Risk Factors for Adverse Outcomes in Developed Countries: Role of Intrauterine Growth Restriction

Among pregnant women, the determinants and risk factors commonly associated with intrauterine growth restriction (IUGR) differ worldwide. IUGR in developing countries is usually a consequence of chronic malnutrition and infectious diseases such as malaria, dysentery, and chronic diarrhea. On the other hand, the vast majority of intrauterine growth restriction (IUGR) in developed countries results primarily from chronic conditions and behavioral risk factors. These include malnutrition and reduced protein-calorie intake brought on by a growing trend in eating disorders and bariatric/bypass surgery, observed among women of reproductive age; maternal depression that may facilitate the release of stress hormones, thereby causing maternal and/or fetal hormonal imbalance which impairs the function of placental transporters; maternal lifestyle behaviors, such as smoking, alcohol consumption, and use of illicit substance abuse during pregnancy, have been known to cross the placenta, and, as a result, these substances can possibly alter the blood, nutrients, and oxygen flow between mother and child; hypertensive and autoimmune disorders during pregnancy may lead to placental insufficiency, a pathogenic mechanism that plays a central role in IUGR; and lastly, the use of assisted reproductive technology (ART) could affect gene expression, as well as increase the rate of multiple births.