SMALL FOR GESTATIONAL AGE

Small for Gestational Age* (Growth < 10th percentile for GA) Detailed pregnancy, and labour/delivery history Assess pattern of growth* (asymmetric vs symmetric IUGR) Constitutionally Small Maternal Illness Chronic Maternal Disease (e.g., Maternal hypertension, Renal insufficiency, pulmonary disease, chronic anemia, Type 1 Diabetes Mellitus, autoimmune disease, etc.) Gestational hypertension Anatomical uterine abnormalities Maternal Lifestyle Malnutrition Smoking Drug use Alcohol Iatrogenic Drugs (e.g., ACE inhibitors, phenytoin, etc.) Fetal Infection Congenital infections (e.g., TORCH infections) Genetic Chromosomal disorders (e.g., Trisomy 21) Genetic disorders Congenital anomalies Multiple gestation Metabolic disorders Placental Factors Placental insufficiency Placental abnormalities (placental abruption, placental infarction, hemangioma, chorioangioma) Symmetric* Head circumference, length, and weight proportionally decreased Usually occurs early in pregnancy (1st or 2nd trimester) Causes: Intrinsic fetal factors (i.e., genetic) or first-trimester insult (e.g., infection) Asymmetric* Head circumference is spared relative to decreased weight, length Usually occurs later in pregnancy (3rd trimester) Causes: Often due to maternal factors. Thought to result from adaptation to an unfavourable environment late in pregnancy *Indicates Key Condition This is not an exhaustive list of medical conditions.