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