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4) Nutrition Through Life > 3) Placental Metabolism > Flashcards

3) Placental Metabolism Flashcards

1
Q

When does the fastest growth of the placenta occur? Why?

A
  • During the first half of pregnancy

- To prepare for the fetal growth spurt during the second half of pregnancy

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2
Q

What is the placenta?

A

The interface between the microcirculatory systems of the mother and fetus

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3
Q

What are functions of the placenta?

A
  • Exchange of nutrients, respiratory gases, and metabolic waste
  • Protection of the fetus from xenobiotics
  • Acting as a source of hormones
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4
Q

When is there mixing of the maternal and fetal blood?

A
  • There is NEVER any direct mixing of the maternal and fetal blood
  • The placenta is composed of a maternal and fetal portion
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5
Q

Where does the majority of amniotic fluid come from?

A

The maternal blood via diffusion from the intervillus spaces of the placenta

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6
Q

What are functions of amniotic fluid?

A
  • Acts as a shock absorber
  • Prevents desiccation of the fetus
  • Provides room for fetal movements
  • Assists in body temperature regulation
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7
Q

The ________ plate forms the fetal surface of the placenta.

A

chorionic

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8
Q

______________ are cells from the placenta that connect the mother and fetus.

A

Cytotrophoblasts

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9
Q

What components form the large area for exchange of fetal and maternal material?

A
  • Cytotrophoblastic shell

- Anchoring villi

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10
Q

Where does the exchange between maternal and fetal material occur?

A

Within the intervillus spaces, as maternal blood flows around the villi

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11
Q

What is the major functioning unit of the placenta?

A

Chorionic villus

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12
Q

What placental defects do IUGR infants display?

A

They have microscopically less branching of the villi

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13
Q

What is the function of the villi within the placenta?

A

Enhances the surface area, allowing for greater exchange of gases and nutrients

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14
Q

The placenta uses 50% of _______ and 65% of _______ from the maternal blood supply.

A

oxygen

glucose

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15
Q

What substances does the placenta synthesize for fetal use?

A
  • Glycogen
  • Lactate
  • Cholesterol
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16
Q

What substances cannot cross the placental membrane?

A

Compounds possessing a large molecular weight

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17
Q

What substances are transported across the placental membrane via passive diffusion?

A
  • Oxygen and carbon dioxide
  • Fatty acids
  • Steroids
  • Electrolytes
  • Fat-soluble vitamins
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18
Q

How does fetal hemoglobin differ from regular hemoglobin?

A

Fetal hemoglobin has a greater binding capacity for oxygen

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19
Q

How are fatty acids transported through the placental membrane?

A
  • Passive diffusion
  • Carrier-mediated transport for long-chain FAs (enhancement of PUFA transport)
  • The fetus depends on a supply of EFAs
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20
Q

Of the substances that are transported via passive diffusion, there is a poor transfer of which one?

A

Fat-soluble vitamins

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21
Q

How are sugars transported through the placental membrane?

A

Carrier-mediated facilitated diffusion

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22
Q

What is the importance of glucose transporters within the placenta?

A
  • Glycation is a mechanism of teratogenesis

- Glucose transporters are used to protect the fetus from high glucose levels

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23
Q

If a mother experiences hyperglycemia, is a fetus exposed to a hyperglycemic environment as well? Why or why not?

A
  • No, the fetus experiences a lower glucose level

- Because of the use of glucose transporters

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24
Q

What substances require energy-dependent active transporters to cross the placental membrane?

A
  • Amino acids
  • Certain cations
  • Water-soluble vitamins
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25
Q

What do iron and folate require to cross the placental membrane?

A

Pinocytosis

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26
Q

What do water and solutes use to cross the placental membrane?

A

Solvent drag

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27
Q

The fetal size is proportional to the _______ size.

A

placental

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28
Q

How may maternal malnutrition, such as iron deficiency, affect placental size and fetal growth retardation?

A
  • Reduced blood volume expansion
  • Decreases cardiac output and placental blood flow
  • Decrease in placental size, reduced nutrient transfer, and subsequent fetal growth retardation
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29
Q

What conditions may decrease uterine blood flow and affect placental transport?

A
  • Hypotension
  • Renal disease
  • Placental infarction
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30
Q

During the third trimester, how does the fetal weight and the placental weight change?

A
  • The fetal weight more than doubles at the last 10 weeks

- The placental weight only increases by 50%

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31
Q

A lower rate of placental growth is a limiting factor for what?

A

For sufficient transfer of nutrients for fetal needs

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32
Q

What is partially responsible for the deceleration in fetal growth rate during the last 4 weeks of gestation?

A

A progressive decline in the quantity of nutrients transferred per unit of fetal body mass per unit of time

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33
Q

What mechanism often causes the failure of the placenta?

A

Failure of the uteroplacental blood vessels to deliver an increased uterine blood flow

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34
Q

How do essential fatty acid affect the placenta?

A

Deficiencies in EFAs cause defects in placental integrity and function

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35
Q

Low placental weight is found to be associated with lower plasma concentrations of which fatty acids?

A
  • Arachidonic acid
  • DHA
  • Linoleic acid
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36
Q

What are reduced concentrations of AA, DHA, and LA associated with?

A
  • Short gestation

- Small head circumference

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37
Q

The percent distribution of DHA is highest in which fetal structure?

A

The fetal brain, then liver and umbilical cord

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38
Q

70% of energy during fetal growth is devoted to what?

A

Brain development

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39
Q

______ form 50 to 60% of the structural matter of the brain.

A

Lipids

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40
Q

The brain is a structurally lipid-rich organ. What PUFAs does it use? Which ones in particular?

A
  • 20- and 22-carbon PUFAs
  • Arachidonic acid
  • DHA
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41
Q

What kind of PUFA is arachidonic acid?

A
  • 20:4 (n-6)

- Omega-6

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42
Q

What kind of PUFA is DHA?

A
  • 22:6 (n-3)

- Omega-3

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43
Q

What is the function of hCG?

A

Maintains the corpus luteum, which secretes estrogen and progesterone

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44
Q

What secretes estrogen during the beginning of pregnancy? What structure replaces its secretion? When?

A
  • The blastocyst secretes estrogen on day 7
  • After implantation, hCG is produced by the placenta, allowing for the maintenance of the corpus luteum, which secretes estrogen
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45
Q

When does the peak of hCG occur? What happens after?

A
  • The peak occurs at the 10th and 11th week of gestation

- After, hCG levels decline and remain low for the rest of pregnancy

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46
Q

What produces placental lactogen? When?

A

The placenta in late gestation

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47
Q

What is the function of placental lactogen?

A

Influences fat and carbohydrate metabolism (breakdown of maternal fats to provide fuel for the fetus)

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48
Q

What is a synonym for placental lactogen?

A

Human chorionic somatotrophin

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49
Q

What structures produce progesterone during pregnancy?

A
  • Corpus luteum until the 10th week of gestation

- The placenta takes over afterwards

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50
Q

What are the functions of progesterone in supporting pregnancy?

A
  • Inhibits the secretion of LH and FSH to prevent ovulation

- Supports the endometrium

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51
Q

How does progesterone prevent pre-term birth?

A

Suppresses contractility in uterine smooth muscle

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52
Q

Which hormone decreases and which hormone increases to facilitate parturition?

A
  • Progesterone decreases

- Estrogen increases to increase contractility of the smooth muscles of the uterus

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53
Q

When is estrogen secreted maximally during pregnancy?

A

Towards the end of gestation

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54
Q

What are the functions of estrogen in pregnancy?

A
  • Stimulates myometrium growth
  • Antagonizes myometrial-suppression by progesterone
  • Stimulates mammary gland development
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55
Q

Catabolism of which substances are controlled by the placenta?

A
  • Glucocorticoids
  • Insulin
  • Thyroxin
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56
Q

How does the exposure to hormones vary if the placenta is underdeveloped?

A

The placenta developing inadequately decreases catabolism of these molecules, which may cause harm to the fetus

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57
Q

True or False: the placenta offers a substantial amount of protection against xenobiotics.

A
  • False
  • The placenta is highly permeable to a large variety of substances, and thus offers limited protection against xenobiotics
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58
Q

When does the majority of physiological adjustments during pregnancy occur? In most cases, how does physiological activity vary?

A
  • During the first half of gestation

- In most cases, physiological activity increases

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59
Q

The physiological activity of which structures do not increase during pregnancy? Why?

A
  • Smooth muscle function of the uterus (to prevent contractions)
  • Smooth muscle function of the GI tract (to prevent heartburn)
60
Q

What occurs to the kidney during pregnancy? Why?

A
  • An increase in GFR and decrease in tubular reabsorption capacity
  • Leading to an increased blood volume to facilitate the increased excretion of fetal waste products
61
Q

What are the consequences of an increased blood volume during pregnancy?

A

An increase in renal losses of glucose, folate, iodine, and amino acids

62
Q

What occurs to the stomach during pregnancy?

A

Depression of function due to a decreased secretion of pepsin and histamine

63
Q

What does a decreased function of the stomach lead to?

A

Increased risk of heartburn due to the relaxation of the cardiac sphincter, causing a higher risk of regurgitation

64
Q

What occurs to the gastrointestinal tract during pregnancy? Why?

A
  • Decrease in motility to slow down transit time

- Leads to an increased efficiency of absorption of certain nutrients (vitamin B12, iron, calcium)

65
Q

What is a possible consequence of the decrease in motility of the GI tract? In what situation?

A

Constipation, if combined with a lack of sufficient fluid intake

66
Q

What occurs to the heart during pregnancy? Why?

A
  • Cardiac hypertrophy, which increases cardiac output to allow a larger blood volume to circulate
  • Improves blood flow to the placenta and fetus
67
Q

What occurs to the lungs during pregnancy? Why?

A

Increased ventilation to accommodate for increased oxygen demands by the fetus, placenta, and maternal tissues

68
Q

How does BMR vary during pregnancy? Why?

A
  • BMR increases by 15 to 20% due to an increase in oxygen consumption
  • BMR returns to normal a week after the baby is born
69
Q

How do plasma lipid profiles vary during pregnancy? Why?

A
  • Increased levels of plasma lipids (triacylglycerols and cholesterol)
  • Since the maternal system is preferentially using lipids to conserve glucose for the fetus
70
Q

How do blood glucose levels vary during pregnancy, specifically during the third trimester?

A
  • The fetus’ glucose demands are increased, which causes maternal blood glucose to fall
  • Increased lipolysis and ketosis compensates for the decrease in glucose
71
Q

What occurs to hepatic gluconeogenesis during pregnancy? Why?

A

Impaired hepatic gluconeogenesis due to a decreased availability of alanine

72
Q

What is the decreased availability of alanine during pregnancy due to?

A

To a decrease in muscle breakdown and an increase in placental uptake of alanine

73
Q

What other physiological adjustments occur during pregnancy?

A
  • Altered appetite and thirst
  • Altered digestion and assimilation of food
  • Hemodilution
74
Q

The first half of pregnancy is the (anabolic/catabolic) phase, while the second half of pregnancy is the (anabolic/catabolic) phase.

A

anabolic

catabolic

75
Q

What occurs to carbohydrates during the anabolic phase of pregnancy?

A

Excess carbohydrates are stored as glycogen or converted to fat, due to the sharp rise in blood insulin after meals

76
Q

What occurs to fats during the anabolic phase of pregnancy?

A
  • Rapidly synthesized into TGs

- Decreased rate of lipolysis to conserve fat stores for the second half of pregnancy

77
Q

What occurs to proteins during the anabolic phase of pregnancy?

A

Increase in maternal protein synthesis, particularly in RBCs and the placenta

78
Q

What is the preferred form of energy of the fetus?

A
  • Glucose

- The fetus requires a quick source of energy for rapid growth

79
Q

What occurs to fats during the catabolic phase of pregnancy? What is the result?

A
  • Fat is mobilized to conserve glucose for the fetus

- Results in an increase in ketones and blood cholesterol

80
Q

What occurs to insulin during the catabolic phase of pregnancy? What is the result?

A
  • The action of insulin is blunted by estrogen, progesterone, and placental lactogen
  • Catabolism of maternal fat, glycogen, and protein
81
Q

What occurs to glucose levels after a meal during the catabolic phase of pregnancy? Why?

A
  • Glucose levels rise sharply given the blunted insulin response
  • Results in a greater uptake of glucose by the placenta
82
Q

Does the placenta rely on insulin for absorption of glucose?

A

No

83
Q

Prior to conception, a woman should possess __% body weight fat.

A

22

84
Q

What is the average weight gain during pregnancy?

A

12.5 kg

85
Q

How does the expected weight gain during pregnancy of underweight women compare to overweight women?

A

Underweight women need to gain more weight

86
Q

What weight gain is recommended for adolescents?

A

28 to 40 pounds

87
Q

What weight gain is recommended for twins?

A

35 to 45 pounds

88
Q

What are the patterns of weight gain expected during the first 10 weeks of pregnancy, and the rest of the pregnancy?

A
  • First 10 weeks: 3 to 4 pounds per week

- Rest of pregnancy: 1 pound per week

89
Q

Gaining over ___ kg per week during pregnancy is a cause of concern.

A

one

90
Q

What is the likely causes for gaining over a kilogram per week during pregnancy? What are possible risk factors?

A
  • The presence of excessive edema, causing a risk for pre-eclampsia
  • Increased risk for placental abruption, stillbirth, decreased blood flow to the placenta, and low-birth weight
91
Q

What are the sources of obligatory fetal weight gain?

A

The growing presence of the fetus, placenta, and amnionic fluid

92
Q

What are the sources of obligatory maternal weight gain?

A
  • Enlarged uterine and breast tissue

- Expansion of blood volume

93
Q

What are the sources of non-obligatory maternal weight gain?

A

Gain in adipose tissue, protein stores, and extracellular fluid

94
Q

When does 50% of the increase in maternal blood peak? How does hemoglobin mass vary? What is the result?

A
  • During the third trimester
  • Lower increase in hemoglobin
  • Hemodilution
95
Q

How does the hematocrit vary during pregnancy?

A

The hematocrit decreases (hemodilution)

96
Q

What are correlated outcomes associated with insufficient blood volume expansion?

A
  • Stillbirths
  • Low-birth weight
  • Spontaneous abortions
97
Q

Edema is commonly present in pregnancy. When is it not a cause for concern?

A

If it is gained gradually

98
Q

When is the majority of the energy needed to support pregnancy deposited? What is it characterized by?

A
  • In the first 20 weeks (anabolic phase)

- Characterized by an increase in subcutaneous fat in the abdominal and upper thigh areas

99
Q

What comprises most of the weight gained during the second half of pregnancy?

A

Fetal tissues, placenta, and amniotic fluid

100
Q

An increase in plasma volume and RBCs is directly related to what?

A

Fetal size

101
Q

Describe the S-shaped curve of fetal weight.

A
  • Little weight gain during the first trimester
  • Rapid weight gain during gestational weeks 8 to 23
  • Weight tapers off at weeks 37-38
102
Q

What are the effects of weight maintenance and slight losses during the first trimester?

A

There is little effect on embryonic weight gain

103
Q

What is the cause of morning sickness?

A
  • Increase in estrogen and hCG
  • Nausea and vomiting are a positive predictor of pregnancy outcome and decreased risk of fetal death, as it represents an adequate level of hormones
104
Q

What are the effects of eating less during the first trimester?

A
  • Does not substantially affect the growth of the fetus

- However, too many skipped meals may lead to ketosis and hypoglycemia (teratogenic risk)

105
Q

What are the women recommended to eat in terms of meals?

A

Small, but frequent, high-fat, low-bulk meals

106
Q

What are the three most important determinants of birth weight?

A

1) Gestational age
2) Maternal weight gain
3) Pre-conception weight

107
Q

What is the best clinical indicator to judge pregnancy progress?

A

Maternal weight gain possesses the strongest influence on fetal weight gain

108
Q

Mortality rates are lowest for infants of what weight range?

A

2.5 to 4 kg

109
Q

What risks do dietary restrictions pose?

A
  • Low-birth weight
  • Hypertension
  • Perinatal mortality
  • IUGR
110
Q

The highest perinatal mortality rates are in which type of women? What about the lowest perinatal mortality rates?

A
  • Highest: underweight women who gain little weight during pregnancy
  • Lowest: underweight women who gain an appropriate amount of weight
111
Q

What are the risks of obese pregnant women?

A
  • Pre-eclampsia
  • Gestational diabetes
  • Infection
  • Cesarian
  • Prolonged labor and complications during delivery (asphyxia, abnormal glucose regulation in infant)
112
Q

What are the two main problems in pregnancy that are related to infants with a low-birth weight?

A
  • Small for gestational age

- Prematurity

113
Q

Define a preterm birth.

A

A preterm birth is below 37 weeks, while a term birth is above 37 weeks

114
Q

What are the three criteria for IUGR?

A
  • Below 2SDs in weight for gestational age
  • Below the 10th percentile in weight for gestational age
  • Below 2500 grams and gestational age above 37 weeks
115
Q

If they survive birth, extremely premature infants are at a risk for severe morbidities, such as what?

A
  • Retinopathy of prematurity
  • Chronic lung disease
  • Neurocognitive disease
116
Q

What are the most severe morbidities of preterm infants?

A
  • Cerebral palsy
  • Mental retardation
  • Seizure disorders
117
Q

What are mildly preterm infants (32 to 36 weeks) at a risk for?

A
  • Respiratory distress syndrome
  • Infection
  • Mortality
118
Q

Define a low-birth weight.

A

Below 2500 grams

119
Q

Define a small for gestational age infant.

A

Below the 10th percentile for gestational age

120
Q

All infants who are (IUGR/SGA) are also (IUGR/SGA), but not all (IUGR/SGA) infants are (IUGR/SGA).

A

IUGR, SGA

SGA, IUGR

121
Q

What are causes of preterm birth?

A
  • Genitourinary infection
  • Multiple pregnancies
  • Pregnancy-induced hypertension
  • Low pre-pregnancy BMI
  • Prior history of a preterm birth
  • Smoking
  • Strenuous physical labor
122
Q

What are the two types of IUGR? How do they differ?

A
  • Proportionate: infants with decreased growth potential or extreme fetal malnutrition
  • Disproportionate: infants with maternal malnutrition
123
Q

What are causes for decreased growth potential in proportionate IUGR infants?

A
  • Congenital infection
  • Genetic disorder
  • Environmental toxins
124
Q

What are the characteristics (length, weight, and head circumference) of proportionate IUGR infants?

A
  • Length, weight, and head circumference are proportional, occurring within a similar percentile
  • May also occur if the head is small relative to the body (microcephaly)
125
Q

What are the characteristics (length, weight, and head circumference) of disproportionate IUGR infants?

A

The length and head circumference are closer to the expected percentiles for gestational age, but the weight is disproportionately small

126
Q

What are causes of IUGR?

A
  • Low-energy intake
  • Low pre-pregnancy BMI
  • Short maternal stature
  • Pregnancy-induced hypertension
  • Smoking
  • Malaria
127
Q

IUGR is a component of _____, a set of dysmorphic features

A

FAS

128
Q

What are the effects of malaria in primiparous women? What has this been associated with?

A
  • Major cause of anemia

- Associated with reduced birth weight and an increased risk of IUGR

129
Q

What may severe IUGR lead to in the early neonatal period?

A

Hypoglycemia and hypocalcaemia

130
Q

What adult diseases has IUGR been shown to be associated with?

A
  • Hypertension
  • Type II diabetes
  • Cardiovascular diseases
131
Q

The rapidly developing fetus is more susceptible to the permanent programming effects of malnutrition during which period of gestation?

A

Late gestation

132
Q

What are the three abnormal patterns of fetal growth that are linked to adult diseases?

A

1) Symmetrical small babies of low-birth weight
2) Babies are thin at birth, but undergo catch-up during infancy
3) Average birth weight, but are abnormally small in proportion to their placental weight

133
Q

What are risks of low-birth weight?

A
  • Decreased lung capacity during childhood
  • Twice the risk of cardiovascular disease
  • Six times the risk of diabetes and impaired glucose metabolism
  • Increased blood pressure risk, abnormally high TGs, insulin resistance, and low HDL
134
Q

What is excessive birth weight (above 9 pounds) related to?

A

An increased risk of hormonally-related cancers

135
Q

What advantageous mechanism occurs during undernutrition? Why?

A
  • Maternal corticosteroid production increases as a stress response
  • Increases fetal maturation of lungs and other organs
136
Q

How is poverty associated with an increased nutritional risk for pregnancy?

A

Poor nutritional intake status, and increased smoking, in low-income groups are associated with twice the rate of low-body weight infants (down by 200 to 300 grams)

137
Q

Define a short inter-conception interval.

A

Refers to a woman becoming pregnant shortly (less than one year) after giving birth

138
Q

How is a short inter-conception interval associated with an increased nutritional risk for pregnancy?

A

High physiological and nutritional demand on the nutrient body stores of the mother, which increases the likelihood of deficiencies

139
Q

What chronic illnesses may place heavy demands on nutritional intake?

A

Diabetes, chronic infection, cancer, alcoholism, and malabsorption

140
Q

What unusual dietary patterns may place a woman at a higher risk of having an infant with a low-birth weight?

A
  • Consuming microbiotics
  • Dieting constantly
  • Anorexia
  • Pica
141
Q

What is pica associated with, in terms of nutritional status?

A
  • Low zinc and iron status

- Displacement of other nutritious foods

142
Q

How is a history of anemia and/or obesity associated with an increased nutritional risk for pregnancy?

A

Indicates long-term imbalance or an inappropriate diet, which may adversely affect reproductive success

143
Q

Why are teen pregnancies at a high-risk of low birth weight?

A
  • Poor nutritional status
  • Low pre-pregnancy weight
  • High incidence of food fads
  • Increased drug and alcohol use
  • Decreased obstetric, nutritional, and social support
  • Increased body image consciousness (insufficient maternal weight gain)
144
Q

Why is there a greater risk of an infant with a low-birth weight in a younger adolescent mother?

A
  • Due to immature endocrine and reproductive functioning

- 5 years post-menarche are required to foster a healthy pregnancy

145
Q

What hormones are blunting the action of insulin during the catabolic phase of pregnancy?

A

Estrogen, progesterone, and placental lactogen

4) Nutrition Through Life (19 decks)

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