188b - Fetal Origins of Disease Flashcards

1
Q

What is developmental plasticity?

How does it affect the fetus?

A

Developmental plasticity causes the fetus to adapt to an environmental stressor

  • No harm to the fetus
  • Confers a survival advantage
    • However, may affect person later on in life with metabolic issues, etc

Example: Malnutrition in utero -> thrifty phenotype -> obesity later in life

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2
Q

What are the risk factors for intrauterine growth restriction? (7)

A
  • Increased maternal age
  • High altitude
  • Pre-eclampsia (maternal HTN)
  • Smoking
  • Undernutrition
  • 2 vessel cord
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3
Q

Describe the develpment of gestational diabetes melitus

A
  • Early in pregnancy mother is insulin sensitive
  • At ~24 weeks, insulin resistance increases
    • Baby is growing rapidly
    • GDM develops if maternal insulin production cannot keep up

Similar to the development of T2DM, but GDM goes away when baby is born

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4
Q

List 4 risk factors for gestational diabetes

A
  • Maternal age >35
  • Overweight or obese maternal BMI
  • Family hx of diabetes
  • Parity 2+
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5
Q

Why does maternal GDM increase the risk fo fetal demise?

A

Maternal excess circulating glucose

  • -> Fetal hyperglycemia
  • -> Increased fetal insulin production
    • Maternal insulin does not cross the placenta
  • -> Increaed fetal glucose uptake
    • Increased tissue O2 consumption
    • Hypoxia
    • -> increased risk of still birth
    • Also, increased erythropoetin
      • Polycythemia, hyperbilirubinemia, jaundice
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6
Q

What systems might be affected in a fetus born to a mother with obesity? (4)

A
  • Metabolic
  • Allergy/asthma/atopy
  • Endocrine disruption
  • Neurodevelopment

The key is that in-utero exposures may have a life-ling impact on offspring health

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7
Q
A

B - fetal insulin binds IGF-1 receptors with high affinity

-> Excessive growth of the fetus

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8
Q

How will methylation affect gene expression?

A

Methylation -> decreased gene expression

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9
Q
A

C - placental insufficiency

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10
Q

How does maternal gestational diabetes affect RBCs in the fetus?

What is the effect?

A
  • *Hypoxia -> Increased EPO -> increased RBCs -> polycythemia**
  • > Jaundice
  • Maternal excess circulating glucose
  • -> Fetal hyperglycemia
  • -> Increased fetal insulin production
    • Maternal insulin does not cross the placenta
  • -> Increaed fetal glucose uptake
    • Increased tissue O2 consumption
    • -> Hypoxia
      • -> increased risk of still birth
      • -> increased erythropoetin -> Polycythemia, hyperbilirubinemia, jaundice
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