List some of the major complications of human pregnancy?
Define preterm labor?
Labor before 37 weeks gestation
Describe the incidence and mortality associated with preterm labor?
80% perinatal mortality and morbidity
Describe the cause of preterm labor?
Roles of: ascending infection, premature rupture of membranes, multiple pregnancies, polyhydramnios (excess amniotic fluid)
Define and describe pre-eclampsia?
High maternal blood pressure
Placental dysfunction and IUGR
When is pre-eclampsia most likely to occur?
Describe the incidence and mortality associated with pre-eclampsia?
Mild: 5-10%; severe: 1-2%
15% direct maternal mortality
10% perinatal mortality
Describe the cause of pre-eclampsia?
Dependent on trophoblast
Describe the treatment for pre-eclampsia?
What is the rationale?
(irrespective of stage of pregnancy)
Gets rid of placenta and trophoblast, which are causing the problem
Intrauterine growth restriction
Low birth weight (<2500g)
Small for gestational age (<2SD below mean)
Describe the incidence and mortality of IUGR?
2-3 times normal perinatal mortality
Describe the cause of IUGR?
Roles of: multiple pregancies, malformations (oligohydramnios), foetal infection, maternal disease (pre-eclampsia), excercise and oxygen deprivation, smoking, malnutrition, placental insufficiency
Describe the pathway between the mother, placenta and foetus?
Describe the genetic factors that control foetal growth?
15% of size at birth dependent on genotype
2% dependent on sex
Describe the hormonal factors that control foetal growth?
NOT GH DEPENDENT
Glucocorticoids inhibit foetal growth
Describe the effect of maternal stress on foetal growth?
maternal stress > cortisol > glucocorticoids inhibit foetal growth
Describe the environmental and maternal factors that control foetal growth?
High altitude/hypoxia/O2 deprivation
Foetal and maternal infection
What is the major cause of foetal growth restriction in Western and developing countries?
Western: placental insufficiency
Developing: maternal undernutrition
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
List some of the adult diseases associated with suboptimal intauterine conditions?
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
Describe the mechanismsm which are thought to underlie the developmental origins of adult disease?