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Reproduction, Development and Ageing > Fetal Growth and Nutrition > Flashcards

Fetal Growth and Nutrition Flashcards

1
Q

What is the most important factor in fetal growth?

A

Substrate supply via the placenta

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2
Q

What is the primary cause of growth restriction?

A

Poor placentation

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3
Q

Infant mortality and morbidity is lowest at ___ wks

A

39-40

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4
Q

• Low birthweight (LBW) ____g

A

• Low birthweight (LBW) <2500g
• Very low birthweight (VLBW) <1500g
• Extremely low birthweight (ELBW) <1000g
Macrosomia > 4500g

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5
Q

• Small for gestational age (SGA) __th centile

A

• Small for gestational age (SGA) <10th centile

Large for gestational age (LGA) >90th centile

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6
Q

What are the four types of birthweight centiles?

A
  • Population reference
  • Population standard
  • Fetal growth curves
  • Customised birthweight
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7
Q

When is your metabolic capacity determined?

A

In fetal life and infancy

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8
Q

What are the three most important determinants of fetal growth?

A
  • Nutrition
  • Hormones
  • Genetics
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9
Q

What are the four components of the fetal diet in utero?

A
  • Glucose
  • Amino acids
  • Lactate
  • Fatty acids
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10
Q

What is the most important hormone in fetal growth?

A

Insulin-like growth factors

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11
Q

What is the role of IGFRs in fetal growth?

A
  • Mitogens
  • Protein anabolism,
  • Paracrine and endocrine hormones
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12
Q

What is the difference in function between IGF2 and IGFR in fetal growth?

A
  • IGF1 regulated by fetal nutrition

- IGF2 main circulating fetal IGF, constitutive drive for growth

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13
Q

What is the role of insulin in fetal growth?

A
  • Regulate growth when nutrition is plentiful
  • Increases glucose uptake, fat deposition, protein anabolism, placental growth
  • Amino acids stimulate fetal insulin secretion in early pregnancy
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14
Q

Why does deficiency of growth hormone have minimal effects on fetal weight despite high circulating concentrations?

A

Absence of receptorss in the liver

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15
Q

What is the role of corticosteroids in fetal growth?

A
  • Promote differentiation and tissue maturation

- Decreased DNA synthesis and cell division

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16
Q

Which enzyme is the placental barrier to maternal cortisol?

A

11 betaHSD2

17
Q

Fetal growth normally limited by ____

A

Constraint

18
Q

Which factors cause maternal constraint?

A
  • Ability of utero-placental unit to supply oxygen and nutrients
  • Maternal size
  • Maternal age
  • Parity
  • Shorter inter pregnancy interval
  • Macronutrient imbalance
19
Q

Which factors cause constraint during embryogenesis?

A
  • Twins

- Periconceptual undernutrition

20
Q

Compare fetal and postnatal growth

  • Constraint
  • Growth regulation
A
  • Maternal environment vs genetic potential
  • Endocrine status adequate -> regulation by substrate supply

VS nutritional status adequate -> regulation by endocrine status

21
Q

Define fetal growth restriction

A
  • In utero growth potential limited by pathological process

- Causes decreased accretion of fat and lean tissue +/- skeletal growth

22
Q

Which fetal pathologies can lead to fetal growth restriction?

A
  • Congenital malformation
  • Congenital infction
  • Toxins
  • Chromosomal disorders
  • Specific genetic disorders
23
Q

What is the genetic abnormality in Beckwith Wiedemann Syndrome? How does this affect fetal growht?

A
  • Overexpression of IGF2 (maternal allele normally imprinted)
  • Usually due to paternal uniparental disomy
  • Causes macrosomia
24
Q

What is the genetic abnormality in Russell Silver Syndrome? How does this affect fetal growht?

A
  • 60% due to reduced expression of IGF2

- SGA, short, normal head growth

25
Q

What are the health risks associated with the thrifty phenotype?

A
  • Low nephron mass
  • Low lean mass
  • Endothelial dysfunction, arterial stiffness
  • Insulin resistance
  • Dyslipidaemia, central adiposity
  • Exaggerated stress
26
Q

What is the mechanism of gestational diabetes?

A

• Excess fetal substrate (glucose, FFA) -> excess fetal insulin

Excess substrate + excess insulin -> excess growth

Reproduction, Development and Ageing (26 decks)

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