Early environmental and biological impacts on lifelong health

Question 1

what is the DOHaD hypothesis?

Answer 1

concept that challenges to fetus in utero can impact long term health after birth

Question 2

what are the six main challanges that can affect a fetus in utero?

Answer 2

infection
maternal nutrition
maternal illness
maternal medication
maternal stress
environmental factors/exposures

Question 3

what are the biological influences vs social and environmental cues that influence long term health and risk of disease?

Answer 3

biological = genetics and epigenetics
social and environmental = environment, family, neighbourhood, school, nutrition, social (behaviours seen etc)

Question 4

how does undernutrition in utero lead to increased risk of cardiovascular events?

Answer 4

undernutrition in utero leads to overnutrition as a child. this increases risk of metabolic syndrome which in turn increases risk of cardiovascular events

Question 5

what is the underlying mechanism that DOHaD is based on?
barker hypothesis

Answer 5

Idea of PROGRAMMING in utero

Leads to epigenetic changes which influence development and physiology

Question 6

what is epigenetics?

Answer 6

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 7

what are the aims of the NHS healthy child programme?

Answer 7

aims to prevent disease and promote good health

Question 8

how does the NHS aim to deliver the NHS healthy child programme?

Answer 8

Health Promotion (Obesity prevention is a key aspect)
Supporting care giving and care givers
Screening
Immunisation
Identification of high-risk families/ individuals for additional support
Signposting
accident prevention
dental hygiene

Question 9

what are the fundamentals of a good screening test?

Answer 9

The Disease it is screening for
should be able to identified early/before critical point
treatable
prevent/reduce morbidity/mortality

Acceptable/easy to administer
Cost effective
Reproducible and accurate results

Question 10

identify and recall one screening test undertaken pre-conception.

Answer 10

women with diabetes mellitus are offered diabetic eye (DE) screening annually.

Question 11

identify and recall one screen undertaken in the first trimester

Answer 11

screen for sickle cell and thalassaemia. All pregnant women in England are offered a blood test to find out if they carry a gene for thalassaemia.

Those at high risk of being a sickle cell carrier are offered a test for sickle cell.
should be done before 10wks pregnant

Question 12

identify and recall one screen undertaken in the second or third trimester

Answer 12

offered a screening test for Down’s syndrome, Edwards’ syndrome and Patau’s syndrome between 10 and 14 weeks of pregnancy.

Question 13

identify and recall one screen undertaken in the newborn period.

Answer 13

newborn hearing test
If you give birth in hospital, you may be offered a newborn hearing test for your baby before you’re discharged.

Otherwise it will be done by a healthcare professional, healthcare assistant or health visitor within the first few weeks.

Question 14

per the early life origins concept, fetal gene expression is modified by:

Answer 14

maternal health and environment
fetal nutrient demand>supply
endocrine milleau
placental vascular supply

Question 15

per the early life origins concept, foetal development responses include:

Answer 15

altered fetal endocrinology/ metabolism
altered fetal blood flow
altered fetal immune responses
epigenetic changes/ changes to DNA methylation

Question 16

per the early life origins concept, what happens following fetal gene expression modification and the fetal development responses, what happens next?

Answer 16

amplification of these changes in infancy and due to adult exposure