PERINATAL HEALTH RESEARCH Michael C. Lu, MD, MPH UCLA Schools of Medicine & Public Health Panel on “The Future Research Agenda for MCH” 2004 APHA Annual Meeting Washington DC, November 10, 2004

Objectives for Panel  What are the current key issues?  What are the future questions?

Key Issues Integration

Key Issues  Longitudinal disconnect  Contextual disconnect  Methodological disconnect

Longitudinal Disconnect

Life Course Perspective Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective. Matern Child Health J. 2003;7:13-30.

Good health Poor Health 0 Risk Factors Life Course Protective Factors

Future Direction  Longitudinal Integration What are the life course influences on perinatal outcomes? What are the perinatal influences over the life course? What are the pre-disease pathways (not just risk factors) leading to poor outcomes (e.g. maternal allostatic load)? What are the pathways leading to positive health and development?  References Kotelchuck M. Building on a life-course perspective in maternal and child health. Matern Child Health J. 2003;7:5-11 Wise P. Framework as metaphor: the promise and peril of MCH life-course perspectives. Matern Child Health J. 2003;7: Misra DP, Guyer B, Allston A. Integrated perinatal health framework. A multiple determinants model with a life span approach. Am J Prev Med. 2003;25:65-75.

Contextual Disconnect

Multiple Determinants Evans RG, Stoddart GL. Producing health, consuming health care. Soc Sci Med. 1990;31:

Ecological Model Bronfenbrenner U. Ecology of Human Development: Experiments by Nature and Design. Cambridge MA: Harvard University Press

Integrated Perinatal Health Framework Misra DP, Guyer B, Allston A. Integrated perinatal health framework. A multiple determinants model with a life span approach. Am J Prev Med. 2003;25:65-75.

Future Direction  Contextual Integration Individual  How do contextual factors become embedded in pregnancy physiology or developmental biology (e.g. envrionmentally induced gene expression)? Interpersonal  What personal ties are important to perinatal outcomes?  Where is the M in MCH (male involvement) Neighborhood & community  What collective properties influence perinatal outcomes (e.g. social capital, neighborhood stressors)? Population health  What macro-level factors (e.g. macro-economy or the healthcare system) influence perinatal outcomes?

Methodological Disconnect

Methodological Disconnect  Across academic disciplines  Between academia & community

Future Direction  Methodological Integration Integrative approach to perinatal research  What are the methodological issues (measurement techniques, study designs, levels of analyses)?  What infrastructure is needed to support an integrative approach?  How do we do better collaborative research between academia and community? Singer BH, Ryff CD. Eds. Nataional Research Council. New horizons in health: An integrative approach. Washington DC: Natioanl Academy Press. 2001

Future Direction Summary  Longitudinal integration  Contextual integration  Methodological integration