Intrauterine programming of adult disease Flashcards Preview

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Flashcards in Intrauterine programming of adult disease Deck (22):
1

List some of the major complications of human pregnancy?

Preterm labor
Preeclampsia
IUGR
Bleeding
Diabetes mellitus
Breech
Obesity

 

2

Define preterm labor?

Labor before 37 weeks gestation 

3

Describe the incidence and mortality associated with preterm labor?

Incidence: 5-8%

80% perinatal mortality and morbidity

4

Describe the cause of preterm labor?

Unknown aetiology

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

5

Define and describe pre-eclampsia?

High maternal blood pressure 

Proteinuria

Generalised oedema

Placental dysfunction and IUGR

6

When is pre-eclampsia most likely to occur?

First pregnancy

7

Describe the incidence and mortality associated with pre-eclampsia?

Mild: 5-10%; severe: 1-2%

15% direct maternal mortality

10% perinatal mortality 

8

Describe the cause of pre-eclampsia?

Aetiology unknown

Dependent on trophoblast

Genetic basis?

9

Describe the treatment for pre-eclampsia?

What is the rationale?

Delivery
(irrespective of stage of pregnancy)

Gets rid of placenta and trophoblast, which are causing the problem

10

Define IUGR?

Intrauterine growth restriction

Low birth weight (<2500g)
Small for gestational age (<2SD below mean)

11

Describe the incidence and mortality of IUGR?

2-10%

2-3 times normal perinatal mortality 

12

Describe the cause of IUGR?

Unknown aetiology

Roles of: multiple pregancies, malformations (oligohydramnios), foetal infection, maternal disease (pre-eclampsia), excercise and oxygen deprivation, smoking, malnutrition, placental insufficiency

13

Describe the pathway between the mother, placenta and foetus?

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14

Describe the genetic factors that control foetal growth?

15% of size at birth dependent on genotype

2% dependent on sex

15

Describe the hormonal factors that control foetal growth?

NOT GH DEPENDENT

IGFs
Thyroid hormone 
Insulin

 

Glucocorticoids inhibit foetal growth

16

Describe the effect of maternal stress on foetal growth?

maternal stress > cortisol > glucocorticoids inhibit foetal growth

17

Describe the environmental and maternal factors that control foetal growth?

High altitude/hypoxia/O2 deprivation
Hyperthermia
Maternal exercise
Substance abuse
Maternal disease/pre-eclampsia
Oligohydramnios
Multiple pregnancy
Stress
Foetal and maternal infection
Maternal undernutrition
Uteroplacental insufficiency

18

What is the major cause of foetal growth restriction in Western and developing countries?

Western: placental insufficiency

Developing: maternal undernutrition

19

Describe the effect of being born small?

Increased disease susceptibility later in life

Adaptations help foetus in the short term, but are maladaptive later in life 

20

List some of the adult diseases associated with suboptimal intauterine conditions?

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21

Describe the phenomenon of accelerated postnatal growth?

90% of small babies have some accelerated growth in first 6 month

Independently associated with risk of adult diseases

22

Describe the mechanismsm which are thought to underlie the developmental origins of adult disease?

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