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Why is the baby’s weight low?

by Dr Tahira Kazmi
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Tahira kazmii

First, let’s understand how the estimation of a baby’s growth is done.

A pregnant woman at 26 weeks goes to the doctor. Now, the doctor needs to measure the size of her uterus and her abdomen. The old method involved using the width of the fingers, which were placed just above the navel. The new method uses inches and a centimeter of tape. At 26 weeks, if the uterus measures 26 centimeters, it’s alright. There’s a slight margin of error.

However, if at 26 weeks, the height of the uterus is 31 or 36 centimeters, it’s time to consult a gynecologist. Why is the uterus small or large? This is the fundamental question.

To find the answer to this question, an ultrasound is essential, where the baby’s weight is assessed. At 26 weeks, the baby should weigh approximately 1.7 kilograms. For the remaining weeks, we can tell you how much weight is ideal.

In normal cases, up until the 28th week, we don’t usually measure the weight unless there are complications.

28 weeks: 1.1 kg

30 weeks: 1.4 kg

32 weeks: 1.7 kg

36 weeks: 2 kg

38 weeks: 2.4 kg

36 weeks: 2.7 kg

If the baby’s weight is fine, the chances of low amniotic fluid are quite low. However, if the baby’s weight is low, it’s necessary to check the amniotic fluid and perform a Doppler ultrasound. The Doppler ultrasound will show how the blood circulates in the baby.

If, along with low weight, both the Doppler and amniotic fluid are fine, and the baby is moving actively about ten times a day, it’s essential to perform another ultrasound two weeks later to recheck the weight and blood circulation.

Two scenarios will come up:

  1. In the first scenario, the baby’s weight has increased slightly but is still lower than expected. The amniotic fluid, movement, and Doppler are all normal. In this case, the baby would be termed an SGA (small for gestational age) baby. This baby is perfectly healthy; it’s just genetically smaller, or the mother is very thin, and smaller members run in the family. There’s nothing to worry about.
  2. In the second scenario, if the baby’s weight hasn’t increased or has increased very little, the amniotic fluid is low, the baby’s movements are sluggish, and the blood circulation is affected, it would be called Intrauterine Growth Retardation (IUGR).

IUGR can be caused by factors such as chromosomal abnormalities, infections during pregnancy, high blood pressure in the mother, placental issues, and an umbilical cord that isn’t working correctly. The umbilical cord is often very tight in the initial stages of pregnancy.

IUGR is a condition that requires concern. If the mother has high blood pressure, it needs to be controlled. Blood pressure-lowering medications during pregnancy are safe. Daily blood pressure checks and weekly monitoring of the baby are essential. In monitoring, the baby’s movements and blood circulation are observed. When blood circulation drops below a specific level, it’s crucial to deliver the baby. If the blood pressure becomes too high, and it’s not coming down, the baby should be delivered.

If an IUGR baby reaches 36 or 37 weeks, it should be delivered, as there’s a risk of the baby dying in the womb due to low oxygen supply. An SGA baby should be delivered between 37 to 40 weeks.

We learned over the years that our elder daughter was an SGA baby, but back then, we didn’t even know what SGA meant, nor did the doctors diagnose it.

Many people ask about preterm babies, saying, “It was a 7 or 8-month pregnancy, and the baby wasn’t growing, so the doctor did a C-section, but the baby died a few days later. Why?” Let’s understand one thing: in Pakistan, the chances of surviving a 7 or 8-month baby are quite low. Getting to major hospitals isn’t always possible, and even in smaller hospitals, facilities are inadequate. So, if a doctor suggests a C-section for a baby aged 7 or 8 months, you should first find out what the survival rate is for such babies. If the facilities are limited, what’s the point of having a C-section if the baby doesn’t make it?

Empower yourself with knowledge, and life’s journey will become more manageable.

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