Intrauterine programming of adult disease

Question 1

List some of the major complications of human pregnancy?

Answer 1

Preterm labor
Preeclampsia
IUGR
Bleeding
Diabetes mellitus
Breech
Obesity

Question 2

Define preterm labor?

Answer 2

Labor before 37 weeks gestation

Question 3

Describe the incidence and mortality associated with preterm labor?

Answer 3

Incidence: 5-8%

80% perinatal mortality and morbidity

Question 4

Describe the cause of preterm labor?

Answer 4

Unknown aetiology

Roles of: ascending infection, premature rupture of membranes, multiple pregnancies, polyhydramnios (excess amniotic fluid)

Question 5

Define and describe pre-eclampsia?

Answer 5

High maternal blood pressure

Proteinuria

Generalised oedema

Placental dysfunction and IUGR

Question 6

When is pre-eclampsia most likely to occur?

Answer 6

First pregnancy

Question 7

Describe the incidence and mortality associated with pre-eclampsia?

Answer 7

Mild: 5-10%; severe: 1-2%

15% direct maternal mortality

10% perinatal mortality

Question 8

Describe the cause of pre-eclampsia?

Answer 8

Aetiology unknown

Dependent on trophoblast

Genetic basis?

Question 9

Describe the treatment for pre-eclampsia?

What is the rationale?

Answer 9

Delivery

Gets rid of placenta and trophoblast, which are causing the problem

(irrespective of stage of pregnancy)

Question 10

Define IUGR?

Answer 10

Intrauterine growth restriction

Low birth weight (<2500g)
Small for gestational age (<2SD below mean)

Question 11

Describe the incidence and mortality of IUGR?

Answer 11

2-10%

2-3 times normal perinatal mortality

Question 12

Describe the cause of IUGR?

Answer 12

Unknown aetiology

Roles of: multiple pregancies, malformations (oligohydramnios), foetal infection, maternal disease (pre-eclampsia), excercise and oxygen deprivation, smoking, malnutrition, placental insufficiency

Question 13

Describe the pathway between the mother, placenta and foetus?

Answer 13

Question 14

Describe the genetic factors that control foetal growth?

Answer 14

15% of size at birth dependent on genotype

2% dependent on sex

Question 15

Describe the hormonal factors that control foetal growth?

Answer 15

NOT GH DEPENDENT

IGFs
Thyroid hormone
Insulin

Glucocorticoids inhibit foetal growth

Question 16

Describe the effect of maternal stress on foetal growth?

Answer 16

maternal stress > cortisol > glucocorticoids inhibit foetal growth

Question 17

Describe the environmental and maternal factors that control foetal growth?

Answer 17

High altitude/hypoxia/O2 deprivation
Hyperthermia
Maternal exercise
Substance abuse
Maternal disease/pre-eclampsia
Oligohydramnios
Multiple pregnancy
Stress
Foetal and maternal infection
Maternal undernutrition
Uteroplacental insufficiency

Question 18

What is the major cause of foetal growth restriction in Western and developing countries?

Answer 18

Western: placental insufficiency

Developing: maternal undernutrition

Question 19

Describe the effect of being born small?

Answer 19

Increased disease susceptibility later in life

Adaptations help foetus in the short term, but are maladaptive later in life

Question 20

List some of the adult diseases associated with suboptimal intauterine conditions?

Answer 20

Question 21

Describe the phenomenon of accelerated postnatal growth?

Answer 21

90% of small babies have some accelerated growth in first 6 month

Independently associated with risk of adult diseases

Question 22

Describe the mechanismsm which are thought to underlie the developmental origins of adult disease?

Answer 22