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PERINATAL HEALTH RESEARCH
Michael C. Lu, MD, MPHUCLA Schools of Medicine & Public Health
Panel on “The Future Research Agenda for MCH”2004 APHA Annual Meeting
Washington DC, November 10, 2004
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Objectives for Panel
What are the current key issues?
What are the future questions?
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Key Issues
Integration
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Key Issues
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. 2003;7:13-30.
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Good health
Poor Health
0
Risk Factors
Life Course
Protective Factors
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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;7:151-6.
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.
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Contextual Disconnect
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Multiple Determinants
Evans RG, Stoddart GL. Producing health, consuming health care. Soc Sci Med. 1990;31:1347-63.
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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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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.
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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?
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MethodologicalDisconnect
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Methodological Disconnect
Across academic disciplines Between academia & community
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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
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Future DirectionSummary
Longitudinal integration Contextual integration Methodological integration