Fetal growth restriction (fetus)

A baby who is not growing as well as expected inside the womb. The Society for Maternal-Fetal Medicine says it can come from many mother, baby and placenta conditions, happens in up to 10% of pregnancies and is a leading cause of illness and death in infants. It is found by ultrasound. The Society defines it as an estimated fetal weight, or an abdominal circumference, below the 10th percentile for the gestational age, so a growth chart sets the line, and the available charts do not agree on who is small.

Condition
In this atlas

Overview

Technical summary

Condition of the fetus (recipient fetal). Source: Society for Maternal-Fetal Medicine Consult Series #52 (abstract on PubMed). The consult says published diagnostic criteria are disparate, detection rates relatively low and prevention and treatment options limited. It recommends serial umbilical artery Doppler once growth restriction is diagnosed. Trials of delivery timing are filed as the TRUFFLE and DIGITAT study records. Growth restriction is one route to low birth weight; the two are not the same thing.

Recognition

Ultrasonographic estimated fetal weight or abdominal circumference below the 10th percentile for gestational age (SMFM Consult Series #52 recommendation, GRADE 1B as the guideline rates it)

Assessment

Serial umbilical artery Doppler assessment once growth restriction is diagnosed (SMFM recommendation, GRADE 1C as the guideline rates it)

Burden

Burden Guidance Certainty not assessed

The Society for Maternal-Fetal Medicine says fetal growth restriction can result from a variety of maternal, fetal and placental conditions, occurs in up to 10% of pregnancies and is a leading cause of infant morbidity and mortality.
Applies to Fetal
- Fetuses in pregnancies in general. The SMFM statement is about how often fetal growth restriction occurs; it does not describe a study population.
- Not stated in the abstract
- Not stated in the abstract (SMFM is a US society)
- Pregnancy
- Gestational age Not reported
- Postnatal age Not reported
Follow-up Not stated in the parts of the source that were read.
Certainty method
Not assessed

Limitations
A general statement in the abstract of a guideline, without a stated source population, country or year. The figure up to 10% depends on the diagnostic criteria used. Only the abstract was read.

Last checked
2026-10-14

Next evidence check due
Not scheduled
Sources and citations (2)
1. Supports Society for Maternal-Fetal Medicine Consult Series #52: Diagnosis and management of fetal growth restriction: (Replaces Clinical Guideline Number 3, April 2012)
  
  Publication · American journal of obstetrics and gynecology · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read. · Published 2020-05-12 · DOI: 10.1016/j.ajog.2020.05.010 · PMID: 32407785
  
  Locator
  Abstract, sentence 1
  
  How it applies
  PubMed abstract.
  
  Retrieved
  2026-10-14T18:18:29Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  46146a6010bb229ca5fd35bacf5da7650a106f68c1ffe3d41d8515bb71aa00c4
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
2. Supports Society for Maternal-Fetal Medicine Consult Series #52: Diagnosis and management of fetal growth restriction: (Replaces Clinical Guideline Number 3, April 2012)
  
  Publication · American journal of obstetrics and gynecology · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read. · Published 2020-05-12 · DOI: 10.1016/j.ajog.2020.05.010 · PMID: 32407785
  
  Locator
  Abstract, sentence 2
  
  How it applies
  PubMed abstract.
  
  Retrieved
  2026-10-14T18:18:29Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  46146a6010bb229ca5fd35bacf5da7650a106f68c1ffe3d41d8515bb71aa00c4
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

Claims and evidence

Context Fetuses with diagnosed fetal growth restriction, as addressed by SMFM Consult Series #52

Recipient: Fetal
Population: Fetuses of pregnancies in which fetal growth restriction has been diagnosed (an ultrasonographic estimated fetal weight or abdominal circumference below the 10th percentile for gestational age, per the guideline).
Care setting: Prenatal care; setting not stated in the abstract
Geography: Not stated in the abstract (SMFM is a US society)
Life stage: Pregnancy
Gestational age: Not reported
Postnatal age: Not reported
Follow-up: Not stated in the parts of the source that were read.

Eligibility: inclusion criteria not stated; 1 exclusion criterion

Included: None stated
Excluded: Not stated in the parts of the source that were read.

Recommendation Guidance Certainty not assessed

The Society for Maternal-Fetal Medicine (Consult Series #52) recommends defining fetal growth restriction as an ultrasonographic estimated fetal weight or abdominal circumference below the 10th percentile for gestational age (the guideline's own rating is GRADE 1B). It also recommends population-based fetal growth references (such as Hadlock) for determining fetal weight percentiles (GRADE 1B).
Applies to Fetal
- Fetuses of pregnancies in which fetal growth restriction has been diagnosed (an ultrasonographic estimated fetal weight or abdominal circumference below the 10th percentile for gestational age, per the guideline).
- Prenatal care; setting not stated in the abstract
- Not stated in the abstract (SMFM is a US society)
- Pregnancy
- Gestational age Not reported
- Postnatal age Not reported
Follow-up Not stated in the parts of the source that were read.
Certainty method
Not assessed

Limitations
The definition depends on which growth chart sets the 10th percentile, and charts disagree (see the growth standard disagreement page). The consult itself says published diagnostic criteria are disparate. Ratings are the guideline authors' and are shown as they state them. Only the abstract was read.

Last checked
2026-10-14

Next evidence check due
Not scheduled
Sources and citations (4)
1. Supports Society for Maternal-Fetal Medicine Consult Series #52: Diagnosis and management of fetal growth restriction: (Replaces Clinical Guideline Number 3, April 2012)
  
  Publication · American journal of obstetrics and gynecology · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read. · Published 2020-05-12 · DOI: 10.1016/j.ajog.2020.05.010 · PMID: 32407785
  
  Locator
  Abstract, sentence 3
  
  How it applies
  PubMed abstract.
  
  Retrieved
  2026-10-14T18:18:29Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  46146a6010bb229ca5fd35bacf5da7650a106f68c1ffe3d41d8515bb71aa00c4
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
2. Supports Society for Maternal-Fetal Medicine Consult Series #52: Diagnosis and management of fetal growth restriction: (Replaces Clinical Guideline Number 3, April 2012)
  
  Publication · American journal of obstetrics and gynecology · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read. · Published 2020-05-12 · DOI: 10.1016/j.ajog.2020.05.010 · PMID: 32407785
  
  Locator
  Abstract, sentence 5, fragment 2 of 32
  
  How it applies
  PubMed abstract.
  
  Retrieved
  2026-10-14T18:18:29Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  46146a6010bb229ca5fd35bacf5da7650a106f68c1ffe3d41d8515bb71aa00c4
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
3. Supports Society for Maternal-Fetal Medicine Consult Series #52: Diagnosis and management of fetal growth restriction: (Replaces Clinical Guideline Number 3, April 2012)
  
  Publication · American journal of obstetrics and gynecology · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read. · Published 2020-05-12 · DOI: 10.1016/j.ajog.2020.05.010 · PMID: 32407785
  
  Locator
  Abstract, sentence 5, fragment 3 of 32
  
  How it applies
  PubMed abstract.
  
  Retrieved
  2026-10-14T18:18:29Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  46146a6010bb229ca5fd35bacf5da7650a106f68c1ffe3d41d8515bb71aa00c4
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
4. Supports Society for Maternal-Fetal Medicine Consult Series #52: Diagnosis and management of fetal growth restriction: (Replaces Clinical Guideline Number 3, April 2012)
  
  Publication · American journal of obstetrics and gynecology · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read. · Published 2020-05-12 · DOI: 10.1016/j.ajog.2020.05.010 · PMID: 32407785
  
  Locator
  ArticleTitle
  
  How it applies
  PubMed abstract.
  
  Retrieved
  2026-10-14T18:18:29Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  46146a6010bb229ca5fd35bacf5da7650a106f68c1ffe3d41d8515bb71aa00c4
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

Clinical links

Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.

Claim, not a settled fact Evaluated for this: Umbilical artery Doppler ultrasound (Evaluated for, seen from the other side)
Applies to Mixed recipients
- Fetuses and babies of women with high-risk pregnancies in 19 randomised and quasi-randomised trials that compared Doppler ultrasound of umbilical and fetal vessels with no Doppler ultrasound. The abstract does not define high risk beyond the trials own definitions. Outcomes in this context (perinatal deaths and stillbirths) are counted in babies and include deaths before and after birth.
- Antenatal care in the included trials; setting not described in the abstract
- Not stated in the abstract
- Pregnancy, high risk; follow-up to birth and the newborn period
- Gestational age Not reported
- Postnatal age Not reported
Follow-up Not stated in the parts of the source that were read.
A Cochrane review of 19 trials involving 10,667 women in high-risk pregnancies found that Doppler ultrasound of the umbilical artery was associated with fewer perinatal deaths than no Doppler or cardiotocography: risk ratio 0.71 (95% confidence interval 0.52 to 0.98; 16 studies, 10,225 babies), 1.2% versus 1.7%, number needed to treat 203 (95% CI 103 to 4352). The review authors graded this evidence moderate.
Limitations. High-risk pregnancy is defined by the included trials and is not limited to growth restriction; the abstract does not say how many had growth restriction. None of the evidence for the main outcomes was graded high; risk of bias was hard to assess because of incomplete reporting, and evidence was downgraded for missing information on trial methods, imprecision and heterogeneity. The upper end of the interval (0.98) is close to no difference. The same review found no clear difference for stillbirths alone (see the stillbirth claim) and reports no comparative long-term follow-up of babies exposed to Doppler ultrasound in these pregnancies. The searches ran to 31 March 2017. Only the abstract was read.
Claim, not a settled fact Recommended for this: Umbilical artery Doppler ultrasound (Recommended for, seen from the other side)
Applies to Fetal
- Fetuses of pregnancies in which fetal growth restriction has been diagnosed (an ultrasonographic estimated fetal weight or abdominal circumference below the 10th percentile for gestational age, per the guideline).
- Prenatal care; setting not stated in the abstract
- Not stated in the abstract (SMFM is a US society)
- Pregnancy
- Gestational age Not reported
- Postnatal age Not reported
Follow-up Not stated in the parts of the source that were read.
The Society for Maternal-Fetal Medicine (Consult Series #52) recommends that once fetal growth restriction is diagnosed, serial umbilical artery Doppler assessment be performed to assess for deterioration (the guideline's own rating is GRADE 1C).
Limitations. This is one recommendation from a long list in the same consult. The rating is the guideline authors' and is shown as they state it. The abstract also suggests that Doppler of the ductus venosus, middle cerebral artery or uterine artery not be used for routine management of fetal growth restriction (GRADE 2B). Only the abstract was read.