(dev&age) impact of the environment on lifelong health

Question 1

what challenges could the fetus face in utero that might have lasting impact on its health?

Answer 1

fetal infection in utero

maternal nutrition

maternal illness

maternal stress

maternal medication

environmental factors/exposures

Question 2

how can a fetal infection in utero affect development?

Answer 2

can have a profound impact on health status at the time and subsequently

Question 3

how can maternal nutrition affect fetal development?

Answer 3

high fat OR low protein in maternal nutrition (maybe at the time of conception) can have impacts on health of fetus

Question 4

how can maternal stress affect fetal development?

Answer 4

if mother is ill/experiencing anxiety or stress = can affect the development of fetus

Question 5

how can maternal medication affect fetal development?

Answer 5

medication can cross the placenta or be modified and can affect fetus

Question 6

what are the two main influences on long-term health and risk of disease?

Answer 6

biological influences

social and environmental influences

Question 7

what are the biological influences that affect long-term health and risk of disease?

Answer 7

genetics (genes, nucleotides, protein sequences)

epigenetics (control how genes are switched on and when)

Question 8

what are the social and environmental influences that affect long-term health and risk of disease?

Answer 8

environment

family, neighbourhood, school

nutrition (maternal and fetal/child)

social - behaviours seen – substance use, caregiver behaviour

accessibility to healthcare

Question 9

how does accessibility to healthcare in early life affect long-term health?

Answer 9

significant issues can be picked up early so can be stopped form developing to become challenges in the future

Question 10

what is the Barker hypothesis?

Answer 10

the idea that the rate of development and growth of children can be correlated w the rate of coronary events experienced as adults

Question 11

what is the main conclusion of the Barker hypothesis?

Answer 11

the risk of coronary events was more strongly related to the RATE of change of childhood BMI, rather than to the BMI attained at any particular age of childhood.

(i.e. how quickly a child put on weight as opposed to how heavy they were = increased risk of CVD)

Question 12

what is the DOHaD hypothesis?

Answer 12

undernutrition in utero followed by overnutrition as a child

= increased risk of ‘metabolic syndrome’ and increased risk of cardiovascular events

Question 13

what is DOHaD?

Answer 13

developmental origins of health and disease

Question 14

what is the mechanism of DOHaD?

Answer 14

fetus nutritionally restricted (due to undernutrition in the womb) = tends to have a high energy intake in childhood to catch up with growth and development

then high energy intake leads to overshoot which puts the individual at risk of metabolic syndrome and CVD

(epigenetic changes that influence development and physiology)

Question 15

define epigenetics

Answer 15

heritable changes in marks on the DNA that do not change the nucleotide sequence but influence how genes are expressed (where, when and how much a gene is switched on or off)

Question 16

what is the NHS Healthy Child Programme?

Answer 16

universal programme that aims to prevent disease and promote good health and healthy living

= reducing health inequalities

Question 17

what is the NHS Healthy Child Programme include?

Answer 17

supporting care giving and care givers

screening

immunisation

identification of high-risk families/individuals for additional support

signposting

accident prevention

dental hygiene (indicator of whether a child is being sufficiently supported)

Question 18

what are the requirements of a good screening test?

Answer 18

easy to administer

cost-effective (detect enough people affected to ensure the intervention is worthwhile)

reproducible and accurate results

Question 19

for a screening test to be good, what must the disease it is screening for be?

Answer 19

should be able to identified early/before critical point

treatable

prevent/reduce morbidity & mortality

Question 20

what are some examples of important early childhood screening tests?

Answer 20

newborn physical check

newborn hearing screen

newborn blood spot check

Question 21

what is Sure Start?

Answer 21

organisation that aims to help support families with under 5s in low-income households to optimise early life outcomes

with 1) parent & child education to enhance parenting and 2) health promotion (e.g. healthy diet, vaccinations)

children’s community centres

Question 22

which screening test is commonly carried out pre-conception and during pregnancy for women with diabetes?

Answer 22

diabetic eye screening (for women with T1 and T2 diabetes and especially if they are preg)

Question 23

why is diabetic eye screening important?

Answer 23

to test for diabetic retinopathy in the mother

Question 24

which screening tests and scans are commonly carried out in the first trimester for pregnant women?

Answer 24

blood test for sickle cell and thalassaemia in fetus

blood test for haemoglobin, group, rhesus, antibodies in mother

blood test for syphilis, hep B, HIV and rubella in mother

early pregnancy scan to support Down’s syndrome diagnosis in fetus (12 week scan)

Question 25

why is a blood test carried out for rhesus and antibodies in the mother during pregnancy?

Answer 25

to check to see if the mother is RhD sensitised so in case her foetus is Rh+, the appropriate anti-D immunoglobulin is administered to prevent haemolytic disease of the newborn

Question 26

what is the scan in the first trimester carried out for?

Answer 26

= 12-week scan

to work out the expected delivery date, see if there are multiple births

to also check to for genetic conditions (e.g. Down’s) via nuchal translucency measurements

Question 27

which screening tests and scans are commonly carried out in the second trimester for pregnant women?

Answer 27

blood test for Down’s syndrome screening

detailed ultrasound scan (20 week scan)

(follow up + more DE scans for women that have diabetic retinopathy + repeat haemoglobin and antibodies)

Question 28

what is the scan in the second trimester carried out for?

Answer 28

= 20-week scan

to check for the presence of either of a selection of eleven rare diseases (e.g. anencephaly, open spina bifida etc)

Question 29

which screening tests and scans are commonly carried out in the newborn period?

Answer 29

newborn blood spot

newborn hearing screen

newborn physical examination

Question 30

when and why is the newborn blood prick test carried out?

Answer 30

ideally on day 5 after birth (within the first week)

to test for MCADD, CF, PKU, congenital hypothyroidism and SCD

Question 31

when and why is the newborn hearing test carried out?

Answer 31

approx three weeks after birth

to test for hearing impairment

Question 32

when is the newborn physical examination carried out?

Answer 32

one at 72 hours and another at 8 weeks

Question 33

which conditions are associated to early environmental exposures?

Answer 33

cardiovascular disease

type 2 diabetes

lung disease

cancer risk

neurological, special sense and intellectual development

allergic and auto-immune diseases

Question 34

how do environmental exposures increase the risk of specific diseases?

Answer 34

foetal gene expression is affected by maternal health and environment (uterine environment), foetal nutrient supply, placental vascular supply

differences in gene expression alter developmental biology of fetus (metabolism, endocrinology, vascular loading and immune responses)

then difference exposure in adult life (stress, poor diet & exercise)

can lead to cardiovascular, metabolic, lung, immune-mediated (etc) disease

Question 35

how can environmental exposures during pregnancy AND adulthood increase the risk of specific diseases?

Answer 35

Question 36

summarise the timeline of screening tests during pregnancy and a few weeks after birth

Answer 36