Jean Amoura, MD, MSc Marvin L.Stancil, MD. Evaluate how fetal, infant, and childhood development is...
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Transcript of Jean Amoura, MD, MSc Marvin L.Stancil, MD. Evaluate how fetal, infant, and childhood development is...
Jean Amoura, MD, MSc
Marvin L.Stancil, MD
Evaluate how fetal, infant, and childhood development is critical to understanding chronic diseases among the elderly
Review the extended significance of reproductive health care for the health of the community
Public health approaches deal with the health of an entire community or population Mostly prevention oriented Why is there an obesity epidemic? What factors put women at risk for preterm
delivery? Medical care approaches deal with the
individual patient More often treatment oriented What can I do to help this patient lose
weight? How can I help this patient avoid preterm
delivery, or treat it if it occurs?
Looks for determinants of a health outcomeBiological (eg, genetic)Social (eg, ability to access health care)Behavioral (eg, smoking)Environmental (eg, lead exposure)
Focus community and patient education on changeable factors
Prioritize policies and funding to community-level factors
A framework to address health determinants:Earlier in developmentOver the course of lifespanWith emphasis on reproductive years
Considerations for reproductive healthDisparities in birth outcomes persist despite
more advanced and expensive therapies for newborns
Improving health care during nine months of pregnancy is not adequate
Woman’s health before and during pregnancy are critical to lifelong health of offspring
Women spend the majority of their reproductive years in a preconceptional or interconceptional state
Combines two modelsEarly programming model
Factors present in early life (fetal/neonatal/childhood) have long-range effects
Cumulative pathway model Lifelong stressors create wear and tear on the
body’s adaptive systems
Addresses emerging epidemicsChildhood obesity, asthma, diabetes, autism
Combining the two models allows us to account for risk factors and their timing
Barker hypothesisFetal events have lasting physiologic effectsGrowth restriction of the fetus indicates
relative malnutrition in uteroPreterm delivery is associated with
exogenous or endogenous cortisol riseBoth factors can contribute to lasting
physiologic changes in fat and carbohydrate metabolism Increased rates of diabetes, obesity,
hypertension, and heart disease in adulthood
Copyright restrictions may apply.
Ben-Shlomo, Y. et al. Int. J. Epidemiol. 2002 31:285-293; doi:10.1093/ije/31.2.285
Schematic representation of biological and psychosocial exposures acting across the life course that may influence lung function and/or respiratory disease
Health before pregnancyA woman with an unplanned pregnancy is
at risk for: Preterm delivery Lack of folic acid supplementation
29% of women report taking folic acid before pregnancy
Late presentation to prenatal care Lack of control of underlying medical conditions
These factors contribute to suboptimal pregnancy outcomes
A woman’s health before and during pregnancy is integral to the lifelong health of her child
Women frequently underestimate their risk for pregnancy and therefore do not adequately plan for pregnancy
50% of pregnancies are unintended
All women of reproductive age should be counseled to:Consider their reproductive life plan
How many children do they desire? When would they ideally like their first/next
pregnancy?Use effective contraception if they do not
desire pregnancy in the immediate futureUnderstand the impact of their health prior
to pregnancy on the health of their childrenTake folic acid supplementation
Applications to medical practice Counseling women about their health in
terms of promoting healthy future children can have greater impactLosing weight if obeseControlling diabetesQuitting smoking
Addressing a women’s probable fertility can improve her likelihood of using effective contraception if she doesn’t desire pregnancy now
Applications for medical practice Use the prenatal and postpartum
periods to:Educate women on factors that will improve
future pregnancy outcomesEmphasize the need for contraception to
adequately space pregnancies
Key points:Women’s health should maintain a focus on
every woman of reproductive age as preconceptional even if she is not planning an immediate pregnancy
Prenatal and postpartum care should have the expanded goal of interceptional care—how to help her improve birth outcomes in her next pregnancy