To determine if isolated echogenic bowel diagnosed on second trimester ultrasound has an independent risk association with intrauterine growth restriction (IUGR) and intrauterine fetal demise (IUFD). This is a retrospective cohort study of all patients with a singleton gestation who presented for second trimester ultrasound over a 16 year time period in our center. Study groups were defined by the presence or absence of echogenic bowel. Primary outcomes were IUFD at ≥ 20 weeks gestation and IUGR, defined as birth weight <10th%ile for gestational age on the Alexander growth curve. Univariate and multivariate logistic regression analyses were used to estimate the risk of IUFD and IUGR in fetuses with echogenic bowel. Analyses were repeated after excluding cases of aneuploidy, cytomegalovirus (CMV) infection, and other major congenital anomalies. Of 64,048 patients, there were 579 (0.9%) cases of IUFD and 8,173 (12.8%) cases of IUGR. The incidence of echogenic bowel was 0.4% (n=260). Of these, 188 cases were isolated. After excluding cases of aneuploidy and CMV infection, echogenic bowel was significantly associated with both IUFD (aOR 17.3, 95% CI 10.1-29.8) and IUGR (aOR 2.0, 95% CI 1.4-2.9) after controlling for potential confounding factors. This risk association remained significant when evaluating echogenic bowel as an isolated sonographic finding. (Table)Tabled 1Isolated Echogenic BowelNo Echogenic BowelRR (95% CI)aOR (95% CI)p-valueIUFD (n=416)5.3%0.8%6.2 (3.4-11.5)13.2⁎Adjusted for IUGR, African American race, and pre-gestational diabetes; (6.7-26.2)< 0.001IUGR (n=6,314)20.7%13.0%1.6 (1.2-2.1)2.1†Adjusted for cHTN, African American race, tobacco use, pre-eclampsia, gestational diabetes, and pre-gestational diabetes. (1.4-3.0)< 0.001 Adjusted for IUGR, African American race, and pre-gestational diabetes;† Adjusted for cHTN, African American race, tobacco use, pre-eclampsia, gestational diabetes, and pre-gestational diabetes. Open table in a new tab The presence of isolated echogenic bowel on ultrasound is independently associated with an increased risk for both IUGR and IUFD. Serial growth assessment and antenatal testing may be warranted in cases of isolated echogenic bowel.