The Life Course Perspective:CuttingEdge Science for Urban MCH

Michael C. Lu, MD, MPHAssistant Professor

Department of Obstetrics & GynecologyDavid Geffen School of Medicine at UCLA

Department of Community Health SciencesUCLA School of Public Health

Life Course Perspective

Pregnancy

Reproductive Potential

Age

Life Course Perspective

Pregnancy

White

AfricanAmerican

Reproductive Potential

Age

Life Course Perspective

Early programming Cumulative pathways

Early Programming

Barker HypothesisBirth Weight and Coronary Heart Disease

0

0.25

0.5

0.75

1

1.25

1.5

<5.0 5.0-5.5 5.6-7.0 7.1-8.5 8.6-10.0 >10.0

Birthweight (lbs)

Age Adjusted Relative Risk

Rich-Edwards 1997

Barker HypothesisBirth Weight and Hypertension

155

160

165

170

Syst

olic

Pre

ssur

e (m

mH

g)

<=5.5 5.6-6.5 6.6-7.5 7.6-8.5 >8.5

Birthweight (lbs) Law 1993

Barker HypothesisBirth Weight and Insulin Resistance Syndrome

0

2

4

6

8

10

12

14

16

18

<5.5 5.6-6.5 6.6-7.5 7.6-8.5 8.6-9.5 >9.5

Birthweight (lbs)

Odds ratio adjusted for BMI

Barker 1993

Prenatal Period is a “Sensitive” or “Critical” Period

Health or Function

Birth

Welberg LAM, Seckl JR. Prenatal stress, glucocorticoids and the programming of the brain.J Neuroendocrinol 2001;13:113-28.

Scientific American 2003

Epigenetics

Cumulative Pathways

Allostasis

McEwen 1998

AllostasisMcEwen 1998

Stress and Allostastic LoadMcEwen 1998

AllostasisChikanza 2000

Life Course Perspective

Pregnancy

White

AfricanAmerican

Reproductive Potential

Age

Life Course Perspective

Prenatal Care

Poor Birth Outcome

0 5 PregnancyPuberty

Internatal Care

Primary Care for Women

Early Intervention

Prenatal Care

Primary Care for Children

Age

White

AfricanAmerican

Lu 2003

Closing Black-White Gap in Birth OutcomesA Life-Course Approach

1. Provide interconception care to women with prior adverse pregnancy outcomes

2. Increase access to preconception care to Black women 3. Improve the quality of prenatal care 4. Expand healthcare access over the life course 5. Restore Black fathers to Black families 6. Enhance coordination and integration of family support

services 7. Create reproductive social capital in Black communities 8. Invest in community building and urban renewal 9. Close the education gap 10. Reduce poverty among Black families 11. Support working mothers and families 12. Undo racism

Prenatal Programming

How to make a smart and healthy baby for life?

Prenatal Programming

Brain development Immune development Metabolic development

Prenatal Programming

Is there prenatal programming of school readiness?

Prenatal Programming

Is there prenatal programming of obesity?