Obstetricians role in preventing cardio metabolic disease 2019 Impact of the intrauterine environment on future reproductive and metabolic health

Question 1

Leading cause of death in women in UK

Answer 1

CVD and stroke

Question 2

Risk of T2DM after GD<

Answer 2

7.43, highest risk 3-6 years post party

Question 3

GDM and relative risk
- future CVD?
- CAD?
- Stroke?

Answer 3

• CVD 1.74
• CAD 2.09
• Stroke 1.25

Question 4

PET, RR of developing HTN in year following pregnancy

Answer 4

3.1
Recurrent PET 6

Higher if preterm

Question 5

If hypertensive disease of pregnancy risk of T2DM (vs non hypoertensive)

Answer 5

2-3 fold

Question 6

If HDP and GDM risk of T2DM, vs GDM alone

Answer 6

RR 18

Question 7

Risk gestational hypertension and CVD within 14 years

Answer 7

HR 1.8

Question 8

What can obstetricians do to reduce risk of T2DM in the future for mothers with GDM

Answer 8

Diet and exercise

Counselling AN

Communicate with GP, pregression highest within 3-6 years of GDM. Fasting blood glucose 6-13 weeks. Annual HbA1c

Breast-feeding (>4-12 weeks) reduced risk 50% by 2 ytears and 78% by 5 years

Question 9

What can obstetricians do to reduced risk of women with hypertensive disorders of pregnancy decwloping CVD in future?

Answer 9

• Inform of risk of HTN in future
• Risk HTN/PET future pregnancy - aspirin
• Lifestyle advice - weight, smoking, exercise diet

Question 10

What proportion of prengnacy
- Overweight/obese
- Dx GDM
- Smoke in pregnancy

Answer 10

• 50%
• 1/20
• 1/10

Question 11

Risk low BMI in pregnancy to long term offspring health

Answer 11

Obesity
Hypertenion

Question 12

Risk obesity in pregnancy to long term offspring health

Answer 12

Obesity
Dyslipidaemia
CVD
T2DM

→ weight loss, physical activity, aspirin

Question 13

Risk smoking in pregnancy to long term offspring health

Answer 13

Obesity
Hypertension
Insulin resistance

Question 14

Risk chronic fetal hypoxia in pregnancy to long term offspring health

Answer 14

Obesity
CVD

Question 15

What % pregnancies ART?

Answer 15

6%

Question 16

Suboptima growth in utero can left to which later life impacts?

Answer 16

Obesity
Diabetes
CV disease
Dyslipaideami
PCOS
Decreased ovarian reserve
Pubertal timing

Question 17

For beer 1 kg in birthweight there is a corresponding what % increase in being overweight in mid-childhood?

Answer 17

50%

Question 18

What is maternal undernutrition rated to in terms of long term weight

Answer 18

Higher risk of obesity

Question 19

Risk of smoking on long term weight of child

Answer 19

Dose dependent increase up to 15/day

Question 20

Can fatty acids cross the plancenta?

Answer 20

Yes

Question 21

How much more hepatic adiposity in mother with GDM vs non GDM

Answer 21

70% increase septic adiposity but no increase in submit or abdominal fat