Intrauterine growth restriction (IUGR) is associated with increased mortality and morbidity not only during the neonatal period but also later in life. It is a pregnancy-associated disease manifested by decreased growth of the fetus compared to its normal genetic growth potential. IUGR affects long-term outcome and is a risk factor for the adult onset of metabolic diseases like cardiovascular disease (CVD), lung diseases, kidney disorders, hepatic diseases, neurodevelopmental abnormalities, metabolic syndrome, and obesity. The placental and fetal growth are also affected by intrauterine exposure to heavy metals and chemicals such phthalates, bisphenol A, cadmium, and organic pollutants like dichloro diphenyl trichloroethane (DDT). DNA methylation, inflammatory mediators, and placental pathology also have a role in the susceptibility and outcome of IUGR neonates. The screening of high-risk antenatal mothers enables early diagnosis, careful monitoring, and appropriate timing for the delivery of IUGR fetuses. Other than treating some of the known causes like infections and avoiding unfavorable environments, there is currently no effective treatment available for IUGR. © 2025 Elsevier B.V., All rights reserved.