Prevention of recurrent fetal growth restriction.

Fetal growth restriction is associated with multiple short- and long-term consequences for the infant. A woman with a prior gestation complicated by fetal growth restriction has nearly a 20% risk of recurrence. Strategies to predict and prevent the recurrence are critical in obstetric management. Effective interventions for prevention of recurrent fetal growth restriction include the following: a reproductive plan because spacing of pregnancies impacts their outcome, optimization of maternal medical conditions, smoking cessation, accurate dating by first-trimester sonography and monitoring of fetal growth with serial sonograms, and low-dose aspirin (80-160 mg) started before 20 weeks. In women with nutritional deficiencies, optimizing caloric intake with low-protein (less than 25%) supplementation of 500-1,000 calories may prevent recurrent fetal growth restriction. In women living in areas endemic for malaria, antimalarial prophylaxis diminishes risk of recurrent fetal growth restriction.