Maternal Vascular Disease and Fetal Growth

Maternal vascular diseases are known to influence fetal growth by reducing the availability of nutrients through the impaired uteroplacental circulation. Intrauterine fetal growth retardation (IUGR) is related to an increased risk for perinatal morbidity and mortality. The etiologic factors that result in IUGR are generally difficult to identify. A distinction can be made between intrinsic and extrinsic factors that cause the restriction of fetal growth potential (Table 1), but in many fetuses IUGR is defined as idiopathic or asymptomatic, as none of the identifying factors can be shown to be responsible for the process. Gestational hypertension and the chronic diseases that affect the maternal placental circulation are the principal factors in IUGR (50% to 60%); chromosomal disorders and congenital anomalies are reported in 5 % to 10% of all cases of IUGR, and fewer than 10% may have impaired intrauterine growth secondary to congenital infections (1). In this chapter, we focus on some findings that seem to open new strategies in the identification and treatment of fetal growth retardation: the possibility of monitoring an increased maternal blood pressure in patients with asymptomatic fetal growth retardation; determination of the relations between maternal hyperinsulinemia and reduced fetal growth; and treatment with intravenous immunoglobulin (IVIG) to reduce the incidence of fetal growth retardation in patients with antiphospholipid antibodies.