181. Fetal Origins of Disease Flashcards
Type of fuel-mediated teratogenesis
Occurs when:
- mother’s insulin decreases –> increase in plasma glucose, AA’s, lipids which cross the placenta –> Increase in mixed nutrients in placenta –> increased insulin of fetus –> macrosomia, hypoglycemia, obesity, IGT –> diabetes mellitus
Developmental over-nutrition
Thin-fat baby phenomenon:
- fetal undernutrition leads to small babies that are at an increased risk for __ __
Low birth weight => catch-up growth (preferential to fat tissue instead of lean tissue)
- increased metabolic load
Insulin resistance
All are part of the __:
- fetal origins of adult disease
- thrifty phenotype
- fuel-mediated teratogenesis
- developmental overnutrition
Developmental Origins of Health and Disease Paradigm
Intrauterine growth restriction (IUGR) can occur in the setting of infection, preeclampsia, pregnancy-induced HTN, smoking, and multiples. What is the common mechanism of these conditions that leads to IUGR?
Placental insufficiency
Developmental adaptation by the fetus
Biological programming may induce a survival advantage
- fetus responding to environment
Plasticity
All of the following maternal fuels cross the placenta to the developing fetus except: (which one?)
- insulin
- glucose
- AA’s
- lipids
Insulin
Environmental exposures influence the development of the __ and __ systems
Can lead to abnormal development
- asthma risk
Respiratory
Immune
Most common type of congenital anomalies seen d/t mothers being diabetics
Cardiac
Who is more likely to develop gestational diabetes (2 types)
- Obese mothers w/ an increased metabolic load
2. Fam hx of diabetes
At what time period in pregnancy do mothers need to start producing more insulin than normal in order to avoid gestational diabetes
- time when fetus really starts to grow
Weeks 24-28
__, __, and __ may influence fetal neurodevelopment
- psych conditions
Could be more likely to have boys w/ ADHD
Anxiety
Depression
Stress
What is the mechanism underlying excessive fetal growth in pregnancies complicated by gestational diabetes mellitus?
Fetal insulin binds __ receptors with high affinity
IGF-1
Mother symptoms:
- possible fetal demise d/t hypoxia
- preeclampsia/HTN
- preterm labor
- operative delivery
- c-section
- future risk of type 2 DM
Gestational diabetes
Growth factor in utero
Insulin
Baby symptoms:
- macrosomia
- shoulder dystocia
- hypoglycemia
- jaundice d/t hyperbilirubinemia from increase erythropoeitin d/t hypoxia d/t increased tissue oxygen consumption
- respiratory distress syndrome from decreased surfactant synthesis
Gestational diabetes
The study of changes in gene function without changes to DNA sequence
- done through methylation and acetylation
Causes variance in susceptibility to adult diseases
Epigenetics
Maternal or Placental abnormalities –> fetal malnutrition (especially amino acids) –> decreased B-cell mass or islet function –> decreased fetal growth –> infant malnutrition –> decreased adult B-cell function –> non-insulin dependent diabetes –> metabolic syndrome
Also develop HTN and other organ malfunction from fetal malnutrition
Thrifty Phenotype Hypothesis
Correlation was found between small size at birth and increased death rate from __
CAD
Developmental disruption causing harm to the fetus
- no advantages from this
Ex: fetal alcohol syndrome, drugs, infections
Teratogenesis
Only source of nutrition to the fetus
Placental blood flow
Relationship between low birth weight and increased risk of __ and __
HTN
DM2
Prenatal factors that can leads to adult health risk factors and adult health outcomes (2 things)
Maternal nutrition
Placental insufficiency
Increased insulin in the fetus neonate causes an increase in size called..
- d/t insulin being a growth factor in insulin
Macrosomia
Leads to an increased adult risk for diabetes, CVD, obesity of the fetus
Developmental programming of glucose and insulin metabolism:
- adaptations to adverse intrauterine conditions
Intrauterine Growth Restriction (IUGR)
