(dev&age) impact of the environment on lifelong health Flashcards
what challenges could the fetus face in utero that might have lasting impact on its health?
fetal infection in utero
maternal nutrition
maternal illness
maternal stress
maternal medication
environmental factors/exposures
how can a fetal infection in utero affect development?
can have a profound impact on health status at the time and subsequently
how can maternal nutrition affect fetal development?
high fat OR low protein in maternal nutrition (maybe at the time of conception) can have impacts on health of fetus
how can maternal stress affect fetal development?
if mother is ill/experiencing anxiety or stress = can affect the development of fetus
how can maternal medication affect fetal development?
medication can cross the placenta or be modified and can affect fetus
what are the two main influences on long-term health and risk of disease?
biological influences
social and environmental influences
what are the biological influences that affect long-term health and risk of disease?
genetics (genes, nucleotides, protein sequences)
epigenetics (control how genes are switched on and when)
what are the social and environmental influences that affect long-term health and risk of disease?
environment
family, neighbourhood, school
nutrition (maternal and fetal/child)
social - behaviours seen – substance use, caregiver behaviour
accessibility to healthcare
how does accessibility to healthcare in early life affect long-term health?
significant issues can be picked up early so can be stopped form developing to become challenges in the future
what is the Barker hypothesis?
the idea that the rate of development and growth of children can be correlated w the rate of coronary events experienced as adults
what is the main conclusion of the Barker hypothesis?
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)
what is the DOHaD hypothesis?
undernutrition in utero followed by overnutrition as a child
= increased risk of ‘metabolic syndrome’ and increased risk of cardiovascular events
what is DOHaD?
developmental origins of health and disease
what is the mechanism of DOHaD?
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)
define epigenetics
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)
what is the NHS Healthy Child Programme?
universal programme that aims to prevent disease and promote good health and healthy living
= reducing health inequalities
what is the NHS Healthy Child Programme include?
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)
what are the requirements of a good screening test?
easy to administer
cost-effective (detect enough people affected to ensure the intervention is worthwhile)
reproducible and accurate results
for a screening test to be good, what must the disease it is screening for be?
should be able to identified early/before critical point
treatable
prevent/reduce morbidity & mortality
what are some examples of important early childhood screening tests?
newborn physical check
newborn hearing screen
newborn blood spot check
what is Sure Start?
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
which screening test is commonly carried out pre-conception and during pregnancy for women with diabetes?
diabetic eye screening (for women with T1 and T2 diabetes and especially if they are preg)
why is diabetic eye screening important?
to test for diabetic retinopathy in the mother
which screening tests and scans are commonly carried out in the first trimester for pregnant women?
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)
why is a blood test carried out for rhesus and antibodies in the mother during pregnancy?
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
what is the scan in the first trimester carried out for?
= 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
which screening tests and scans are commonly carried out in the second trimester for pregnant women?
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)
what is the scan in the second trimester carried out for?
= 20-week scan
to check for the presence of either of a selection of eleven rare diseases (e.g. anencephaly, open spina bifida etc)
which screening tests and scans are commonly carried out in the newborn period?
newborn blood spot
newborn hearing screen
newborn physical examination
when and why is the newborn blood prick test carried out?
ideally on day 5 after birth (within the first week)
to test for MCADD, CF, PKU, congenital hypothyroidism and SCD
when and why is the newborn hearing test carried out?
approx three weeks after birth
to test for hearing impairment
when is the newborn physical examination carried out?
one at 72 hours and another at 8 weeks
which conditions are associated to early environmental exposures?
cardiovascular disease
type 2 diabetes
lung disease
cancer risk
neurological, special sense and intellectual development
allergic and auto-immune diseases
how do environmental exposures increase the risk of specific diseases?
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
how can environmental exposures during pregnancy AND adulthood increase the risk of specific diseases?
summarise the timeline of screening tests during pregnancy and a few weeks after birth
