Intrauterine Programming of Adult Disease

Question 1

What are the human pregnancy complications?

Answer 1

preterm labour, pre eclampsia, intrauterine growth restriction, bleeding, anaemia, coagulation, maternal diseases, heart disease, renal disease, diabetes mellitus, convulsions, breech, intrauterine fetal death

Question 2

What is preterm labour?

Answer 2

labour before 37 weeks gestation

Question 3

What percentage of deliveries are preterm?

Answer 3

5-8%

Question 4

What percentage of fetal morbidity and mortality is due to preterm labour?

Answer 4

80%

Question 5

What are some causes of preterm labour?

Answer 5

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

Question 6

What is the management for preterm labour?

Answer 6

steroids to mature the fetal lungs as quickly as possible

Question 7

What is pre-eclampsia?

Answer 7

high maternal blood pressure, proteinuria, generalised oedema, placental dysfunction and intrauterine growth restrictions

Question 8

What is eclampsia?

Answer 8

convulsions and coma in pregnancy

Question 9

What percentage of maternal mortality is due to pre-eclampsia?

Answer 9

15%

Question 10

What is though to be involved in the development of pre eclampsia?

Answer 10

abnormal placentation

Question 11

What is the treatment for pre eclampsia?

Answer 11

delivery

Question 12

What is the definition of intrauterine growth restriction?

Answer 12

birth weight for gestational age is less than 2 standard deviations below the population mean

Question 13

What is the cause of intrauterine growth restriction?

Answer 13

placental insufficiency, multiple pregnancies, malformations, oligohydramnios, fetal infection, maternal diseases, pre-eclampsia, exercise, oxygen deprivation, maternal smoking, malnutrition or unknown

Question 14

What does low birth weight predispose to?

Answer 14

adult disease and perinatal mortality

Question 15

What factors control fetal growth?

Answer 15

genetics, the mother, the placenta, hormones and fetal hormones and growth factors

Question 16

Which hormones promote fetal growth?

Answer 16

IGFs, thyroid hormone and insulin

Question 17

Which hormones inhibit fetal growth?

Answer 17

glucocorticoids

Question 18

Why are babies born at high altitude smaller?

Answer 18

because of the oxygen deprivation

Question 19

Why are pregnant women advised not to use saunas?

Answer 19

because hyperthermia will restrict fetal growth

Question 20

Why is excessive exercise in pregnant women not advised?

Answer 20

because it will redirect blood from placental circulation to the muscles and will restrict fetal growth

Question 21

What causes oligohydramnios?

Answer 21

when the fetal lungs and kidneys arent producing enough fluid - this will result in slow organ development

Question 22

What is the major cause of intrauterine growth restriction in the western world?

Answer 22

placental insufficiency

Question 23

What is the major cause of intrauterine growth restriction in the third world?

Answer 23

maternal undernutrition

Question 24

What is fetal programming?

Answer 24

Exposure of the fetus to a suboptimal environment causes adaptations that may help the fetus to survive in the short term but leads to increased susceptibility of developing some diseases in adulthood

Question 25

What are some adult diseases associated with intrauterine growth restriction?

Answer 25

hypertension, coronary heart disease, stroke, atherosclerosis, coagulation disorders, pre-eclampsia, obesity, type 2 diabetes, PCOS, COPD, asthma, hypothyroidism, schizophrenia, dementia, osteoporosis

Question 26

What is accelerated postnatal growth?

Answer 26

small babies will have accelerated post natal growth to compensate - if this matches the normal trajectory then its protective but if there is too much growth then it is associated with adult disease