Common causes include Placental insufficiency resulting from maternal disease involving the small blood vessels (eg, preeclampsia, hypertension, renal disease, antiphospholipid antibody syndrome, long-standing diabetes) Relative placental insufficiency caused by multiple gestation Placental involution accompanying postmaturity Chronic maternal hypoxemia caused by pulmonary or cardiac disease Maternal malnutrition Conception using assisted reproductive technology An infant may also have asymmetric growth restriction and be small for gestational age (SGA) if the mother is a heavy user of opioids, cocaine, alcohol, and / or tobacco during pregnancy (see Social and Illicit Drugs During Pregnancy).