Pathologies of intrauterine growth and fetal development during the fetal period

The perinatal medicine literature includes several potentially conflicting terms and concepts related to intrauterine size and fetal growth. In this article, the parameters of the physical development of the fetus are examined from an obstetric point of view.

You will learn about the physiological mechanisms that determine developmental opportunities, risk factors for abnormalities, diagnostic and prognostic problems associated with limited and excessive development of the baby during the fetal period of pregnancy.

What is the fetal period and why does it need to be studied?

The content of the article

The period between the 3rd and 9th month (until the end of intrauterine development) is called fetal. At this time, tissues and organs mature, so the fetus grows quickly. Fetal size and growth trajectory of the fetus are important indicators of the baby’s health. They are studied using standards developed by obstetricians and gynecologists.

Modern doctors insist that significant deviations from average parameters can clearly indicate pathologies of child development. During the fetal period, developmental defects associated with deformations and tissue destruction caused by infections, injuries and other factors are clearly identified.

Detected defects may be insignificant or, on the contrary, significantly affect the child’s health in the future. Therefore, all three screenings during pregnancy include a mandatory study of the height, weight and other characteristics of the fetus.

Causes of pathology

Factors leading to fetal hypertrophy are conventionally classified into groups.

Social status of the mother and her lifestyle:

• Alcohol abuse;
• Smoking;
• Age;
• Prolonged stay in a state of stress;
• Harmful professions;
• Abuse of diets prohibited during pregnancy.

Features of the obstetric history: gynecological diseases, anomalies of the reproductive organs, pathologies of previous pregnancies.

Diseases of the expectant mother:

• Kidney failure;
• Diseases of the digestive system;
• Autoimmune processes;
• Endocrine pathologies;
• Acute liver failure;
• Diseases of an infectious nature.

Pathological course of pregnancy:

• Impaired blood supply to the placenta and fetus;
• High and low water levels;
• Anemia;
• Placenta previa;
• Fetal presentation;
• Intrauterine infection;
• Chromosomal damage;
• Fetal pathologies.

Physiological reasons include body constitution inherited from parents, for example, both parents are short.

In this case, a slight deviation from the average is allowed, but the baby feels great, grows and develops.

In the absence of positive dynamics, the woman must be hospitalized.

Abnormal fetal growth

Intrauterine growth retardation can be considered a weight deficit from the norm exceeding 10%. Anomalies of fetal growth and development are designated as:

• low weight;
• macrosomia - too much weight;
• small gestational age (SGA) - insufficient correspondence of parameters to the gestational age;
• Long gestational age (LGA) is an excess of parameters relative to gestational age.

Diagnoses of SGA or LGA based on normative values ​​for fetal growth standards are similar to diagnosing childhood malnutrition using a weight-for-age chart. Pediatric age-matching tables were developed by observing normally developed children with serial measurements at regular intervals.

It is worth understanding that the fruit may not meet average standards. The height of the parents, ethnic characteristics and other factors should be taken into account. Therefore, when making a diagnosis, the doctor considers multiple characteristics and only after that makes recommendations.

Treatment during pregnancy

Although intrauterine growth restriction cannot be reversed, certain treatments can help slow or minimize the effects.

Specific treatment will be determined by your doctor based on:

• progress of pregnancy, general health and medical history;
• degree of disease;
• your tolerance to certain medications, procedures or treatments.

Treatment may include:

• Nutrition . Some studies have shown that increasing a woman's nutritional intake can increase weight gain and fetal growth.
• Bed rest . This may help improve fetal circulation.
• Childbirth . If IUGR compromises the baby's health, early delivery may be necessary.3

Intrauterine growth retardation: types, prognosis

The diagnosis of “developmental delay” is made when intrauterine underdevelopment of the physical parameters of the fetus is identified. With severe underdevelopment, the fetus dies. If pathologies are combined with life, then “low birth weight” babies are born premature - up to 37 weeks. Less than 10% of children with IUGR have a chance of being born at normal terms. There are two possible forms of IUGR delay: symmetrical and asymmetrical.

• Symmetrical
  shape: deficiency of body weight is combined with insufficient growth length and underdevelopment of head circumference.
• Asymmetrical
  shape: deficiency of body weight is observed with normal height and head circumference. This form is more common.

Intrauterine growth retardation can vary in severity:

• I degree - fetal development is delayed by 2 weeks;
• II degree - developmental delay for 2-4 weeks;
• III degree - the fetus lags behind in development for more than 4 weeks.

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According to many authors, IUGR is an unfavorable background that affects morbidity and mortality in the neonatal period, as well as the further development of the child. Perinatal morbidity and mortality among children with IUGR is 4-8 times higher than that in children with a birth weight corresponding to the gestational age. This pathology makes a significant contribution to the development of childhood disability. More than half of premature children with IUGR have a delay in physical development at an early age, and 40-60% have a delay in intellectual development. In this group of children, there is an increased risk of developing neurological pathologies, such as cerebral palsy, epilepsy, and mental retardation [1].

According to the definition of G.M. Dementieva, IUGR is diagnosed in children who have insufficient body weight at birth in relation to their gestational age, i.e. when the body weight value is below the 10% centile of the mother’s gestational age, and (or) the morphological maturity index is 2 or more weeks behind the true gestational age,

Table 1 and 2 [2].

It should be noted that to date there is no unified classification of IUGR.

JL Ballard and co-authors identify the following clinical variants of IUGR: symmetrical, characterized by a slowdown in the growth rate of all sizes of the fetus; asymmetrical, which is characterized by a decrease in body weight disproportionate to the length and circumference of the head; mixed.

At the same time, G.M. Dementyeva in her work identifies 3 variants of IUGR: hypotrophic, corresponding to the asymmetric variant; hypoplastic - analogue of the symmetrical version; dysplastic or dystrophic, characterized by pronounced imbalances, abnormal physique, stigmas of disembryogenesis, trophic disorders and edema against the background of a significant decrease in body weight, a decrease in the length and circumference of the head. It is this classification that is most often used in neonatologist practice [2].

The formation of IUGR is a complex multi-stage and time-prolonged process that depends on a complex of factors: genealogical, biological and socio-environmental. The leading role in the pathogenesis of IUGR belongs to disruption of the uteroplacental circulation, which leads to hypoxia and a cascade of metabolic and functional disorders in the fetus and newborn.

The reasons leading to the birth of children with low body weight include unfavorable socio-economic conditions, the mother's age over 34 years, and a large number of births in the anamnesis. The risk group consists of primiparous women aged 15-17 years, which is associated with anatomical and functional immaturity, as well as imperfect adaptive reactions of the maternal body [3, 4].

Literature data indicate that children with low body weight are born mainly to women whose height does not exceed 160 cm, so every third woman (32.4%) who gave birth to a child with IUGR had a short height, only in 9% of cases it exceeded 170 cm.

There is no doubt about the important role of the infectious factor in the genesis of IUGR. Thus, when studying the gynecological history of women who gave birth to children with IUGR, colpitis, inflammatory diseases of the uterine appendages, and endometritis were of greatest importance. On the one hand, IUGR is one of the most common symptoms of intrauterine infection; on the other hand, it predisposes to antenatal infection.

According to a number of authors, in the structure of extragenital pathology in women who gave birth to children with IUGR, anemia was in first place (26.2%), kidney and urinary tract diseases were in second (5.2%), and neurocirculatory dystonia was in third ( 5.1%) [5].

Impaired fetal development and high perinatal mortality in arterial hypertension are associated with disorders of hemodynamics and gas exchange, as well as with disturbances in the rheological properties of blood. Hypertension, as well as arterial hypertension, leads to significant disturbances in the peripheral and organ hemodynamics of the maternal body, including in the uterine artery basin. Most often, fetal growth retardation is diagnosed in pregnant women with arterial hypertension [6].

According to N.I. Kulakova, a complicated pregnancy was observed in mothers who gave birth to children with IUGR in 95.6% of cases. The most common complications were gestosis in the second half of pregnancy, the threat of pregnancy termination, anemia, acute respiratory diseases, and a combination of two or more unfavorable factors.

V.V. Kocherova and co-authors associate the development of the hypoplastic variant of IUGR with factors such as underweight of the pregnant woman, preeclampsia, a family history of IUGR, and oligohydroamnion.

Chronic placental insufficiency, caused by numerous factors of obstetric and extragenital pathology, leads to delayed fetal development. As the analysis conducted by O.R. Baev showed, in pregnant women with fetoplacental insufficiency, a lag in these values ​​was detected in 91.3% of cases: 1st. IUGR - in 63%, 2 tbsp. — 23.3%, 3 tbsp. - 13.7%. Moreover, the asymmetric form was diagnosed in 91.8%, while the symmetrical form was diagnosed in only 8.2% [7].

Thus, the range of factors leading to the occurrence of IUGR is very wide. Undoubtedly, unfavorable conditions of intrauterine development determine the course of the postnatal period of ontogenesis. Adaptation of a newborn with IUGR largely depends on the pathology that contributed to the slowdown of the genetic development program.

T.S. Gorban identified patterns characteristic of premature children with IUGR in the neonatal period in comparison with children with a body weight corresponding to the gestational age. Thus, children with IUGR born before 32 weeks had a more severe course of the neonatal period, which was expressed by longer persistence of metabolic acidosis, hypoglycemia, cardiovascular failure and required longer use of total parenteral nutrition, and stay in the intensive care unit and in the hospital [3 , 7].

According to G.M. Dementieva, prematurely born children with IUGR form a risk group for the occurrence of perinatal asphyxia. The central nervous system is the most vulnerable to the effects of acute and chronic hypoxia and largely determines the degree of adaptive capabilities of the newborn child. Research by A.V. Koptseva showed a high frequency of perinatal CNS lesions in all premature infants, but the severity of CNS lesions was significantly higher in premature infants with developmental delay, and the leading lesion syndrome in these children was depression syndrome. In addition, there was a higher incidence of vegetative-visceral disorder syndrome. The severity of CNS damage depended on the type of developmental delay: severe CNS damage was more often observed in children with its hypoplastic form [2, 8].

Purpose of the study: to study the characteristics of pregnancy and childbirth in mothers who gave birth to children with intrauterine growth retardation; identify risk factors that adversely affect the developing fetus and the birth of a small child by gestational age; estimate the frequency of detection of FGR and analyze the health indicators of these newborns. To analyze the relationship between somatic and gynecological diseases of the mother and the development of FGR according to the PC SO data. Features of the course of the neonatal period in premature newborns with IUGR.

Materials and methods. The material for the study was: questionnaires of mothers, observation, examination, analysis of medical documentation: dispensary records of pregnant women, histories of childbirth and development of newborns. The criteria for assessing the condition of children with IUGR were: gestational age, body weight indicators, degree of asphyxia at birth, etc. Diagnosis of growth and development disorders in newborns was carried out by assessing the main anthropometric parameters.

Research results and discussion. In 2015, 3,395 births were carried out at the State Health Institution “KPSCO” (3,404 children were born), of which 465 were premature – 13.7% (400 premature children). There were 226 children (6.6%) diagnosed with IUGR in the newborn. Of the full-term children with the main diagnosis of low gestational weight in 2015, there were 49 full-term and premature 65 children in the pathology department of newborns and premature infants (OPNND), the physiological children's department - 111 children, of which 68 were premature, the intensive care unit therapy - 1 premature infant. The course of pregnancy and birth outcomes were studied in 226 women who gave birth to children with intrauterine growth retardation.

Women are grouped by age: under 17 years old - 10 (4.6%), from 18 to 29 years old - 166 (73.2%) and from 30 to 43 years old - 50 (22.2%) women. The average age was 27.6 ± 9.4 years. As the mother's age increases, the likelihood of chronic diseases increases markedly, which are known to increase the risk of having a child with IUGR.

Marriage was registered for 147 (64.8%) women. There were 200 rural women (88.3%). 27.5% of women received secondary school education, vocational secondary education - 29.0%, higher education - 25.2%, incomplete higher education - 18.3% of women. In 31.3% of women, the height was up to 160 cm, more than 180 cm – 6.8%. 23.5% of patients were registered after 12-13 weeks.

The most common antenatal risk factors were: anemia in 83 women (36.8%), of which 62 (27.6%) had a mild degree, 21 (9.1%) had a moderate degree.

Of the most important reasons for the unfavorable course of induced pregnancy and premature birth, both genital and extragenital factors should be noted. 47 (20.6%) women suffered from ARVI during pregnancy. Infection of the genital tract (colpitis of various etiologies) was detected in 94 (41.4%) pregnant and postpartum women. Carriage of Torch infection (CMV, AIV, toxoplasmosis) in 31 (13.7%). HIV infection was detected in 5 (2.3%), chronic hepatitis B and C - 8 (3.4%) women, a history of syphilis - 5 (2.3%), chlamydia and trichomoniasis in one case - 2 (0). ,9%)

Vegetative-vascular dystonia was detected in 52 (22.9%) patients, chronic pyelonephritis in remission in 26.4% of women, chronic cholecystitis - 60 (26.4%), chronic gastritis - 88 (39.1%), varicose veins lower extremity disease - 18 (8.0%), obesity - 26 (11.2%) (grade 1 - 16 (6.9%), grade 2 - 8 (3.4%), grade 3 - 2 (0 .9%), diffuse enlargement of the thyroid gland of the 1st degree in 16 (6.9%) women. The following obstetric-gynecological and feto-placental factors were identified: age primiparas - 16 (6.9%), young primiparas - 10 (4, 6%). Medical abortions (from 1 to 4 times) were performed in 106 (47.1%) women, a history of miscarriages in 13 (5.7%), frozen pregnancy - 13 (5.7%) women, low weight by the gestational age of previous children – 36 (16.0%) women.

Of the 226 pregnancies, 101 (44.8%) ended in natural birth, 125 (55.2%) - through cesarean section (planned - 101 (44.8%) and emergency - 24 (10.4%)) .

In most cases, the main pathogenetic factor of IUGR was feto-placental insufficiency. Violation of uteroplacental hemodynamics of varying severity (196 (87.1%) pregnant women, grade 1 A - 113 (50.0%), degree 1 B - 51 (22.8%), degree 2 - 29 (12 .9%), 3rd degree - 3 (1.4%). Chronic fetal hypoxia was observed in 216 (95.4%) cases.

A scar on the uterus in 78 (34.4%) pregnant women, uterine fibroids, multiple myomatous nodes - 5 (2.3%), marginal, central location of the placenta - 21 (9.1%), pseudo-erosion of the cervix - 80 (35, 6%), a bicornuate uterus was found in 10 (4.6%) women, a septum (synechial constriction) in the uterus in 5 (2.3%) cases.

Parity in childbirth from 14 to 19 years was in 8 (3.4%) women. Threatened miscarriage - 109 (48.2%). Preeclampsia, the edematous form, and the hypertensive form complicated the course in 49 (21.8%) pregnancies. Preeclampsia of varying severity in 8 (3.4%). Rh conflict with the fetus in 8 (3.4%) cases. A true umbilical cord node was detected in 2 (0.9%) fetuses. Oligohydramnios was diagnosed in 36 (81.3%) cases, polyhydramnios - 8 (3.4%).

Features of the course of the neonatal period: 122 (54.0%) girls and 104 (46.0%) boys were born, 92 (41%) were full-term children, 134 (59%) were premature.

Asphyxia at birth was observed in 102 (45%) children, of which 71 (31.4%) were premature. Severe asphyxia (less than 3 points on the Apgar scale) was in 11 (4.7%) premature newborns and 1 (0.45%) full-term, moderate severity (4-6 points) - 60 26.5%) premature and 30 (13.3%) full-term. The number of bed days was 15 ± 3.2.

Asymmetrical variant of IUGR – 180 (79.7%) (hypotrophic), symmetrical variant –

39 (17.3%) (hypoplastic); dysplastic or dystrophic, characterized by pronounced imbalances, abnormal physique, stigmas of disembryogenesis (hypertelorism, low-lying ears, sandal-shaped foot), trophic disorders and edema against the background of a significant decrease in body weight and length - 7 (3%).

The diagnosis of MSG was made in full-term children whose weight was below 10% centile, which corresponds to the data of Dementieva G.M. and Shabalov N.P., 1 degree of malnutrition is established, or according to the weight-height coefficient (MHR) 55-59.9, such Thus, children with a hypotrophic variant of developmental delay of the 1st degree - 64 (28.3%), premature - 59 (26.1%), 2 degrees of malnutrition from 1 to 5% With an MRC coefficient of 50 - 54.9, there were 14 full-term children ( 6.2%), premature - 35 (15.5%), grade 3 - 2 (0.9%), full-term, 6 premature (2.7%).

The symmetrical form was observed in 9 (4%) full-term infants, premature infants in 30 (13.3%) and 7 (3%) premature infants with the dysplastic type.

Low gestational weight is the main diagnosis in 143 (63.3%) cases, the competing diagnosis is grade 1 cerebral ischemia. In 83 (36.7%) cases, the diagnosis of MSH was background, the main diagnosis was represented by: cerebral ischemia of the 2nd degree - 79 (34.9%), congenital malformations of the central nervous system, cardiovascular system in 2 cases each (1.8% ).

Complications of the underlying disease: respiratory distress syndrome - 49 (22.1%), congenital pneumonia - 18 (8.1%), retinal vascular angiopathy - 146 (65.0%), neonatal jaundice - 73 (32.3%).

Conclusions: the data obtained indicate a greater predisposition to IUGR in the fetus and newborn in premature infants. The predominant type of IUGR is the asymmetric form (the hypotrophic variant is 4.6 times more common). Such perinatal factors as medical abortions, genital tract infections, extragenital pathologies are preventable. Children with MSG should receive adequate replenishment of necessary nutrients and the use of fortifiers. Most children had moderate and mild cerebral disorders; cerebroprotective therapy is required during the rehabilitation process.

Causes of developmental and growth delays

Symmetrical developmental delay most often occurs due to chromosomal and genetic disorders of the fetus, hypofunction (hypothyroidism) of the thyroid gland in the mother and insufficiency of the pituitary gland (pituitary dwarfism), which produces the growth hormone somatropin. Dangerous infections suffered by the mother during pregnancy - rubella, toxoplasmosis, herpes and cytomegalovirus - affect the development of the fetus. They are defined as the TORCH complex. The asymmetric form of developmental delay is associated with pathologies of the placenta - fetoplacental insufficiency, which occurs in the third trimester of pregnancy. FPN leads to hypoxia (oxygen starvation) of the fetus. The causes of fetoplacental insufficiency are late gestosis, multiple pregnancies, umbilical cord defects, placenta previa and vascular insufficiency of the placenta.

Potent drugs, radiation, nicotine, alcohol, etc. affect the growth and physical development of the fetus.

Why is SZVRP dangerous?

The danger of the diagnosis lies in the severity of its manifestation. So, with early diagnosis of developmental delay, there is a great chance to identify the cause and carry out benign treatment.

The risk of fetal death increases regardless of gestational age. In the first weeks of pregnancy, FGR leads to spontaneous miscarriage in 89% of cases.

The risk of complications during labor and perinatal morbidity increases. Possible death increases 7 times.

After birth, children require resuscitation measures.

The role of the placenta in the physical development of the fetus

Fetal growth is largely modulated by placental function, as the placenta is responsible for the infant's breathing and nutrition. Placental disorders lead to critical respiratory, hepatic and renal dysfunction of the fetus. In this case, its growth and development are inhibited.

Early placental problems arise from incomplete invasion of trophoblasts, which leads to remodeling (pathological change) of the myometrial arteries and a decrease in uteroplacental blood flow, which is usually associated with preeclampsia (a serious condition accompanied by edema, high blood pressure and other unpleasant symptoms) and restriction fetal growth. Research shows that the ability of the uterine placental unit to support the fetus gradually decreases. At the same time, there is an increase in the diameter of the umbilical artery, a change in the speed and volume of blood flow in response to the growing needs of the fetus. These parameters actually cover the gradually decreasing ability of the uteroplacental system to meet the requirements for normal growth and development.

What to expect after childbirth?

Slower fetal development during pregnancy is not the end of the world, as most children with IUGR catch up with their peers after birth. In cases of severe intrauterine growth restriction, complications similar to those experienced by premature babies may occur. But such children can also live a normal life after 3 years of age. While IUGR is a condition that poses risks to the baby, advances in modern medicine and accumulated knowledge allow doctors to address most of the problems associated with it.7

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How does the fetus develop during the fetal period?

The growth, size and proportions of the fetus in the fruiting (fetal) period are constantly changing. For example:

• Fetal growth accelerates in the 2nd trimester, at 3-5 months.
• Body weight changes significantly in the last 2 months of pregnancy.
• In the third month, the head begins to grow slowly, and body growth, on the contrary, accelerates.

Body proportions at the 3rd month: the size of the head is equal to half the length of the baby’s body in a sitting position (parietal-coccygeal size).

Body proportions at the 5th month: the size of the head is equal to a third of the length of the body in a standing position (parietal-calcaneal size). At birth, the head is 1/4 of this length. Already in the 3rd month, the baby’s face becomes human-like. The eyes and ears move to normal positions. The limbs become proportional to the length of the body. By the end of the third month, the long bones and skull begin to ossify. And the external genitalia develop so much that they are easy to distinguish on an ultrasound.

The fourth - fifth month the fetus actively grows in length, and its weight is less than 500 grams. Starting from the 2nd half of the fetal period, the fetus gains weight. Over the past 2 months, the baby gains half of its birth weight and acquires clear body contours due to the formation of subcutaneous fat.

Before birth, the fetal head becomes large and hardens, because it has to go through a difficult journey through the birth canal. The weight of the fetus is more than 3 kg, and its height is more than 50 cm.

Symptoms of FGR

A pregnant woman cannot determine the pathology on her own. The problem is identified during a routine ultrasound of the fetus, where the gynecologist compares the obtained parameters with tabular data. Therefore, it is very important to attend all scheduled screenings, and if developmental delay or fetal growth is detected, undergo additional examination.

An important symptom is rare and weak fetal movements. This happens with a significant degree of developmental delay, so you should definitely contact a clinic.

One of the symptoms indicating a possible developmental delay is insufficient weight gain in the pregnant woman. This sign cannot be considered 100% reliable, since other factors also influence it - quality of nutrition, level of physical activity, characteristics of the body, etc. Therefore, it is still better to trust ultrasound in this matter,

Preventing the occurrence of the syndrome during pregnancy

No pregnant woman is insured against FGR.
Preventive measures will reduce possible risks. The main condition for prevention is pregnancy planning, where future parents undergo a full laboratory and instrumental examination.

It is also necessary to adhere to a healthy lifestyle. Hiking, staying outdoors, and a balanced diet are the simplest measures to prevent the development of IGR.

Visit the gynecologist's office and treat gynecological problems on time.

Author: Elena Yuryevna, obstetrician-gynecologist of the highest category Specially for the site kakrodit.ru

Survey

A gynecologist, examining a pregnant woman, measures the height of the uterine fundus, checking it with the norms calculated for a given period of pregnancy. If the size of the uterus is smaller than normal, an ultrasound scan of the fetus is urgently needed.

During an ultrasound, a specialist records several parameters in the fetus:

• Head circumference;
• abdominal circumference;
• thigh volume.

The approximate weight of the fetus is calculated.

If a pathology of physical development is suspected, Doppler measurements are performed to show the quality of blood flow in the vessels of the placenta and baby.

Another important study is fetal cardiotocography, which records the heartbeat. The norm is 120 - 160 beats. per minute With a lack of oxygen, the heartbeat changes its rhythm up or down

Treatment of delayed development and growth of the fetus

Modern medicine allows us to treat many pathologies of IUGR, so it is very important to identify the problem in time. If there is a slight delay of the 1st degree, observation is necessary; this may be a temporary phenomenon and everything will be restored. As the problem progresses, treatment with drugs that improve uteroplacental blood flow will be required. The gynecologist may prescribe:

• Tocolytic drugs that relax the uterus: beta-agonists and antispasmodics. These can be tablets, injections and droppers.
• Infusion therapy with glucose and blood substitutes that reduce blood viscosity. The drugs are infused intravenously.
• Medicines that improve microcirculation and metabolism in tissues. Usually administered intramuscularly.
• Vitamins C, B, microelements. magnesium, etc. Administered intramuscularly.
• Ozone therapy and oxygen therapy.

You will have to undergo treatment and observation throughout your pregnancy. In addition, the doctor will prescribe a diet. The diet should be balanced and contain dairy and meat products. You also need to follow a daily routine, walk and avoid depression.

Complications of IUGR

Unfortunately, such pathologies do not go away without leaving a trace. The following complications are possible:

• intrauterine fetal death;
• premature birth;
• oxygen starvation (hypoxia) of the fetus;
• developmental anomalies.

After birth, such babies have an increased risk of developing neurological disorders, hypoglycemia, respiratory distress syndrome, and hypocalcemia (calcium deficiency). To avoid problems, you need to be promptly examined and treated for infectious diseases before pregnancy.

Prevention of FGR

Preventive measures at the stage of planning and preparation for pregnancy include:

• treatment of chronic diseases, diagnosis of infectious diseases, sanitation of the oral cavity (untreated caries is also a source of infection);
• giving up harmful addictions.

When pregnancy has already occurred, it is important to prevent the development of FGR:

• proper nutrition, taking vitamin and mineral complexes;
• avoiding heavy physical labor, changing work and rest schedules, getting adequate sleep;
• lack of stress;
• Regular visits to an obstetrician-gynecologist, carrying out all mandatory screening tests within the recommended time frame.