Medications for IUGR Management
There are no proven pharmacological treatments for intrauterine growth restriction (IUGR) itself—management relies on surveillance and timely delivery, not drug therapy. 1, 2
No Effective Drug Treatments Available
The American College of Obstetricians and Gynecologists explicitly states that no preventative strategies or treatments for fetal growth restriction have been proven effective. 1 The following interventions should NOT be used:
- Low-molecular-weight heparin should not be used for prevention of recurrent IUGR (GRADE 1B recommendation). 1
- Sildenafil should not be used for in utero treatment of IUGR (GRADE 1B recommendation). 1
- Activity restriction/bed rest should not be used for treatment of IUGR (GRADE 1B recommendation). 1
- Nutritional and dietary supplements have no consistent evidence for preventing IUGR or reducing small-for-gestational-age births. 1
Aspirin for Prevention (Limited Role)
Low-dose aspirin should NOT be used solely for IUGR prevention in otherwise low-risk women, according to the American College of Obstetricians and Gynecologists. 1 While two meta-analyses showed modest risk reduction, the ASPRE trial (designed for preterm preeclampsia prevention) did not confirm this benefit for IUGR. 1 Aspirin may be considered in high-risk women for preeclampsia prevention, which may secondarily reduce IUGR risk, but this is not its primary indication. 1
Medications Used for Perinatal Support (Not IUGR Treatment)
While no drugs treat IUGR itself, two medications are critical for managing anticipated preterm delivery in IUGR pregnancies:
Antenatal Corticosteroids
- Administer if delivery anticipated before 33 6/7 weeks or between 34 0/7 and 36 6/7 weeks in women at risk of delivery within 7 days who haven't received prior course (GRADE 1A recommendation). 1, 2
- Give corticosteroids if absent or reversed end-diastolic flow noted at <34 weeks (Level A recommendation). 2
- After administration, observe for 48-72 hours as transient return of end-diastolic flow may occur in two-thirds of cases. 2
Magnesium Sulfate for Neuroprotection
- Administer intrapartum magnesium sulfate for pregnancies <32 weeks gestation for fetal and neonatal neuroprotection (GRADE 1A recommendation). 1, 2, 3
Management Focus: Surveillance and Delivery Timing
Since no drugs treat IUGR, management centers on:
- Weekly umbilical artery Doppler once IUGR diagnosed. 2, 3
- Delivery at 37 weeks with decreased diastolic flow or severe IUGR (<3rd percentile). 1, 2
- Delivery at 33-34 weeks with absent end-diastolic velocity. 1, 2, 3
- Delivery at 30-32 weeks with reversed end-diastolic velocity. 1, 2, 3
Common Pitfall to Avoid
Do not prescribe sildenafil, heparin, or recommend bed rest despite their theoretical rationale—these interventions lack evidence of benefit and carry the American College of Obstetricians and Gynecologists' recommendation against their use. 1 The only medications indicated are corticosteroids and magnesium sulfate for anticipated preterm delivery, not for treating IUGR itself. 1, 2