Jenny is a very busy woman. She has been building her career in business for the last few years and it’s going well but takes a lot of her time. Now 35 years old, she manages a dozen new people in her group. Some of her newer staff however are not that competent so she has to continually check their work for errors before it goes out to upper management.
Despite her busy and stressful schedule, Jenny eats a healthy diet, has a healthy weight and is physically active – she walks to and from work and is enrolled in yoga and spin classes at her local gym. She does not have many medical conditions other than occasional bouts of diarrhea and constipation which is likely caused by her mild inflammatory bowel syndrome that is aggravated by stress. As a teenager Jenny was prescribed a 6-month course of Accutane for her acne after at which point her acne cleared. As an adult, she does suffer from asthma and has to take puffers occasionally when she gets some bronchoconstrictions. Jenny has always wanted to start a family, but her career always came first up to now. She feels that if she waits any longer, it will be too challenging to be an older mom.
Her husband Jim is a little older than her at 45 years of age. He has a sedentary office job in government and has been working from home for the last couple of years. Unlike his wife, Jim does not eat as healthy, has been a moderate smoker for several years, is physically inactive and a little overweight causing him to be a slightly hypertensive. In his spare time, he has a hobby working with plastics models. He enjoys gluing the pieces together and painting them. Over the years, John has experimented with different types of glues and paints. Jenny keeps telling John that his lifestyle will catch up to him someday, but he just smiles and says, “I’m OK.”. He takes a proton pump inhibitor for reflux and has a bit of arthritis in his knee but does not take anything for it yet.
Jenny and John have been trying to start a family for a while now but have not had any success so under her doctor’s recommendation Jenny enrolled for testing and approval for in vitro fertilization. A few weeks later she had the procedure, and everything went pretty well with no complications. Jenny told her husband that they should go on a big holiday now as it would be difficult to travel internationally after they had the baby, especially with all the COVID restrictions.
She also wanted to travel early before she started to experience any pregnancy-related signs and symptoms like morning sickness and before she gets too big and uncomfortable. Together, Jenny and John, quickly planned a 6-week holiday as soon as it was confirmed that she was pregnant, and left after a week so she would not likely have any pregnancy issues or concerns. Jenny was advised to take prenatal vitamins but did not have time to buy some so she thought it would be fine to wait and start taking them after they got back for their vacation. After all it was only going to be about 6 weeks of a 40 week pregnancy.
The rush planning and packing for such a long trip was a bit stressful but they got it done and went for a 6-week vacation to the costal regions of Mexico with a few trips in the interior of the country to visit different cities as well as a couple of other beach resorts.
Of course, the airline lost their luggage, and it did not arrive for a couple of days after they got to their resort. They had a wonderful time relaxing on the beautiful sandy beaches but it was always very hot, so they often drank cold dinks. Jenny only had the occasional one with alcohol as she knew she should not drink too much alcohol when pregnant. They also found the mosquitos to be a nuisance in the early evening. One night they attended a bonfire on the beach. It was quite windy and the smoke from the fire triggered an asthma attack in Jenny. She took her Ventolin but that was not enough, so they went to emergency where she was given more Ventolin and a 5-day prescription of prednisone to reduce the inflammation in her lungs.
Having to seek emergency care in a foreign country caused Jenny considerable stress. A few days later she started with a bit of a fever. She thought it was either the travel stress or the pregnancy, but not wanting to take chances, they went to a doctor who told her she must have gotten some type of viral infection and just to take Tylenol for the fever and rest for a few days. Jenny did not lose her appetite, but the food was very different than their normal diet. They tried to sample and enjoy the local cuisine as much as possible but it was rich in fats and one evening Jenny did not feel well and started vomiting and had a fever. She went to the emergency room again where they diagnosed her with food poisoning but for some reason they gave her a 10-day prescription of antibiotics. She was not sure why, but she took them as prescribed.
During their excursions, Jenny and John visited some larger cities, saw poor neighbourhoods as well as industrialized areas with a lot of pollution and smog which they could smell and feel. Jenny had to take her puffers again to avoid another asthma attack. Neither of them knew the types of industrial pollutants that were present in the air, but they were concerned that some would be in the food they ate at the restaurants. They ate at restaurants a lot and Jenny could tell that she was not eating the healthy diet she was at home.
It was an interesting trip to say the least, but they finally arrived home again when Jenny was 8 weeks pregnant. She went to her doctor for a check-up and started taking her prenatal vitamins.
Everything felt fine with the pregnancy but during a prenatal ultrasound at 20 weeks, the doctor noticed that Jenny’s placenta was small and lying low in the uterus. Further examination using doppler led to the discovery that there was increased resistance in the umbilical blood flow.
At 26 weeks’ gestation Jenny underwent the standard prenatal glucose tolerance test and the results indicated she was hyperglycemic. She was advised that she would need to change her diet to control her blood glucose levels. She did her best to adhere to this medical advice, however her glucose levels remained elevated throughout the pregnancy.
Unfortunately, Jenny started having contractions in her 34th week of pregnancy. She was given prophylactic antibiotics and steroids and delivered the baby vaginally within 48 hours. Upon examination, Jenny’s placenta demonstrated poorly developed tertiary villous structures, including decreased numbers and size of capillaries. Interestingly, her placenta also showed evidence of a past, acute pro-inflammatory event. Despite this, Jenny had few complications and was able to go home 48 hours after birth. She was successfully able to breastfeed her little boy Caleb from birth. John is excited too but is not sure how to care for a newborn.
c) Jenny and John relied on IVF to become pregnant. Briefly describe this procedure. List four possible exposures (or lack thereof) directly related to the IVF procedure through which these exposures may induce programming changes in the zygote/blastocyst and briefly discuss a mechanism. Once Jenny is pregnant with Caleb, how are the micronutrients of Vitamins A, D and omega-3 fatty acids contribute to fetal development? [20 pts]
a) Jenny did not take her prenatal supplements provided on a regular basis. Which vitamin included in this supplement would be the most important for the peri-conception and early pregnancy window? Identify what clinical outcome(s) is(are) most associated with this vitamin deficiency during early pregnancy (be specific) and describe the mechanisms by which this happens. Be sure to include in your response the effects of this vitamin deficiency on both embryo/fetal development and placental development, including how this nutrient crosses the placenta. [15 pts].
b) Teratogens and endocrine disruptors can both cause damage to the fetus, but they do so in different ways. Explain the major difference in the type of damage caused by exposure to these two classes of substances. Using one example for each class of chemical (Retinoic acid and BPA), discuss the mechanism and factors/conditions required by which they cause damage or change to the developing fetus and the primary organ or system affected. [20 pts]
c) Would a somatic or germline mutation have a greater negative impact on the fetus? Provide a rationale for your response, highlighting what the impact of each type of mutation might be. Both Jenny and John are getting older, how might their age affect their potential for transmitting germline mutations? [10 pts]
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