Early Environmental And Biological Impacts On Lifelong Health

Question 1

What challenges could the foetus face in utero that might have a lasting impact on its health?

Answer 1

Foetal infection in utero
Maternal nutrition - high fat diet, low protein diets
Maternal illness
Maternal stress
Maternal medication
Environmental factors/exposures

Question 2

What do biological influences on long term health include?

Answer 2

Genetics
Epigenetics

Question 3

What do social and environmental influences on long term health include?

Answer 3

Environment
Family, neighbourhood, school
Nutrition (maternal and foetal/child)
Social - behaviours seen, substance use, care giver behaviour
Health provisions

Question 4

Describe the Barker Hypothesis and the conclusions from the study looking at coronary events in adults

Answer 4

Idea that early life influences can be predictors/influencers of health status in adulthood
Conclusions: on average, adults who had a coronary event had been small at birth and thin at two years of age - thereafter, put on weight rapidly
-> 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

Question 5

What does DOHaD stand for?

Answer 5

Developmental Origins of Health and Disease - Barker Hypothesis

Question 6

Summarise the DOHaD (with regards to CV events)

Answer 6

Undernutrition in utero + overnutrition as a child -> increased risk of ‘Metabolic Syndrome’ -> increased risk of cardiovascular events

Question 7

Describe the mechanisms of DOHaD

Answer 7

Idea of programming in utero
Leads to epigenetic changes which influence development and physiology
Inadequate nutrition in utero so nutritional overshoot during childhood, increasing risk of metabolic syndrome and subsequently CV events

Question 8

Describe the links between mechanisms of DOHaD and biology

Answer 8

Question 9

What conditions have been linked to environmental exposures in early life?

Answer 9

Cardiovascular disease
Type 2 diabetes
Lung disease
Cancer risk
Neurological, special sense and intellectual development
Allergic and auto-immune diseases

Question 10

What are the main aims of the NHS Healthy Child Programme?

Answer 10

Aims to prevent disease and promote good health
- Universal
- Reduce health inequalities

Question 11

What are the different aspects of the NHS Health Child Programme?

Answer 11

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 12

What are the fundamentals of a good screening test?

Answer 12

Disease should be
- able to be identified early/before critical point
- treatable
- preventable/reduce morbidity/ mortality
Test should be
- acceptable/easy to administer
- cost effective
- reproducible and provide accurate results

Question 13

List three examples of important early childhood screening

Answer 13

Newborn Check
Newborn Hearing Screen
Blood Spot Check (heel prick test)

Question 14

What is Sure Start?

Answer 14

Government-driven project
High level of investment in children’s community centres
Aims to help support families with under 5 year old children in low income households
Parent & child education
Health promotion

Question 15

Describe one screening test undertaken pre-conception

Answer 15

Diabetic eye screening
Offered annually for women with T1/T2DM
In pregnancy, offered for women when they first present to care

Question 16

Describe one screening test undertaken in the first trimester

Answer 16

Blood for sickle cell and thalassaemia
Identifies whether mother is a carrier/has the condition
If mother/father is a carrier or has the condition, diagnostic tests for baby will be offered

Question 17

Describe one screening test undertaken in the second/third trimester

Answer 17

Detailed ultrasound scan (20-week scan) to check baby’s development
Screens for 11 physical conditions

Question 18

Describe one screening test undertaken in the newborn period

Answer 18

Newborn bloodspot screens for MCADD, CF, PKU, congenital hypothyroidism and sickle cell disease
Test ideally on day 5
Can be tested for up to 1 year, except for CF (up to 8 weeks)