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reproduction, development and aging > fetal growth and nutrition > Flashcards

fetal growth and nutrition Flashcards

1
Q

problems faced by small babies

A
  • 6-fold increase in perinatal mortality and morbidity
  • average IQ 8 points lower
  • intention, hyperactivity, behavioural problems
  • lower income
  • increased adult non-communicable disease
  • 20% of adult short stature
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2
Q

problems face by large for babies

A
  • birth trauma
  • increased neonatal admissions
  • increased adult non-communicable disease
    - e.g. childhood obesity, metabolic syndrome
    - (depends on neonate body composition, interaction with maternal diabetes)
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3
Q

define full term and benefits

A

39-40 weeks

  • lowest risk for respiratory distress, cerebral palsy and childhood mortality
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4
Q

how is pregnancy dated?

A

first trimester ultrasound looking at the crown rump length
-(95% confidence interval +/- 5 days)

accurate dating important for improving outcomes

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5
Q

birth size (number definitions)

A

LBW = <2500g

VLBW = <1500g

ELBW = <1000g

appropriate for gestational age = between 10-90%

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6
Q

fetal growth

A

increase in body size & mass from end of organogenesis

  • hyperplasia (not hypertrophy)

mean weight gain = 16-17g/kg per day

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7
Q

life course epidemiology (duration of hyperplasia)

A

key body organs undergo hyperplasia before birth

e.g. neurons, skeletal muscles, kidneys, heart, pancreas (metabolic)

therefore what you’re born with is largely what you maintain for life (+ hypertrophy)

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8
Q

fetal growth restriction

A
  • pathological process limiting growth in utero
  • decreased adipose tissue and lean tissue
  • can make baby shorter
  • majority due to poor placental function
  • key risk factor for stillbirth, neonatal death, asphyxia
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9
Q

relationship between FGR and SGA

A

fetal growth restriction and being small are not the same thing

can be growth restricted and still in the normal birth weight

can be small and not growth restricted

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10
Q

4 possible references to compare babies birth weight too

A

population reference
- actual birthweight across population
(preterm centile too low)

population standard
- actual birthweight in optimal pregnancy conditions
(few preterm babies)

fetal growth curves
- serial ultrasound biometry of healthy fetuses born at term
(small samples)

customised birthweight
- models that incorporate maternal size, ethnicity, parity, fetal growth velocity
(ethnicity, interpretation of upper centiles)

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11
Q

determinants of fetal growth

A
  1. nutrition
  2. hormones
  3. genetics

(pyramid)

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12
Q

nutrition in fetal growth

A

histiotrophic nutrition

  • endometrial glands
  • growth ‘autonomous’

maternal placenta circulation established end of 1st trimester (3-fold rise in intra-placental O2)

haemotrophic nutrition

  • 10-12 weeks (proper)
  • fetal supply line
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13
Q

‘fetal diet’ of glucose

what is its placental transport and role?

A

transport
= facilitated diffusion (GLUT1)

role
= key oxidative fuel
carbon source for tissue accretion
limited fetal glucogenesis therfore needs to be constant

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14
Q

‘fetal diet’ of amino acids

what is its placental transport and role?

A

active transport
some synthesized by placenta

key role in metabolic balance between oxidation vs growth

carbon & nitrogen for tissue accretion, nucleotides

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15
Q

‘fetal diet’ of lactate

what is its placental transport and role?

A

produced by placenta

mostly oxidised (energy)

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16
Q

‘fetal diet’ of fatty acids

what is its placental transport and role?

A

readily cross placenta by diffusion

role = cell membranes, energy store, limited energy supply

17
Q

hormones for fetal growth

A

serve to coordinate fetal growth with the supply of nutrition

e.g. insulin-like growth factors and insulin

18
Q

insulin-like growth factors (IGF)

A

is the major growth hormone in the fetus

  • produced in all fetal tissues and placenta
  • regulated by fetal nutrition

IGF1 & IGF2

19
Q

actions of fetal insulin

A
  • increased glucose uptake
  • fat deposition
  • protein anabolism
  • may promote placental growth
  • stimulates fetal IGF1

key role = tissue accretion and fuel storage

20
Q

secretion of fetal insulin

A

early pregnancy = amino acids

late pregnancy = placental uptake of glucose and free fatty acids

21
Q

genetic influences on fetal growth

A
  • race and sex account for <20% variance in birthweight
  • genetic factors have more influence on lean mass
  • fetal growth is normally limited by constraint from mother (e.g. non-genetic or non-pathological)
22
Q

maternal constraint

A

the major constraining factor is the ability of the utero-placental unit to supply oxygen and nutrients

  • maternal size
  • maternal age (young less utero-placental function)
  • parity
  • short inter-pregnancy interval
  • macro-nutrient imbalance
23
Q

fetal growth constraints

A

fetal growth is normally constrained

  • constrained below optimal for survival
  • best chance is born around 80-90th centile
24
Q

fetal vs postnatal growth

A

fetal

  • normally constrained by maternal environment
  • if endocrine status is adequate growth is normally regulated by substrate supply

postnatal

  • is normally to genetic potential
  • if nutritional status is adequate growth is normally regulated by endocrine status
25
Q

causes of FGR (fetal growth restriction)

A

fetal under-nutrition

  • placental insufficiency
  • maternal under-nutrition

fetal pathology

  • congenital malformation
  • congenital ingection
  • toxins
  • chromosomal disorders
  • specific genetic disorders
26
Q

placental insufficiency

A
  • deficient trophoblast invasion and remodelling of spiral arteries with maldevelopment of terminal villi
  • reduced SA, diffusing capacity, BF
  • placental inflammation, hypoxic stress etc
27
Q

genetic disorders affecting fetal growth

A

genes regulating growth are commonly imprinted:

  • maternally expressed genes suppress growth
  • paternally expressed genes promote growth
28
Q

beckwith wiedemann syndrome

A
  • overexpression of IGF2 (maternal allele imprinted)
  • overexpression of paternal gene
  • large tongue and ears etc
29
Q

russell silver syndrome

A
  • SGA, short, normal head

- 60% due to reduced expression of IGF2

30
Q

long-term effects of FGR

A
  • low nephron mass
  • low lean mass
  • insulin resistance
  • exaggerated stress response
  • endothelial dysfunction
  • hypertension
  • ischaemic heart disease
  • stroke
  • diabetes
  • metabolic syndrome
31
Q

gestational diabetes and consequence

A
  • glucose intolerance developing in pregnancy

excess substrate + excess insulin -> excess growth

32
Q

what determines fetal growth

A

substrate supply via the fetus

33
Q

what contributes to adult non-communicable disease

A

fetal under- and over-growth

reproduction, development and aging (27 decks)

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