I'm pregnant. Why is my baby smaller than she should be, and what does that mean?

During the 2nd half of pregnancy, you'll notice at your prenatal appointments that your OB provider measures your belly. And what they're measuring is the pubic bone to the top of the uterus. And this is called the fundus, and so the official name for this measurement is the fundal height, and it should match your gestational age in centimeters. In other words, at 28 weeks, your measurement should be 28 centimeters. There are things that can affect this measurement. It could just be your height actually. If you have a really long trunk because you're tall, then your baby has more places to hide, and you may measure a week or so behind. And if you're really short, the baby has nowhere else to go but out, and so you may measure a week ahead. But the doctor is looking for trends, and as long as the baby is growing steadily and things are looking good, then duly noted and they continue to monitor. But if they're noticing a lag in growth or it seems like your belly is continuing to measure larger than it should, then it warrants further investigation, and this usually means an ultrasound to actually look at the size of the baby, to look at the placenta and the amount of fluid surrounding the baby, all of which can play into what's going on and causing this discrepancy in the measurement and the gestational age.

In the case of a baby being small, you may have heard terms like "small for gestational age", or "intrauterine growth restriction", or "fetal growth restriction". And what these things all mean is that the baby's growth is lagging, and they're not as big as most babies should be (and are) at that gestational age, and so the doctor considers causes. And causes can come from the maternal side, it could have something to do with her health. It could have something to do with the baby's health. Sometimes congenital anomalies, or genetic defects or disorders can cause a lag in growth. And then sometimes it has to do with the fact that the placenta is not working like it should. The placenta is literally the baby's lifeline and that's how a baby receives oxygen and nutrients from the mother, and so if it stops working like it should, then it will affect what the baby gets, and thus it can affect their growth.

If the doctor does notice a lag in your baby's growth, it could just mean more monitoring, so more ultrasounds, non-stress tests, more frequent prenatal appointments just to check on you and the baby more frequently, and sometimes it warrants early delivery. And basically, what a doctor weighs out is the risk of a woman staying pregnant versus the risk of a woman delivering at an early gestational age, and once the risk of staying pregnant is higher than delivering early, then delivery is recommended. And this may be in cases where the baby's growth is just totally stopped or is just so far behind where it should be that they're not getting what they need inside the mother and they need to be born. And this is hard for some parents to understand, because they think, "Well if they're small, just leave them inside and they'll continue to cook and grow and it will be okay.", but that's the whole problem is they're inside and not growing well for whatever reason.

So if your doctor has talked to you about your baby being small for gestational age, talk with them about your questions and concerns, and based on their knowledge of your circumstances, they can give you tailored information and advice about what the ultrasounds, and measurements, and test results mean and what implications it has for your pregnancy. If you have more questions in the future for me, feel free to ask them on our Facebook page at http://www.facebook.com/IntermountainMoms, and recommend us to your friends and family too.

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