are presented. The pathogenetic variant of FGR determines the features of the functioning of the immune system, has a significant impact on the programming of metabolic and endocrine processes, the formation of fetal brain structures. Identification of pregnant women at risk for the development of FGR of various periods of manifestation, timely diagnosis, selection of the timing and method of delivery should correspond to the main directions of the "4P-model" of modern medicine and represent an integral predictive, preventive and personalized system of examination and observation based on evidence-based medicine data and the requirements of practical obstetrics and perinatology.

The fetal growth retardation takes one of the leading places in the structure of perinatal morbidity and mortality. The frequency of this pregnancy complication in Russia is high – from 3% to 24% among full-term infants and from 18% to 46% among premature newborns. The article analyzes the capabilities of various diagnostic methods for predicting fetal growth retardation. The more indicators are included in the review the more effective isitsreliability in the formation of risk groupsforthis pathology and more effective measures to prevent fetal growth retardation can be taken.Conflict of interest: The authors of this article confirmed the lack of conflict of interest and financial support, which should be reported.

The study assessed trends in posthypoxic changes in the cardiovascular system over the first six months of life in babies with and without fetal growth restriction. The infants born with fetal growth restriction and those born without this condition were found to have similar posthypoxic changes in terms of the type of dilated, hypertrophic cardiopathy or cardiopathy with normal heart chambers. The formation of normal heart function that remained during the first six months of life was impaired in all cases. Fetal growth restriction in babies with the lower heart chambers was related to the changes at birth and during 6 months of life, which were similar to those of cardiopathy with normal heart chambers, but more pronounced. Fetal growth restriction in infants with the enlarged heart chambers was associated with autonomic dysregulation as excessive sympathetic activity at birth, impaired automatism and conductivity, and decreased contractility and relaxation of the left ventricle. The sympathetic component and compensatory resources were observed to be depleted in these babies at the age of 6 months. More pronounced changes were associated with the duration and severity of fetal distress.

Purpose of the study: Rational for the use of folates for the prevention of fetal growth restriction on the basis of the identification of a MTHFR polymorphism.Material and methods: 200 patients (case-control) were enrolled in the study. The (main) group I included 100 patients with fetal growth restriction (FGR), the (control) group II included 100 conditionally healthy patients. The features of the anamnesis, the initial clinical characteristics, the course of pregnancy, childbirth and the postpartum period in patients with placental insufficiency were studied in detail, and the features of the early neonatal period were analysed comprehensively. At the second stage, the polymorphism of the MMP2, MMP3, MMP9, and MTHFR genes was studied and their dependence with the development of the FGR was established. Statistical processing of the results was carried out on a personal computer using the SPSS Statistics 17.0 for Windows software package.Results:The clinical risk factors for the development of FGR include: chronic pyelonephritis, medium degree myopia, varicose veins, threat of abortion, ultrasound-detected subchorionic hemorrhage in the I trimester of gestation, anemia. Along with clinical risk factors for ZRP, the carriage of MTGFR (677 C> T) polymorphism is also considered, which justifies its identification in patients at risk.Conclusion: The data obtained make it possible to use the identification of MTHFR polymorphism as a predictor of placental abnormalities during pregnancy and to start taking folic acid supplements at the preconception stage in good time. Femibion 1 vitaminmineral complex has proved to be an effective product that is suitable for women in the period of preparation for pregnancy and in the first trimester of gestation, reducing the risk of fetal malformations and endothelial dysfunction caused by a violation of folic acid metabolism.