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

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;7:151-6.

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.

Contextual Disconnect

Multiple Determinants

Evans RG, Stoddart GL. Producing health, consuming health care. Soc Sci Med. 1990;31:1347-63.

Ecological Model

Bronfenbrenner U. Ecology of Human Development: Experiments by Nature and Design. Cambridge MA: Harvard University Press. 1979.

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?

MethodologicalDisconnect

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 DirectionSummary

Longitudinal integration Contextual integration Methodological integration