Special Circumstances

Question 1

What proportion of the fetal growth occurs in the last trimester?

Answer 1

2/3

Question 2

When is the anabolic phase of pregnancy and why does this happen?

Answer 2

early pregnancy

increase nutrient stores in preparation for high demand from foetus

Question 3

When does the catabolic phase of pregnancy occur?

Answer 3

late pregnancy

Question 4

Why is there a small increase in insulin sensitivity in early pregnancy?

Answer 4

To increase fatty acid uptake so that stores of TAG are increased.

Question 5

Why is insulin sensitivity in the mother decreased in late pregnancy?

Answer 5

nutrients are directed to foetus

less glucose is used by the mother

Question 6

How do most substances travel across the placenta?

Answer 6

simple diffusion

Question 7

Name a molecule type that requires active transport to cross the placenta

Answer 7

amino acids

Question 8

Which transporter is required in the placenta for glucose?

Answer 8

GLUT1

Question 9

What is the fetoplacental unit?

Answer 9

A new endocrine entity that can control the maternal hypothalmic pituitary axis.

Question 10

Give examples of hypothalamic like hormones secreted by the placenta

Answer 10

CRH
GnRH
TRH
GHRH

Question 11

Give examples of pituitary like hormones released from the placenta

Answer 11

ACTH
hCG
cCT
hPL

Question 12

Which 2 steroid hormones are released from the placenta?

Answer 12

Oestriol and progesterone

Question 13

What does the first half of pregnancy prepare the mother for?

Answer 13

rapid growth rate of the foetus
birth
lactation

Question 14

How does maternal utilisation of nutrients change?

Answer 14

uses less glucose

utilise more fatty acids

Question 15

What are the anti-insulin hormones that the fetoplacental unit releases?

Answer 15

CRH
hPL
progesterone

Question 16

When can maternal hypoglycaemia occur and why?

Answer 16

between meals and at night time

due to the continuous fetal draw of glucose

Question 17

How do oestrogens and progesterones affect beta cells?

Answer 17

They increase the sensitivity of beta cells to glucose. This results in beta cell hyperplasia and hypertrophy. Therefore more insulin in synthesised and secreted.

Question 18

What happens if the beta cells do not respond normally to pregnancy?

Answer 18

The maternal blood glucose increases and the mother may get gestational diabetes.

Question 19

What is overt diabetes?

Answer 19

Diabetes that was discovered in pregnancy but was present before.

Question 20

What is gestational diabetes?

Answer 20

A disease in which the pancreatic beta cells do not produce sufficient insulin to meet increased requirement in late pregnancy.

Question 21

What are the 3 known causes of gestational diabetes?

Answer 21

beta cell dysfunction
autoantibodies
genetic susceptibility

Question 22

What does gestational diabetes increase the incidence of?

Answer 22

miscarriage
congenital malformation
fetal macrosomia (large body)
shoulder dystocia (shoulders stuck during birth)
hypertensive disorders eg. gestational hypertension/preeclampsia

Question 23

What defines preeclampsia?

Answer 23

High blood pressure and protein in the urine whilst pregnant

Question 24

What are the risk factors for gestational diabetes?

Answer 24

age
BMI
more common in Asians, Blacks and Hispanics
family history of diabetes
family history of macrosomia

Question 25

What is the management for gestational diabetes?

Answer 25

calorie restriction insulin injections if severe regular ultrasounds to check on foetal development

Question 26

What should be ensured in exercise?

Answer 26

rate of mobilisation = rate of utilisation minimal disturbance to homeostasis glucose supply to brain maintained end products of metabolism removed quickly

Question 27

How long do the ATP stores in muscle last?

Answer 27

approx 2 seconds

Question 28

How long does creatine phosphate last?

Answer 28

approx 5 seconds

Question 29

What accounts for the largest amount of ATP usage in exercise?

Answer 29

The myosin ATPase that is used for the sliding filament model of contraction.

Question 30

How long could you exercise at low intensity using only the glycogen from the muscle and liver?

Answer 30

60 minutes

Question 31

What is the principal organ for the regulation of glucose?

Answer 31

The liver because it recycles lactate.

Question 32

Which transporters are used in the muscle for glucose uptake?

Answer 32

GLUT4 | GLUT1

Question 33

What is the cascade sequence for increased GLUT4 expression?

Answer 33

increased glucose in cell increased AMP AMPK activated GLUT4 channels expressed on cell surface

Question 34

How is ATP produced during a 100m sprint?

Answer 34

anaerobically because the body cannot deliver sufficient oxygen lactate builds up muscle store of glycogen is used

Question 35

How is ATP produced in a medium intensity 1500m race?

Answer 35

some oxygen can be delivered so partly aerobic and partly anaerobic fatty acids can be utilised muscle glycogen is utilised

Question 36

How is ATP produced during a marathon?

Answer 36

95% aerobic | muscle glycogen, liver glycogen and fatty acids are utilised

Question 37

What happens to insulin and glucagon levels during a marathon?

Answer 37

insulin levels slowly decrease | glucagon levels increase

Question 38

What hormones, other than glucagon, increase during a marathon?

Answer 38

adrenaline growth hormone cortisol

Question 39

What are the benefits of exercise?

Answer 39

``` change in body composition glucose tolerance improves insulin sensitivity increases blood triglycerides decrease blood pressure falls psychological effects ```

Question 40

What is the average weight gain of a pregnant women?

Answer 40

8kg