Intrauterine Programming of Adult Disease Flashcards
What are the 3 major pregnancy complications?
Pre-term labour; pre-eclampsia; and intrauterine growth restriction (IUGR)
What is the impact of heart and renal disease on pregnancy?
heart, CV, and kidney have to undergo massive changes in CO and blood flow redistribution which can be compromised by disease
Term labour is at
40 weeks completed gestation
Pre-term labour is
before 37 weeks gestation
Pre-term labour affects ___% of deliveries and causes ___% of perinatal mortality and morbidity
5-8%; 80%
What is the cause of preterm labour?
Generally unknown - could be infection (systemic or ascending), premature rupture of membranes, common in multiple pregnancy, polyhydramnios (excess amniotic fluid)
What is polyhydramnios?
Excess amniotic fluid; indicator of preterm labour
Pre-eclampsia is characterized by
high maternal BP, proteinuria, and generalized oedema
In pre-eclampsia, the placenta
is dysfunctional and not providing sufficient oxygen and nutrients to the baby - IUGD
Pre-eclampsia causes __% of direct maternal mortality and __% of perinatal mortality
15; 10
What is the cause of pre-eclampsia?
unknown but dependent on trophoblast invasion of the maternal endometrium malfunctioning which compromises blood flow and maternal CV function
What is the treatment for pre-eclampsia?
delivery of the placenta and trophoblast
What is intrauterine growth restriction?
Low birth weight less than 2.5kg (2% of term babies)
Small for gestational age (IUGR) is characterized by
being less than 2 SD from the population mean (10% of babies at that gestational age)
Intrauterine growth restriction is characterized by
placental insufficiency and predisposition to adult diseases
What controls fetal growth?
genetic factors (paternal/maternal); hormonal factors (placental/fetal); environmental factors (maternal/placental)
T/F growth of the human fetus is GH dependent
False; dependent on IGFs, thyroid hormones, and insulin
T/F glucocorticoids inhibit fetal growth
True; eg if the mother is stressed during pregnancy, cortisol goes up which inhibits fetal growth
T/F mothers at high altitudes have smaller babies
True; due to reduced oxygen delivery to the fetus which reduces fetal growth
How does body temperature impact fetal growth?
When core body temperature is elevated the fetus acts as a heat sink which is detrimental to growth
T/F marathon runners/elite athletes have smaller babies
True; reduced uteroplacental perfusion during extreme exercise reduces fetal frowth
T/F Blood alcohol/substance level is the same in the fetus and the mother and is cleared at the same rate
False; substances are cleared slower in the fetus because the systems are not developed enough to process them
Oligohydramnios occurs when
fetal kidneys are not producing urine or fetal lungs are not producing fluid sufficiently; fluid transfer across membranes is excessive
Oligohydramnios is associated wtih
slowed fetal growth and slowed organ development
The major cause of fetal growth restriction in Western countries is
uteroplacental insufficiency where there is nothing wrong with the mother but the placenta is not functioning properly to supply oxygen and nutrients
The major cause of fetal growth restriction in third world countries is
maternal undernutrition
T/F fetal programming depends on current level of obesity or exercise
False; it is independent of these factors though they increase your risk of CVD
T/F association between small birth weight and adult disease differs across populations, races, sexes, ethncity, etc.
False
Increased risk of adult disease in small babies is compounded by
late accelerated growth as a child - ie being born small then getting fatter (not necessarily obese) increases risk; being male
Being born small is associated with increased risk of
CVD, metabolic syndrome, PCOS, respiratory and endocrine problems, osteoporosis, neurological disorders, schizophrenia and dementia
