188b - Fetal Origins of Disease Flashcards
What is developmental plasticity?
How does it affect the fetus?
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
What are the risk factors for intrauterine growth restriction? (7)
- Increased maternal age
- High altitude
- Pre-eclampsia (maternal HTN)
- Smoking
- Undernutrition
- 2 vessel cord
Describe the develpment of gestational diabetes melitus
- 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
List 4 risk factors for gestational diabetes
- Maternal age >35
- Overweight or obese maternal BMI
- Family hx of diabetes
- Parity 2+
Why does maternal GDM increase the risk fo fetal demise?
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
What systems might be affected in a fetus born to a mother with obesity? (4)
- Metabolic
- Allergy/asthma/atopy
- Endocrine disruption
- Neurodevelopment
The key is that in-utero exposures may have a life-ling impact on offspring health
B - fetal insulin binds IGF-1 receptors with high affinity
-> Excessive growth of the fetus
How will methylation affect gene expression?
Methylation -> decreased gene expression
C - placental insufficiency
How does maternal gestational diabetes affect RBCs in the fetus?
What is the effect?
- *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