Background and aims Normal fetal growth depends on the genetically predetermined growth potential and its modulation by the health of the fetus, placenta and mother. If any of these factors is deficient, adverse pregnancy outcome and/or fetal growth restriction (FGR) may be the consequence-condition when a fetus is unable to achieve its genetically determined potential size. Although FGR is probably a physiologic adaptive response to various stimuli, it is associated with neonatal mortality and distinct short or long-term morbidity.

Methods During the period of 3 years, causes and early neonatal outcome of 160 fetal growth restricted pregnancies were studied. We used late versions of SPPS and Statgraf for Win statistical programs. Results were compared by Person Chi-Square (<0.05) and logistic regression analyses.

Results Compared with normally grown fetuses, those who were growth restricted (GR) were more frequently exposed at fetal (OR 2.49; 95% CI 1.33–4.65), placental (OR 2.83; 95% CI 1.52–5.29), and maternal prenatal conditions, such as hypertensive disorders (OR 3.05; 95% CI 1.69–5.52), addictions (OR 10.57; 95% CI 2.25–49.48), and prior complications of pregnancy (OR 2,61; 95% CI 1.18–5.76). GR newborns had increase risk of resuscitation (OR 2.81; 95% CI 2.83–4.32), immediate transfer to intensive care unit (OR 2.38; 95% CI 1.56–3.65), and were more prone to acute neonatal consequences, such as perinatal asphyxia (OR 3.26; 95% CI 1.96–5.43). Compared with normally grown, GR newborns had increase risk for neonatal adaptive problems, such as hypothermia (OR 2.02; 95% CI 1.11–3.68), hypoglycemia (OR 2.94; 1.85–4.68), and polycythemia (OR 5.09; 95% CI 2.25–11.52).

Conclusions The clinician’s challenge is to identify real, at-risk GR fetuses, because of a hostile intrauterine environment. Once FGR has been detected, the management of the pregnancy should depend on a surveillance plan that maximises gestational age with minimising the risks of neonatal adverse outcome, avoiding iatrogenic prematurity. Immediate management in delivery room should be focus on adequate resuscitation of a depressed newborn, insuring normal physiologic transition, and preventing acute neonatal adaptive problems.