Where Is MCH In Relation to the Life-Course Perspective?

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Where Is MCH In Relation to the Life-Course
Perspective?

• Michael C. Lu, MD, MPH
• Associate Professor
• Department of Obstetrics Gynecology
• David Geffen School of Medicine at UCLA
• Department of Community Health Sciences
• UCLA School of Public Health
• National MCH Life Course Meeting
• Oakland, CA
• June 9, 2008

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Major Disconnects in MCH

• Longitudinal Disconnect
• Contextual Disconnect
• Methodological Disconnect

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• Longitudinal
• Disconnect

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Life Course Perspective
Lu MC, Halfon N. Racial and ethnic disparities in
birth outcomes a life-course perspective.Matern
Child Health J. 2003713-30.
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Developmental Programming
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Programming

• The process whereby a stimulus or insult, at a
  sensitive or critical period, has lasting or
  lifelong impact on health or function.

Barker DJP. Mothers, babies and health in later
life. Edinburgh Churchill Livingstone. 1998.
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Prenatal Programming of Childhood Obesity
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Prenatal Programming of Childhood Obesity
Dysregulation of the Adipoinsular Feedback System
Maternal Diabetes Intrauterine Hyperglycemia
Maternal Diabetes Intrauterine Hyperglycemia
Maternal Diabetes Intrauterine Hyperglycemia
Intrauterine Hyperinsulinemia (Fetal Pancreatic ß
Cells)
Intrauterine Hyperinsulinemia (Fetal Pancreatic ß
Cells)
Intrauterine Hyperinsulinemia (Fetal Pancreatic ß
Cells)
Prenatal Postnatal Hyperleptinemia
Prenatal Postnatal Hyperleptinemia
Preadipocyte Differentiation
Programmed Insulin Resistance
Programmed Insulin Resistance
Prenatal Postnatal Hyperleptinemia
Preadipocyte Differentiation
Programmed Insulin Resistance
Adipocyte Hyperplasia
Adipocyte Hyperplasia
Adipocyte Hyperplasia
Postnatal Hyperinsulinemia
Postnatal Hyperinsulinemia
Postnatal Hyperinsulinemia
Hypothalamic Leptin Resistance
Hypothalamic Leptin Resistance
Pancreatic ß- Cell Leptin Resistance
Pancreatic ß- Cell Leptin Resistance
Hypothalamic Leptin Resistance
Pancreatic ß- Cell Leptin Resistance
Hyperphagia
Hyperphagia
Hyperphagia
Hyperinsulinism
Hyperinsulinism
Hyperinsulinism
Adipogenesis
Adipogenesis
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Epigenetics
Gibbs WW. The Unseen Genome Beyond DNA.
Scientific American 2003
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EpigeneticsSame Genome, Different Epigenome
R.A. Waterland, R.A. Jirtle, "Transposable
elements targets for early nutritional effects
on epigenetic gene regulation," Mol Cell Biol,
235293-300, 2003. Reprinted in the New Scientist
2004
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Allostasis Maintain Stability through Change
McEwen BS. Protective and damaging effects of
stress mediators. N Eng J Med. 1998338171-9.
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Allostastic LoadWear and Tear from Chronic
Stress
McEwen BS. Protective and damaging effects of
stress mediators. N Eng J Med. 1998338171-9.
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Stressed vs. Stressed Out

• Stressed
• Increased cardiac output
• Increased available glucose
• Enhanced immune functions
• Growth of neurons in hippocampus prefrontal
  cortex

• Stressed Out
• Hypertension cardiovascular diseases
• Glucose intolerance insulin resistance
• Infection inflammation
• Atrophy death of neurons in hippocampus
  prefrontal cortex

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Allostasis Allostatic Load
McEwen BS, Lasley EN. The end of stress As we
know it. Washington DC John Henry Press. 2002
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Weathering

• The effects of social inequality on the health of
  populations may compound with age, leading to
  growing gaps in health status through young and
  middle adulthood that can affect fetal health.
• Geronimus AT (1996)

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• Contextual
• Disconnect

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Epidemiological Model
Environment
Agent (Parasite)
Host
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Multiple Determinants
Evans RG, Stoddart GL. Producing health,
consuming health care. Soc Sci Med.
1990311347-63.
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Ecological Model
Bronfenbrenner U. Ecology of Human Development
Experiments by Nature and Design. Cambridge MA
Harvard University Press. 1979.
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Toxic Environments
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• Methodological
• Disconnect

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Transdisciplinary Research

• Multidisciplinary Research
• researchers from different fields work
  independently or sequentially, each from his or
  her own disciplinary perspective, to address a
  particular research topic
• Interdisciplinary Research
• entails greater sharing of information and closer
  coordination among researchers from various
  fields than occurs in multidisciplinary projects,
  yet the participants remain anchored in their
  respective disciplinary models and methodologies
• Transdisciplinary Research
• researchers work together to develop a shared
  conceptual framework that integrates and extends
  discipline-based concepts, theories, and methods
  to address a common research topic.
  Transdisciplinary research collaborations are
  intended to achieve the highest levels of
  intellectual integration across multiple fields
  and yield shared conceptual formulations that
  move beyond the disciplinary perspectives
  represented by team members.

Stokols D. Toward a science of transdisciplinary
action research. Am J Community Psychol. 2006
Sep38(1-2)63
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Community-Based Participatory Research (CBPR)

• A collaborative process that equitably involves
  all partners in the research process and
  recognizes the unique strengths that each brings.
  CBPR begins with a research topic of importance
  to the community with the aim of combining
  knowledge and action for social change to improve
  community health and eliminate health disparities

Minkler M, Wallerstein N, eds. Community Based
Participatory Research for Health. San Francisco,
Calif Jossey-Bass Publishers 2003
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Praxis

• Integration of theory and practice

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• Now What?

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• Integration

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Integration

• Longitudinal Integration
• Measurements
• Data Infrastructure
• Data linkages
• Longitudinal studies
• National Childrens Study
• Longitudinal modeling
• Contextual Integration
• Measurements
• Bias confounding
• Multilevel modeling
• Interactions
• Gene-environment
• Cumulative risks
• Methodological Integration
• Transdisciplinary Research
• Community-Based Participatory Research

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Integrated Science of MCH Life Course

• Theory
• Research
• Practice
• Policy
• Education

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