Early Environmental and Biological Impacts on Lifelong Health Flashcards
What challenges could the foetus face in utero that might have a lasting impact on its health?
Infection
Maternal nutrition
Maternal illness
Maternal medication - prescribed and recreational drug use
Environmental factors - tobacco smoke, toxins (lead), maternal stress
What is the Nature VS Nuture divide on a child’s long term health and risk of disease?
Nature =
Genetics
Epigenetics
Perinatal influences
Nuture = Environment Family, neighbourhood, school Nutrition Social - behaviours seen - substance use, caregiver behaviour Health provisions
Most of the long term health and risk of disease factors are based on gene-environment interactions
How do the adults treat the child in this video? What would happen if this was what the child faced long-term?
1 y/o baby
Mother greets baby, baby greets mother
Mothe engages with baby - co-ordinating emotions
Then, mother is asked to not respond to the baby - still face
Baby picks up on the mother’s still face - baby then tries to get mother’s attention
Baby feels the stress of the situation from mother’s lack of response
Still face is stopped - mother and baby go back to playing
Long-term =
Effects longer term social and emotional functioning - huge consequences on child’s development = changes in risk of disease/health in later life
What did David’s Barker’s study find?
On average, adults who had a coronary event had been small at birth and thin at two years of age, but then rapidly put on weight afterwards
Suggesting the risk of coronary events was more strongly related to the tempo of childhood gain in BMI, than to the BMI attained at any particular age of childhood
What is the Barker hypothesis?
Undernutrition in utero, overnutrition as a child –> leads to increased risk of ‘metabolic syndrome –> leads to increased risk of CVD
Malnutrition in utero can lead to an increased risk of disease later in life
e.g. maternal malnutrition -> small baby due to reduced growth of foetus -> energy consumption decreases to compensate malnourishment -> epigenetic changes for metabolic syndrome remain outside of utero -> overweight / obese health problems in later life
Why might a foetus be undernourished in utero? How does this lead to being overnourished outside of utero?
Due to reduced placental blood flow –> reduced growth of foetus
Leads to epigenetic changes where the foetus becomes more acquisitive of calories –> want to store energy in fat stores as they are not growing as well as thy are genetically intended to
Epigenetic changes = long-term metabolic changes
So outside of the womb, they continue to deposit fat and energy stores more easily than others
So more like to become obese = increased CVD risk
What external factors can affect foetal gene expression? How might foetal gene expression change?
Foetal gene expression can be altered by:
- Maternal health and environment
- Foetal nutrient demand>supply
- Endocrine environment
- Placental vascular supply
Foetal development responses to the above factors include:
- altered endocrinology / metabolism
- changes in foetal bone, lean and fat mass
- altered blood dlow / vascular loading
- altered immune responses
These foetal responses remain and are amplified during infancy, combined with adult exposures leading to many diseases
What diseases are associated with early environmental exposures?
CVD T2DM Lung disease Cancer risk Brain is malleable and sensitive to environmental stimulations - neurological, special sense and intellectual development Allergic and autoimmune diseases
What is important in the growth of children?
Growth and weight should be tracked on a planned projectory based on weight and size at birth
Great deviations in this are a cause for alarm
What other influences shape your health?
Inherited genes
Environmental development
What is the NHS Healthy Child programme?
Cannot change inherited genes, but can help change child’s environment
Programme of screening and intervention - aims to detect things early and intervene
Aims to prevent disease and promote good health universallty by reducing health inequalities
NHS Healthy Child Programme includes:
Health promotion (obesity preventional particularly)
Supporting caregiving and caregivers
Screening
Immunisation
Identification of high-risk families / individuals for additional support
Signposting - accident prevention and dental hygiene
What screening programmes take place during pregnancy and early childhood? How do they help with early interventions?
During pregnancy:
Pre-eclampsia (PE) - blood tests, urine tests, BP check
Screening for congenital defects - during regular USS checks
Sickle cell anaemia (SCA)
Thalassemia (inherited condition where body makes insufficient Hb)
Blood incompatibilities between mother and foetus
Other major chromosomal disorders
Diabetes
Early childhood:
Newborn Hearing Screening - useful to place cochlear implant as early as possible to improve language learning, decoding language, etc. Intervening too late with deafness - auditory cortex does not develop and so cochlear implant will not work
Newborn check - physical examination
Blood spot check (heel prick) - day 5, PKU (phenylketonuria) check, diet restriction allows child to develop healthily, otherwise many mental disorders
Hypothyroidism - TSH checked on day 5 (congenital hypothyroidism in 1/1000), thyroxine replaced from early life = healthy child
6 week check - physical and clinical examination
When is it worthwhile screening for a health condition?
Bradford Hill’s criteria:
Can the disease be indentified early / before critical point?
Is the disease treatable?
Can we prevent the disease / reduce morbidity or mortality?
Is the test easy / acceptable to administer?
Is the test cost-effective?
Is the test reproducible and accurate?
Why is folic acid important to supplement when pregnant / when planning to become pregnant?
For CNS development - prevents anencephaly (where your brain is severely underdeveloped, is usually fatal, 1/500 pregnancies) and spina bifida (spinal cord does not form properly and close at the end, many health issues)
These conditions can be prevented by folic acid supplementation - but only works if it is taken during the first trimester, where the neural tube is forming and folding
What is Sure Start?
They are centres that help children have a good start at life through:
- High level of investment in children’s community centres
- To help support families with under 5 year old children in low income households
- Education
- Health promotion
