Presentation on theme: "Jean Amoura, MD, MSc Marvin L.Stancil, MD. Evaluate how fetal, infant, and childhood development is critical to understanding chronic diseases among."— Presentation transcript:
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 outcome Biological (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 development Over the course of lifespan With emphasis on reproductive years
Considerations for reproductive health Disparities 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 models Early 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 epidemics Childhood obesity, asthma, diabetes, autism
Combining the two models allows us to account for risk factors and their timing Barker hypothesis Fetal events have lasting physiologic effects Growth restriction of the fetus indicates relative malnutrition in utero Preterm delivery is associated with exogenous or endogenous cortisol rise Both 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 pregnancy A 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 future Understand the impact of their health prior to pregnancy on the health of their children Take folic acid supplementation
Applications to medical practice Counseling women about their health in terms of promoting healthy future children can have greater impact Losing weight if obese Controlling diabetes Quitting 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 outcomes Emphasize 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
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