Preconception Health: Building the Foundations of Life Flashcards
What is preconception care?
Any intervention provided to women and couples of childbearing age, regardless of pregnancy state or desire, before pregnancy, to improve health outcomes for women, newborns, and children.
When is the most critical time for development and health in future life?
Occurs right after conception, often before mothers know they are pregnant.
What are some adverse outcomes related to pregnancy? (to newborn and mother during pregnancy)
Birth defect Fetal alcohol syndrome Low birth weight Preterm birth Complications of pregnancy e.g. BP, diabetes Operative birth (caesarian)
Describe the trend of maternal mortality rates.
Recent decades has shown a dramatic decrease maternal mortality rate. However few improvements in the past few years.
Describe the trend for preterm birth.
Preterm birth rate static or rising.
Increase related to socially disadvantaged groups and their preconception health status.
Describe the trend for low birth weight, and the difference between indigenous and non-indigenous communities.
Low birth weight rates has remained static in the past few decades. However remains a distinctive gap between non-indigenous and indigenous rates
How has the parents age when they have their first child changed?
Steadily increased, father age > mother age
Why is antenatal care programs too late? (hint: critical time of development vs. when you find out your pregnant)
When pregnant mothers realise they have missed their period, essential organ development is already under way. And the average time that pregnant mothers actually seek a medical professional, most critical time of development for organs have already passed
What is the Barker Hypothesis?
Map of CVD across a country was a replica of low birth weight. If small in utero, metabolically reprogrammed to survive on not very much, but grow up in overnourished and sedentary lifestyle, causes an metabolic imbalance that leads to higher risk of CVD
Was there any evidence that genes had a direct effect as a potential mechanism on how neonatal life shapes the rest of your life? (hint: weight gain of mother vs. birth weight, and immune function in twins)
Excessive weight gain in pregnant mothers increases birthweight of babies independent of genetic factors.
Genes of monozygotic and dizygotic twins showed incomparable immune function (cytokines, cell subsets, cellular responses)
The actual genes may not have a direct effect, but the epigenetics (way genes function) may play a key role. How does epigenetics work?
DNA methylation
Small interfering RNA
Histone acetylation
What discoveries was exposed during the Dutch Hongerwinter?
The Hongerwinter limited food availability, which had a crippling effect on pregnant mothers.
Pregnant women that had limited food in early gestation resulted in reduced methylation on IGF2 gene leading to less function. Offspring more likely to have diabetes
What seasonal differences in The Gambia are seen to facilitate successful pregnancies?
Best to conceive in rainy season. Ensures lots of nutrient-rich foods and lots of folic acid. Offspring of mothers who fell pregnant during rainy season more likely to live longer.
Describe the experiment that links obese/lean body types to microbiota.
Obese and lean twin transplanted respective microbiota to identical mice. Both mice were fed to low-fat high-fibre diet. Mice which received microbiota from obese twin had increased adiposity, whilst the other mice remained lean.
What is the proposed explanation of differences in microbiota of obese and lean individuals?
Obese microbiota have different ratio of microbes than lean, less diversity.
How does maternal microbiota link to foetal gut microbiota?
Foetal gut microbiota is basically a small sampling of maternal gut microbiota. So if disrupted gut microbiota, foetus will inherit the adverse metabolic outcome.
What are some external factors that influence intestinal microbiota of infant?
Intrauterine contamination
Type of feeding to infants (breastfeeding, formula feeding)
Delivery mode (caesarean vs. vaginal)
What are risks associated with overweight/obese pregnancy?
Recurrent miscarriage
Gestational diabetes/hypertension
Child obesity
What is the relationship between obesity and diabetes?
The higher the mother’s pregnancy BMI the greater the likelihood for gestational diabetes mellitus.
Which is also likely to lead to childhood obesity, and greater risk of offspring cardiovascular death.
How does maternal gestational diabetes affect baby?
More glucose crosses placental perfusion, more IGF produced, leads to bigger baby
Children born to women with gestational diabetes are…
More likely to have impaired glucose.
More likely to be obese
Have accelerated BMI growth
More likely to develop type II diabetes
What do women know about gestational weight gain and obesity?
Majority of women underestimate their BMI category. Obese and overweight women overestimate their recommended gestational weight gain.
What are some interventions for preconception obesity?
Calorie restriction and physical activity
A support system and monitoring
Sustained over long periods
–> evidence of increased clinical pregnancy rate and live birth
What are interventions for gestational diabetes?
Lifestyle changes
Hypoglycaemic therapy
Folic acid supplementation
