Placental insufficiency is a serious condition that happens when the placenta doesn’t work as well as it should. The placenta is an organ that forms in your uterus when you’re pregnant. It carries blood, nutrients, and oxygen from your body to your fetus.
When you have placental insufficiency, less blood and fewer nutrients circulate between you and the fetus. This could delay your baby’s growth.
You might also hear this condition called uteroplacental insufficiency, fetoplacental insufficiency, or placental dysfunction.
What Causes Placental Insufficiency?
Doctors are still learning about the causes of placental insufficiency, says Shipra Jain, MD, a neonatologist at Cincinnati Children’s Hospital Medical Center. Many times, there isn’t a clear reason.
Sometimes, it’s caused by a problem with the placenta itself. Here are some of these placenta deficiencies:
- The placenta may not be attached to your womb as well as it should be. Normally, the placenta sends out little “fingers” called villi, which help it connect to the wall of your uterus. If something goes wrong with the villi, the placenta may not attach well. And it might have fewer blood vessels to carry blood between you and your fetus.
- Other problems with blood flow inside the placenta. There may be small areas of dead tissue on the placenta, or small clots inside it.
- The placenta may not grow as much as it should, or it may be too small.
- The placenta may have a different shape than usual.
High blood pressure is a major risk factor for placental insufficiency. You’re more likely to get it if you had high blood pressure before you got pregnant or if you have preeclampsia, a condition involving high blood pressure during pregnancy.
Other things that raise your chances of placental insufficiency include:
- Diabetes
- Smoking cigarettes, drinking alcohol, or using substances such as cocaine or heroin during pregnancy
- First-time pregnancy
- Being over 35
- Having a previous baby who didn’t grow well in the womb or was smaller than expected at birth
- Health conditions that affect your heart or blood, including problems with blood clotting
- Certain medications, including medicines that help stop you from getting blood clots. Make sure your doctor knows about any medications you take.
- Being malnourished during pregnancy
- Having a multiple pregnancy, such as twins or triplets
What Are the Signs of Placental Insufficiency?
Placental insufficiency can be hard to detect, especially if you’ve never been pregnant before. There are usually few or no symptoms.
You may notice your belly isn’t getting as big as in previous pregnancies or that you aren’t gaining as much weight. You may also realize that your fetus is moving less.
Placental Insufficiency Complications
When the placenta doesn’t bring enough blood to the fetus, it can cause intrauterine growth restriction (IUGR), which is when a developing baby doesn’t grow enough. IUGR can lead to other problems, including harm to the baby’s brain and other organs.
Placental insufficiency raises your risk for complications during pregnancy and childbirth, such as:
- Miscarriage
- Placental abruption, a health emergency that happens when the placenta separates from the uterus
- Stillbirth
- Health issues in the fetus that can include anemia (low red blood cell count), buildup of waste products in the blood, low blood sugar, and low calcium
- Too low oxygen levels in your baby’s brain, either while you’re pregnant or in labor
- Preterm labor (before 37 weeks)
- Premature birth, in which the baby is born too soon
If your baby isn’t growing enough in the womb, they might need to be delivered early so they can get medical care.
Once your baby is born, they’re also more likely to have certain medical problems, especially if they had IUGR or were premature. These include:
- Trouble breathing, eating, or keeping body temperature consistent
- Issues with blood sugar
- Jaundice, in which a buildup of waste products turns their skin or eyes yellow
- Blood clots
- Infections
- Slower-than-expected growth and delays in development, such as learning to talk or crawl later than most other babies
Some babies will need to spend time in a neonatal intensive care unit (NICU). There, they might get oxygen, a machine to help them breathe, or extra nutrition through an IV or tube to help them grow.
After your baby comes home from the NICU, they’ll need follow-up care. Placental insufficiency, IUGR, and premature birth can lead to longer-term health issues, such as:
- Cerebral palsy
- Disabilities related to learning, thinking, and processing information
- ADHD
- Anxiety disorders
- Heart disease, high blood pressure, or cholesterol problems
- Asthma
- Epilepsy (seizures)
- Problems with blood sugar, and a higher chance of diabetes when they’re older
Later in life, people who had placental insufficiency and IUGR before birth may be more likely to have problems with their kidneys, fertility, hormones, and blood sugar. They could be shorter than others in their families, and they might start puberty earlier. They may also have challenges with their development, thinking, emotions, or mental health.
Before you leave the hospital with your baby, talk to your health care team about what kind of follow-up care and support your child will need. Therapies and monitoring can help them avoid or manage problems as they grow up, Jain says.
How Is Placental Insufficiency Diagnosed?
At your prenatal appointments, your health care provider will track your baby’s growth with ultrasounds, fetal monitoring, and by measuring your belly. If your baby isn’t growing as much as expected, they’ll try to figure out why. This can be a sign of IUGR.
There’s no one test to diagnose placental insufficiency. If your doctor thinks you may have it, they’ll do tests such as:
- Ultrasound to look at the placenta, estimate its size, and measure the fetus. They may also use Doppler ultrasound, which lets them measure blood flow to the developing baby.
- Fetal non-stress test (NST), which involves keeping track of how fast the baby’s heart beats when they move.
- MRI, another imaging test that can provide more detailed information.
You might see a maternal-fetal medicine specialist to diagnose placental insufficiency and help manage your care.
Quick detection of any type of placenta deficiency will improve your baby’s chances. Always consult a health care professional if you think something is wrong during pregnancy.
How Is Placental Insufficiency Managed?
There’s no treatment for placental insufficiency. But there are things your health care provider can do to reduce the chances of harm to you and your baby.
You’ll probably get frequent ultrasounds or other tests to monitor your baby’s health. Your doctor or midwife might also teach you to count how often your baby kicks. You might get your blood pressure checked more often or have other medical tests. In serious cases, you might need to stay in the hospital so doctors can monitor your baby.
Treating other conditions you have, such as high blood pressure or preeclampsia, can help prevent problems for you and your baby. Your health care provider might tell you to take low doses of aspirin, especially if you have preeclampsia or are at risk for it. You might get medicine to prevent blood clots or certain vitamins to support your overall health during pregnancy.
If your baby isn’t growing enough or there are signs of other problems, your provider may talk to you about giving birth early. Usually, babies do better if they’re born when you’re at least 37 weeks pregnant. But if you have placental insufficiency and IUGR, early delivery might be safer.
Your health care team will balance the risks of giving birth early with the risks of full-term delivery.
“It’s a shared decision with the (obstetrician), the neonatologist, and the parents, to make the right choice for the family as a whole,” Jain says.
If you decide early delivery is best, you’ll probably get medication that helps your baby’s lungs develop. Your doctor might give you medication to induce (start) labor. You may need a C-section if that doesn’t work or if your baby needs to be born right away.
Does bed rest help placental insufficiency?
In the past, people with placental insufficiency were often told to avoid physical activity and stay in bed as much as possible. But this can be bad for your mental health, and there wasn’t enough evidence that it helped babies grow more. Being on bed rest also makes you more likely to get a blood clot, and it can affect your muscles and bones. So, it’s not as common anymore.
What’s the Outlook for Someone With Placental Insufficiency?
Placental insufficiency is a serious condition, but babies usually survive it.
The outlook for placental insufficiency depends on many things, including:
- How far along you are in your pregnancy, and when the placental insufficiency started. Placental insufficiency that starts early in pregnancy tends to be the most serious.
- How much blood is getting to your developing baby, and how well is your baby’s health
- If you have medical issues, such as high blood pressure or diabetes, or other pregnancy complications, and whether these conditions can be treated
- Whether your baby is born prematurely
- Whether you have access to quality health care and other resources, such as a hospital with a NICU
After your baby is born, extra monitoring and early treatment programs can help prevent some of the longer-term problems that can happen with IUGR. Things like reading to your baby and playing music for them can also help with their brain development, Jain says.
"Parental involvement is so, so important,” she says.
Can placental insufficiency improve?
While there’s no way to repair a placenta that isn’t working well, your health care team can help manage its effects. This includes keeping a close eye on you and your baby and treating other conditions you may have, such as high blood pressure, preeclampsia, or diabetes. Your health care team will let you know if they think it’s best for your baby to be delivered early.
How to prevent placental insufficiency
Since doctors don’t always know what causes placental insufficiency, it can be hard to prevent. But catching it early allows your health care team to watch your pregnancy closely to help you avoid complications. That’s one reason prenatal care is so important.
Being as healthy as possible before you get pregnant might lower your chances of placental insufficiency. If you smoke, drink alcohol, or use other substances, quitting helps you have a healthy pregnancy.
If you have high blood pressure or other risks for preeclampsia, your doctor or midwife may recommend that you take low doses of aspirin early in your pregnancy. This might also help lower your risk of getting placental insufficiency, but doctors aren’t sure.
Takeaways
Placental insufficiency is when the placenta, which provides nutrients to a developing fetus, doesn’t work as it should. There’s no cure, but your health care team can help you manage it and avoid complications. Make sure you’re getting good prenatal care to keep track of your baby’s growth. And tell your doctor right away if you think anything’s wrong.
Placental Insufficiency FAQs
Can a baby survive placental insufficiency?
Most babies with placental insufficiency survive. Your doctor, midwife, or maternal-fetal medicine provider can help you manage the condition and decide when it’s safest to deliver.
After your baby is born, they may need care in the NICU. They’ll also need regular medical care to make sure they’re growing well and catch any problems early. They might need more or different support than other children their age.
Is vaginal delivery possible with placental insufficiency?
It’s possible to give birth vaginally when you have placental insufficiency. Your health care provider will explain the risks of both C-section and vaginal delivery, and help you decide which option is best. In serious cases, where your baby’s brain might not be getting enough oxygen, a C-section delivery may be safer. Even when the condition is less serious, labor can be more stressful for babies with placental insufficiency or IUGR. If your baby gets too stressed, you might need a C-section.
Does placental insufficiency cause brain damage in the baby?
When you’re pregnant, your baby gets nutrients and oxygen from your blood. In serious cases of placental insufficiency, the baby’s brain might not get as much oxygen as it needs. This could cause brain damage. Your care team will monitor your baby closely and may recommend early delivery if they think the baby’s brain is at risk of damage.
Can a low placenta in pregnancy cause placental insufficiency?
Some doctors think you may have higher odds of placental insufficiency if you have placenta previa. That’s when the placenta lies across your cervix (the opening of your womb), instead of higher in your uterus. Experts aren’t sure, but they think this may raise the risk of placental insufficiency because it leaves less surface area for the placenta to attach to.
Some doctors think there could also be less blood flow to the placenta if it’s lower in your uterus. But experts aren’t sure whether this affects your chances for placental insufficiency.
