17
Inadequate Glycogen Stores and Decreased Glucose Production: High Risk Groups
(continued)
A chronically stressed fetus may use most, if not all, of the placentally transferred glucose for
growth and survival. This limits the ability to make or store glycogen for use after birth. The risk for
hypoglycemia in term infants who have intrauterine growth restriction (IUGR) is estimated at 25
percent. Preterm infants with IUGR are at even higher risk.78
Sugar and Safe Care
Clinical Tip
Symmetric growth restriction (or symmetric SGA)
infants have a lower weight, length, and head circum-
ference for their gestational age. When these param-
eters are plotted on a graph, each will usually be at
or below the 10th percentile. Symmetric SGA growth
often results from intrauterine viral infection in early
gestation, longstanding maternal disease with placen-
tal growth restriction present throughout most of preg-
nancy, or from chromosomal or genetic causes.
Intrauterine growth restriction (IUGR) is a term used
to describe infants who have altered fetal growth, espe-
cially in the third trimester when lipid accumulation is
greatest and growth is rapid. However, IUGR can at
times be detected on a second trimester ultrasound.
The term “IUGR” is often used interchangeably with
“SGA”, however, they are not the same thing. Infants
with IUGR have asymmetric growth restriction.
Their weight will be low for their gestational age, fol-
lowed by some impact on length, but with relative-
ly less restriction in brain growth and head circumfer-
ence (often referred to as “head sparing”). IUGR infants
may appear “wasted,” long and thin. This asymmetric
pattern of growth usually results from maternal medi-
cal conditions or poor placental function that disrupts
oxygen and nutrient delivery to the fetus during the
last trimester of pregnancy. While the cause of growth
restriction may not be easily apparent, assessment of
the above factors (genetics, infection, maternal medi-
cal conditions, and placental function) must be consid-
ered as they may impact future pregnancies.
It is important to perform an accurate gestation-
al age assessment before plotting the weight, head
circumference, and length on the growth chart. If
the gestational age assessment is incorrect, then the
assessment of the infant’s size may be inaccurate.
See Appendices 1.2 and 1.3 for female and male
growth charts.81
What is the difference between
symmetric and asymmetric
patterns of growth and is SGA
the same as IUGR?69,71,74,75,79,80
