188 Fetal Disease

Question 1

What is the developmental origins of health and disease hypothesis?

Answer 1

The hypothesis that prenatal factors and childhood factors directly influence adult health risk factors and adult health outcomes by a variety of mechanisms

Question 2

What is the difference between developmental disruption vs. plasticity?

Answer 2

disruption = teratogenesis, harmful to fetus without benefit

plasticity = adaptation to fetus, may produce a survival advantage

Question 3

When a mother has diabetes while pregnant, ________ is able to cross the placenta while _________ is not.

Answer 3

When a mother has diabetes while pregnant, glucose is able to cross the placenta while insulin is not.

this leads to increased insulin production in the fetus, which leads to excess growth

Question 4

What are the major complications for neonates exposed to diabetes in pregnancy?

Answer 4

large birth weight, excessive adiposity, hypoglycemia, jaundice

Question 5

What is the thrifty phenotype of intrauterine growth restriction?

Answer 5

poor fetal growth and risk of developing impaired glucose tolerance and metabolic syndrome

intrauterine growth restriction can be caused by age, altitude, infections, pre-eclampsia, smoking, undernutrition

Question 6

Beyond metabolic diseases, what other diseases have evidence of developmental origins?

Answer 6

allergy/atopic diseases, neurological diseases

Question 7

The developmental origins of health and disease is an evolving field. Choose the correct statement:

a) paternal contribution to risk of metabolic disease has been as well studied as maternal contributions
b) epigenetic methylation is a proposed mechanism
c) a post-natal diet consisting of high-fat, highly processed food is necessary for early childhood catch up growth
d) maternal anemia is teratogenic

Answer 7

b) epigenetic methylation is a proposed mechanism

Question 8

TRUE/FALSE

Intrauterine growth restriction only occurs in underweight or lean women.

Answer 8

FALSE

Question 9

Placental insufficiency can result from all the following, except:

a) maternal alcohol abuse
b) pregnancy-induced hypertension
c) maternal smoking
d) 2-vessel cord

Answer 9

a) maternal alcohol abuse

Question 10

Which of the following hormones induces excessive fetal growth in pregnancies complicated by gestational diabetes mellitus?

a) Growth hormones
b) IGF-1
c) Insulin
d) Thyroxine

Answer 10

c) Insulin

Question 11

Why does insulin induce excessive fetal growth in pregnancies complicated by gestational diabetes mellitus?

a) fetal growth hormone is stimulated by excessive maternal glucose crossing the placenta
b) IGF-1 oversaturates the fetal insulin receptors
c) insulin has equal affinity for the IGF-1 receptor and the Insulin Receptor
d) high fetal growth hormone increases fetal thyroxine

Answer 11

c) insulin has equal affinity for the IGF-1 receptor and the Insulin Receptor

Question 12

Gestational diabetes mellitus is associated with adverse pregnancy outcomes. Which of the following accurately lists potential consequences?

a) gestational hypertension, permanent diabetes after pregnancy, C-section
b) fetal demise, permanent need for insulin after pregnancy
c) placental insufficiency, operative delivery
d) C-section, fetal demise

Answer 12

d) C-section, fetal demise

Question 13

GDM is associated with adverse neonatal outcomes. Which of the following accurately lists potential consequences?

a) neonatal hypoglycemia, large for gestational age neonate
b) congenital heart defects, shoulder dystocia, jaundice
c) small for gestational age neonate, neonatal hypoglycemia
d) respiratory distress syndrome, neural tube defects

Answer 13

a) neonatal hypoglycemia, large for gestational age neonate