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
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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
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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
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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 communitylevel factors
A
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framework to address health determinants:
Earlier in development
Over the course of lifespan
With emphasis on reproductive years
 Considerations
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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

Early programming model

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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

two models
emerging epidemics
Childhood obesity, asthma, diabetes, autism
 Combining
the two models allows us to
account for risk factors and their timing
 Barker hypothesis
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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
Schematic representation of biological and psychosocial exposures acting across the life course
that may influence lung function and/or respiratory disease
Ben-Shlomo, Y. et al. Int. J. Epidemiol. 2002 31:285-293; doi:10.1093/ije/31.2.285
Copyright restrictions may apply.
 Health

A woman with an unplanned pregnancy is at risk
for:
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before pregnancy
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:
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Consider their reproductive life plan
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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
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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:
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Educate women on factors that will improve
future pregnancy outcomes
Emphasize the need for contraception to
adequately space pregnancies
 Key
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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