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Pregnancy complications, fatal morbidity and assisted reproduction EAR7 > Hormonal involvement in development > Flashcards

Hormonal involvement in development Flashcards

1
Q

How do structured become more complex during growth and development t

A

Morphogenesis and differentiation

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2
Q

What does fetal growth depend on

A

Genetics of the fetus

Availability of nutrients and oxygen to the fetus

Maternal nutrition

Presence of environmental influences

Various hormones of maternal, fetal and placental origin

Various growth factors of maternal, fetal and placental origin

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3
Q

What play a role in growth and differentiation

A

Growth hormone (IGFs)

Insulin (a growth hormone)

Thyroid hormones

Glucocorticoids

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4
Q

Role of Foetal growth hormone on prenatal growth

A

NO direct effect

Absence of fetal growth deficiencies in congenital hypopituitarism

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5
Q

Role of IGFs (Insulin like growth factors) in foetal development

A

They are mitogenic, stimulating foetal metabolism and coordinating feto-placental metabolism

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6
Q

Role of IGF1

Role of IGF 2

A

1- regulates early embryonic development

2-responsible for growth of newborn

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7
Q

Role of fetal insulin in development

A

Indirect role in regulation of fetal growth. Modulates expression of the fetal IGFs. Hyperinsulinelia behind macrosomia

Direct effects on adipose tissue and the proliferation of the cells within the fetus. Fetus therefore becomes bigger. Risk of hypoxia and birth trauma

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8
Q

When is IGF2 more abundant than IGF1

A

During mid to late gestation

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9
Q

What are the circulating concentrations of IGFs reduced by

A

Undernutrition and deficiency of:

  • Insulin
  • Thyroxine
  • Glucocorticoids
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10
Q

What does a reduced circulating conc of IGs do

A

Uptake and utilisation of nutrients.

  • Constitutive drive for intrauterine growth (IGF2 plays a key role in placental growth and nutrient transfer)
  • Fetal growth in relation to nutrient supply (IGF1 stimulates fetal growth when nutrients are available)
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11
Q

What are thyroid hormones critical for

A

Development of fetal and neonatal brain and other aspects of pregnancy and fetal growth

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12
Q

What can hypothyroidism in mother of fetus lead to

A

Fetal disease. This includes a high incidence of lowering IQ, impaired psychomotor development

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13
Q

What do fetal glucocorticoids affect and how

A

Tissue differentiation and prenatal maturation of organs:

Lungs- maturation of surfactant

Liver- Control of glycaemia

Intestines- Maturation of the expression of digestive enzymes and proliferation of the villi

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14
Q

How is maternal thyroid function altered during pregnancy

A

Thyroid stimulation is by chorionic gonadotropin

  • Placenta secretes huge amounts of hCG which is similar to TSH
  • hCG can use TSH receptor on thyroid epithelial cells . Significant fraction of thyroid stimulating activity is from hCG
  • Blood levels of TSH are suppressed
  • Thyroid stimulating activity of hCG causes some women to develop transient hyperthyroidism (reversible)
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15
Q

How can the effects of thyroid stimulating activity of hCG be prevented

A

Adequate thyroxine medication

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16
Q

What is the net effect of pregnancy on the thyroid gland

A

Increased demand. IN normal individuals, not appear to represent much of a load to the thyroid gland, but in females with subclinical hypothyroidism, extra demands of pregnancy can precipitate clinical disease

17
Q

Does gestational hyperthyroidism as a result of increased levels of HCG need treatment and why

A

No

IT is transient

18
Q

Effects of hyperthyroidism on pregnancy

A

HEart failure
PRe-eclampsia
-Gestational diabetes
-Preterm delivery

19
Q

Effects of hyperthyroidism on fetus

A

Increased risk of neonatal mortality
IUGR
Low birth rate
Stillbirth

20
Q

How does maternal thyroid function increase the demand for iodine

A

1) Oestrogens stimulate expression of T4 binding globulin in liver
2) Lowered free T4 concentrations- elevated TSH secretion by the pituitary
3) Significant increase in total T4 and T3 levels

Leads to increased demand for iodine. Significant pregnancy associated increase in iodine clearance by the kidney (Increased GFR)

21
Q

What does the WHO recommend for iodine intake during pregnancy

A

TO at leat 200 ug/day

22
Q

What is isolated maternal hypothyroidism associated with

A

Infertility

-when pregnancy does occur, there is increased risk of intrauterine fetal death and gestational hypertension

23
Q

How is subclinical hypothyroidism a cause of developmental disease

A

Caused by autoimmune disease

-Anti-thyroid antibodies cross the placenta. Passive Immune attack on the fetal thyroid gland

24
Q

Isolated fetal hypothyroidism problems

A

Most children born with this are normal at birth. Must treat very shortly after birth. If not, child will become permanently mentally and growth retarded (cretinism)

25
Q

Effect of iodine deficiency on baby

A

It is due to combined maternal and fetal hypothyroidism

-without adequate maternal iodine intake, child may develop cretinism, with mental retardation, deaf-mutism and spasticity

26
Q

Effects of hypothyroidism on pregnancy

A 
Early pregnancy failure 
Pre-eclampsia 
Placental abruption 
Preterm delivery 
Malpresentation 
Stillbirth 
POst-paartum haemorrhage
27
Q

Effects of hypothyroidism on fetus

A 
Neurodevelopmental delay 
Deafness 
Stunted growth 
Peripartum hypoxia 
Increased risk of neonatal mortality 
Low birthweight
28
Q

What are adrenal hormones involved in in fetal development

A

Production of precursor for placental oestrogen production, ovary and brain development, the maturation of the lung and other developing systems

29
Q

When id intestinal maturation most glucocorticoid sensitive

A

IN late fetal and early neonatal period (in association with a peak in circulation levels of glucocorticoid)

30
Q

How do cortisol levels change during pregnancy and if there is undernutrition

A

Elevated by undernutrition in both maternal and fetal serum

Increased with gestational age

31
Q

What is cortisol inversely correlated with

A

Serum IGF-1 in both maternal and fetal serum

32
Q

What causes the development of the male

A

Leydig cells in embryonic testes secrete testosterone which is responsible for male differentiation

33
Q

What is Beckwith-Weidemann syndrome

A

Sevral key hormone genes involved in embryonic and fetal growth are imprinted. In this syndrome, they are disrupted and this syndromes associated with dental overgrowth

34
Q

What is Silver- Russel syndrome

A

Sevral key hormone genes involved in embryonic and fetal growth are imprinted. In this syndrome, they are disrupted and this syndromes associated with intrauterine growth retardation

35
Q

What is incidence of intrauterine growth retardation associated with

A

High risk of metabolic and cardiovascular complications in later life

Pregnancy complications, fatal morbidity and assisted reproduction EAR7 (8 decks)

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