PDK4 encodes pyruvate dehydrogenase lipoamide kinase isozyme 4, a key metabolic regulator contributing to a shift from glucose to fatty acids as major energy fuel (Pettersen et al., 2019), and could indicate that pyruvate oxidation in the hepatic mitochondria is lower due to higher PDK4 and LDHA expression in IUGR individuals compared to normal individuals (Pendleton et al., 2021). Here, PDK4 is linked to fetal growth restriction.