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The Life Course Perspective: CuttingEdge Science for Urban MCH

The Life Course Perspective: CuttingEdge Science for Urban MCH. Michael C. Lu, MD, MPH Assistant Professor Department of Obstetrics & Gynecology David Geffen School of Medicine at UCLA Department of Community Health Sciences UCLA School of Public Health. Life Course Perspective.

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The Life Course Perspective: CuttingEdge Science for Urban MCH

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  1. The Life Course Perspective:CuttingEdge Science for Urban MCH Michael C. Lu, MD, MPH Assistant Professor Department of Obstetrics & Gynecology David Geffen School of Medicine at UCLA Department of Community Health Sciences UCLA School of Public Health

  2. Life Course Perspective Reproductive Potential Age Pregnancy

  3. Life Course Perspective White Reproductive Potential African American Pregnancy Age

  4. Life Course Perspective • Early programming • Cumulative pathways

  5. Early Programming

  6. Barker HypothesisBirth Weight and Coronary Heart Disease Age Adjusted Relative Risk Rich-Edwards 1997

  7. Barker HypothesisBirth Weight and Hypertension Law 1993

  8. Barker HypothesisBirth Weight and Insulin Resistance Syndrome Odds ratio adjusted for BMI Barker 1993

  9. Prenatal Period is a “Sensitive” or “Critical” Period Health or Function Birth

  10. Welberg LAM, Seckl JR. Prenatal stress, glucocorticoids and the programming of the brain. J Neuroendocrinol 2001;13:113-28.

  11. Scientific American 2003

  12. Epigenetics

  13. Cumulative Pathways

  14. Allostasis McEwen 1998

  15. Allostasis McEwen 1998

  16. Stress and Allostastic Load McEwen 1998

  17. Allostasis Chikanza 2000

  18. Life Course Perspective White Reproductive Potential African American Pregnancy Age

  19. Life Course Perspective White African American Primary Care for Children Early Intervention Prenatal Care Prenatal Care Internatal Care Primary Care for Women Poor Birth Outcome Age 0 5 Puberty Pregnancy Lu 2003

  20. Closing Black-White Gap in Birth OutcomesA Life-Course Approach • 1. Provide interconception care to women with prior adverse pregnancy outcomes • 2. Increase access to preconception care to Black women • 3. Improve the quality of prenatal care • 4. Expand healthcare access over the life course • 5. Restore Black fathers to Black families • 6. Enhance coordination and integration of family support services • 7. Create reproductive social capital in Black communities • 8. Invest in community building and urban renewal • 9. Close the education gap • 10. Reduce poverty among Black families • 11. Support working mothers and families • 12. Undo racism

  21. Prenatal Programming • How to make a smart and healthy baby for life?

  22. Prenatal Programming • Brain development • Immune development • Metabolic development

  23. Prenatal Programming • Is there prenatal programming of school readiness?

  24. Prenatal Programming • Is there prenatal programming of obesity?

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