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A. An unborn baby is small if, at that stage of pregnancy, his or her size or estimated weight on scan is in the lowest 10% of babies. This means the smallest ten out of every 100 babies.
A. Your baby’s weight is affected by many things, including:
A. Your baby could be small because of a combination of the factors above. If this is the case, your baby is likely to be healthy because he or she is meant to be small.
However, sometimes babies are small because they do not grow as well as expected. This is called being ‘growth restricted’. Causes of growth restriction include:
A. Lifestyle choices such as smoking, using cocaine, over-exercising or not eating healthily are all linked to an increased chance of the baby being growth restricted.
You are more likely to have a baby that is growth restricted if you are over 40 or have high blood pressure, kidney problems or diabetes complications. Having lost a baby late in pregnancy or having had a small baby in the past also increases your risk.
Heavy vaginal bleeding, especially in the second half of pregnancy, can also affect the way your baby grows.
A. Some of these risks cannot be changed, but some can:
A. If your baby is small but healthy, he or she is not at increased risk of complications.
If your baby is growth restricted, there is an increased risk of stillbirth (the baby dying in the womb), serious illness and dying shortly after birth. The earlier in pregnancy and the more severely your baby’s growth is affected, the more likely it is that your baby will have a poor outcome. Babies whose growth is only affected later in pregnancy have a better outcome.
Most babies affected by infection or by developmental or genetic problems have severe growth restriction and are usually detected early.
Once your healthcare team has identified that your baby is small, you will be offered extra monitoring to keep an eye on your baby’s growth and wellbeing. You are likely to be advised to have your baby early to be as certain as possible that your baby will be born healthy.
A. Your obstetrician should assess your risk of having a small baby in early pregnancy:
A. You may have the following tests to check your baby’s wellbeing:
You may be referred to a fetal medicine specialist for more frequent and detailed scans if the umbilical artery Doppler test is abnormal.
A. This will depend on how affected your baby’s growth appears to be, and on the Doppler measurements. The scans will help your team decide whether it is better for your baby to be born early or safer for you and your baby to continue your pregnancy longer. If your baby is growing and the Doppler tests are normal, it is usually best to wait until you are at least 37 weeks pregnant.
A. Depending on the timing of birth and the way you are going to have your baby, you may be offered a course of corticosteroids over a 24–48 hour period. This is to help your baby’s development and reduce the chance of breathing problems after birth.
A. If there are no other complications, you may be able to have a vaginal birth. Your baby will be monitored closely during labour. However, if the umbilical artery Doppler measurements are abnormal, your doctor may recommend that your baby be born by caesarean section.
If you go into labour, if your waters have broken or if you have had any bleeding before the date that you have been advised to have your baby, you should attend hospital straight away.
A. You will be advised to have your baby in a hospital where there is a neonatal unit (special care baby unit).