Intrauterine Programming of Adult Disease

Question 1

What are the 3 major pregnancy complications?

Answer 1

Pre-term labour; pre-eclampsia; and intrauterine growth restriction (IUGR)

Question 2

What is the impact of heart and renal disease on pregnancy?

Answer 2

heart, CV, and kidney have to undergo massive changes in CO and blood flow redistribution which can be compromised by disease

Question 3

Term labour is at

Answer 3

40 weeks completed gestation

Question 4

Pre-term labour is

Answer 4

before 37 weeks gestation

Question 5

Pre-term labour affects ___% of deliveries and causes ___% of perinatal mortality and morbidity

Answer 5

5-8%; 80%

Question 6

What is the cause of preterm labour?

Answer 6

Generally unknown - could be infection (systemic or ascending), premature rupture of membranes, common in multiple pregnancy, polyhydramnios (excess amniotic fluid)

Question 7

What is polyhydramnios?

Answer 7

Excess amniotic fluid; indicator of preterm labour

Question 8

Pre-eclampsia is characterized by

Answer 8

high maternal BP, proteinuria, and generalized oedema

Question 9

In pre-eclampsia, the placenta

Answer 9

is dysfunctional and not providing sufficient oxygen and nutrients to the baby - IUGD

Question 10

Pre-eclampsia causes __% of direct maternal mortality and __% of perinatal mortality

Answer 10

15; 10

Question 11

What is the cause of pre-eclampsia?

Answer 11

unknown but dependent on trophoblast invasion of the maternal endometrium malfunctioning which compromises blood flow and maternal CV function

Question 12

What is the treatment for pre-eclampsia?

Answer 12

delivery of the placenta and trophoblast

Question 13

What is intrauterine growth restriction?

Answer 13

Low birth weight less than 2.5kg (2% of term babies)

Question 14

Small for gestational age (IUGR) is characterized by

Answer 14

being less than 2 SD from the population mean (10% of babies at that gestational age)

Question 15

Intrauterine growth restriction is characterized by

Answer 15

placental insufficiency and predisposition to adult diseases

Question 16

What controls fetal growth?

Answer 16

genetic factors (paternal/maternal); hormonal factors (placental/fetal); environmental factors (maternal/placental)

Question 17

T/F growth of the human fetus is GH dependent

Answer 17

False; dependent on IGFs, thyroid hormones, and insulin

Question 18

T/F glucocorticoids inhibit fetal growth

Answer 18

True; eg if the mother is stressed during pregnancy, cortisol goes up which inhibits fetal growth

Question 19

T/F mothers at high altitudes have smaller babies

Answer 19

True; due to reduced oxygen delivery to the fetus which reduces fetal growth

Question 20

How does body temperature impact fetal growth?

Answer 20

When core body temperature is elevated the fetus acts as a heat sink which is detrimental to growth

Question 21

T/F marathon runners/elite athletes have smaller babies

Answer 21

True; reduced uteroplacental perfusion during extreme exercise reduces fetal frowth

Question 22

T/F Blood alcohol/substance level is the same in the fetus and the mother and is cleared at the same rate

Answer 22

False; substances are cleared slower in the fetus because the systems are not developed enough to process them

Question 23

Oligohydramnios occurs when

Answer 23

fetal kidneys are not producing urine or fetal lungs are not producing fluid sufficiently; fluid transfer across membranes is excessive

Question 24

Oligohydramnios is associated wtih

Answer 24

slowed fetal growth and slowed organ development

Question 25

The major cause of fetal growth restriction in Western countries is

Answer 25

uteroplacental insufficiency where there is nothing wrong with the mother but the placenta is not functioning properly to supply oxygen and nutrients

Question 26

The major cause of fetal growth restriction in third world countries is

Answer 26

maternal undernutrition

Question 27

T/F fetal programming depends on current level of obesity or exercise

Answer 27

False; it is independent of these factors though they increase your risk of CVD

Question 28

T/F association between small birth weight and adult disease differs across populations, races, sexes, ethncity, etc.

Answer 28

False

Question 29

Increased risk of adult disease in small babies is compounded by

Answer 29

late accelerated growth as a child - ie being born small then getting fatter (not necessarily obese) increases risk; being male

Question 30

Being born small is associated with increased risk of

Answer 30

CVD, metabolic syndrome, PCOS, respiratory and endocrine problems, osteoporosis, neurological disorders, schizophrenia and dementia