Fetal responses to placental insufficiency: an update.

Disturbance of normal fetal growth can result in a decrease in weight, or altered body proportion at birth. Fetuses that fail to reach their genetically predetermined growth potential due to intrauterine growth restriction (IUGR) following placental insufficiency are at increased risk for adverse short and long term outcomes that can extend all the way into adult life. Because of its diverse impacts, placental disease has been the research focus of a variety of biomedical subspecialties. Consequently, considerable information on IUGR has been published outside the obstetric core literature. Many of these observations may not appear salient in the context of clinical prenatal care. However, obstetricians and fetal medicine specialists are the primary caregivers to pinpoint, manage and co-ordinate research in these high risk pregnancies. Research and development on necessary new therapeutic strategies is most likely to be effective if the multiple interactions between fetal condition and outcomes can be identified and successfully modified prenatally. As these relationships are clarified, the focus of clinical fetal medicine is likely to shift from improvement of perinatal mortality and morbidity to enhancing the life-quality in survivors. It is the aim of this review to illustrate the multisystem fetal effects of placental insufficiency and how this information may stimulate future research.