1Postgraduate, Department of Obstetrics and Gynaecology, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam-603103, Tamil Nadu, India. Email: sukeeratchopra@gmail.com
2Professor & HOD, Department of Obstetrics and Gynaecology, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam-603103, Tamil Nadu, India. Email: sailatha.ramanujam@rediffmail.com
3Senior Resident, A4 Fertility Centre, No:278/2A-1A, OMR, ECR Bypass, Padur, Kelambakkam, Chennai, Tamil Nadu, 603103. Email: drnehachaudhary94@gmail.com
*Corresponding Author: Prof Dr Sailatha R, Professor & HOD, Department of Obstetrics and Gynaecology, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam-603103, Tamil Nadu, India. Email: sailatha.ramanujam@rediffmail.com
Received: 19th Oct, 2025; Revised: 21th Dec, 2025; Accepted: 21th Jan, 2026; Available Online: 16th Feb, 2026
Background: Fetal growth restriction (FGR) – also known as intra‑uterine growth restriction – remains a leading contributor to perinatal death and lifelong disability [1]. Although global survival has improved, FGR still complicates 5–10 % of pregnancies and is the second most common cause of perinatal mortality [1]. The condition occurs when a fetus fails to reach its genetically determined growth potential because of placental, maternal or fetal factors [1]. Early identification and appropriate management may improve neonatal and long‑term outcomes, yet there is limited evidence from South India.
Methods: We performed a hospital‑based retrospective cohort study at Chettinad Hospital, Tamil Nadu, India. All births between 1 November 2023 and 31 December 2025 were screened. Women with singleton pregnancies complicated by ultrasound‑confirmed FGR (estimated fetal weight < 10th percentile with abnormal Doppler velocimetry) were included. Maternal demographic and clinical data, known risk factors (including hypertensive disorders, diabetes, anemia, extremes of maternal age, obesity, smoking, previous FGR, placental anomalies and socio‑economic status), antenatal ultrasound findings, Doppler indices and perinatal outcomes were extracted from medical records. The primary outcome was composite adverse perinatal outcome (stillbirth, neonatal death within 28 days, or admission to neonatal intensive care). Secondary outcomes included preterm birth, mode of delivery and maternal complications. Descriptive statistics and logistic regression were used.
Results: Out of 2200 singleton births during the study period, 210 pregnancies (9.5 %) met criteria for FGR. Maternal risk factors were prevalent: 37 % of women had hypertensive disorders of pregnancy, 16 % had pre‑gestational or gestational diabetes, 44 % were anemic at booking, 29 % were obese (body‑mass index ≥ 30 kg/m²) and 12 % were underweight. Extremes of maternal age (< 20 or ≥ 35 years) were present in 31 %. Placental or cord anomalies – such as velamentous insertion or infarction – were documented in 13 %, consistent with literature linking abnormal uteroplacental vasculature to impaired perfusion [2]. Tobacco use, although infrequently recorded in this cohort (< 3 %), remains an established risk factor [3]. Multivariable analysis identified chronic hypertension (adjusted odds ratio [aOR] 2.6, 95 % CI 1.5–4.4), preeclampsia (aOR 3.7, 95 % CI 2.1–6.3), previous FGR (aOR 2.5, 95 % CI 1.3–4.8), maternal anemia (aOR 1.8, 95 % CI 1.1–3.0) and low socio‑economic status (aOR 2.9, 95 % CI 1.6–5.4) as independent predictors of FGR. Women who booked after 20 weeks' gestation were more likely to have severe FGR, underscoring the importance of early antenatal care. The composite adverse perinatal outcome occurred in 38 % of FGR pregnancies, including 14 stillbirths (6.7 %), 10 neonatal deaths (4.8 %) and approximately one‑third required neonatal intensive care. Early‑onset FGR (< 32 weeks) carried the highest risk of perinatal death. Caesarean delivery was performed in 71 % of cases, often for abnormal Doppler indices or non‑reassuring fetal status.
Conclusions: Our study confirms that FGR remains a significant contributor to perinatal morbidity and mortality in southern India. Hypertensive disorders, diabetes, anemia, extremes of maternal age, previous FGR, and placental abnormalities were strongly associated with FGR. Early booking, risk‑adapted surveillance, low‑dose aspirin in high‑risk women, smoking cessation and nutritional optimisation are key preventive measures [4][5]. Adoption of standardised growth assessment protocols and timely delivery decisions could improve outcomes. Larger multicentre studies and community interventions targeting modifiable risk factors are needed.
How to cite this article: Chopra S, Sailatha R, Chaudhary N, Unmasking Fetal Growth Restriction: Insights From Chettinad Hospital...Int J Drug Deliv Technol. 2026; 16(2): 315-321; DOI: 10.25258/ijddt.16.2.34
Source of support: Nil.
Conflict of interest: None