MCH Challenges & Population Health Overview

Historical Foundations of MCH & Healthy People 2020/2030

• Three major challenges of current MCH policy: Disparities in health outcomes, healthy workforce development, and cost control.
• Infant mortality: Number of deaths of infants under one year of age per 1,000 live births.
• Maternal mortality: Number of maternal deaths due to childbirth-related causes per 100,000 live births.

Population Health and Epidemiology

• Descriptive studies focus on who, what, where, and when. Examples include case reports and cross-sectional studies.
• Analytical studies focus on why and how. Examples include cohort and case-control studies.
• Case-control studies are good for rare outcomes, and faster and less expensive but prone to recall and selection biases.
• Cohort studies are good for studying multiple outcomes and exposures but are time-consuming and expensive.
• Confounding occurs when a third variable is associated with both the exposure and the outcome, distorting the true relationship.
• Null value for relative risk (RR) and odds ratio (OR) is 1.
• Type I error is a false positive (rejecting a true null hypothesis).
• Type II error is a false negative (failing to reject a false null hypothesis).

Reproductive Biology and Teratology

• Fecundity is the biological capacity to reproduce.
• Fertility is the actual reproduction rate.
• Critical windows refer to specific time periods when exposure has irreversible effects on development.
• Sensitive windows refer to time periods when exposure has significant but potentially reversible effects.
• Teratology is the study of congenital malformations and birth defects.

MCH-Life Course Perspectives

• Five principles of life course theory: Life span development, human agency, timing, linked lives, and historical time and place.
• Latency model: Early life events affect health later in life.
• Cumulative model: Risk factors accumulate over time.
• Pathway model: Different risk factors lead to the same outcome.

HIV/Sexually Transmitted Infections (STI)

• HIV transmission from mother to child (MTCT) occurs antenatally (in-utero), intranatally (labor/delivery), and postnatally (breastfeeding).
• Antiretroviral therapy (ART) reduces the risk of MTCT to less than 5%.
• HPV 16 and 18 account for 70% of cervical cancer cases.
• HPV 6 and 11 cause genital warts.

Intimate Partner Violence (IPV)

• Forms of IPV include physical, psychological, sexual, and coercive control.
• Risk factors for IPV include individual factors (age, substance use), relationship factors (marital conflict), and societal factors (gender norms).
• Strategies to prevent IPV include empowering women, engaging men, and transforming harmful gender norms.

Environmental Exposures and Lifestyle

• Environmental toxicants include air, water, soil, food, and consumer products.
• Challenges in implementing environmental toxicant-related policies include limited information, high costs, and barriers to public health education.

Early Life Origins of Adult Health & Disease

• Barker Hypothesis: Early life conditions influence disease risk in adulthood.
• Mechanisms include genetic factors, metabolic programming, tissue growth, and epigenetics.

MCH Nutrition and Breastfeeding

• Folate prevents neural tube defects.
• Breastfeeding benefits include enhanced immunity for the baby and reduced risk of breast/ovarian cancer for the mother, with quicker uterine recovery.

Adolescent Health

• Factors influencing identity formation in adolescents include recreation, spirituality, education, mental health, and relationships.
• Commonly abused substances among U.S. adolescents include alcohol and marijuana.

Special Populations – Women Veterans

• VA reproductive health services for women veterans include contraception, gynecological care, maternity care, and infertility care.
• Adverse pregnancy outcomes associated with deployment include stress, inflammation, and behavioral risks, as well as environmental exposures.

Social Determinants

• Hispanic paradox: Better birth outcomes among Hispanics despite lower socioeconomic status (SES).
• Maternal stress affects birth outcomes by disrupting the hypothalamic-pituitary-adrenal (HPA) axis.

Community-based Participatory Research (CBPR)

• Five Rs of community involvement in CBPR: Respect, relevance, reciprocity, responsibility, relationality.
• Efficacy studies are conducted in controlled settings (Phase II/III trials).
• Effectiveness studies are conducted in practical settings (Phase IV trials).

Pregnancy Complications

• Preeclampsia is characterized by high blood pressure and protein in the urine during pregnancy.
• Gestational diabetes is characterized by high blood sugar during pregnancy.
• Mechanisms of preterm birth include spontaneous labor, preterm prelabor rupture of membranes (PROM), and medical indication.

Impact of Pandemics and Conflicts in MCH

• Potential consequences of the COVID-19 pandemic on maternal and child health include increased maternal stress, reduced preventive screenings, and decreased family planning services.
• Armed conflicts impact maternal and infant mortality by increasing stress, reduced access to healthcare, and widespread damage to infrastructure.

Fetal Alcohol Spectrum Disorders (FASD)

• Senate Bill 5688 established a statewide network of FASD clinics in Washington state.
• There is no known safe level of alcohol intake during pregnancy. Alcohol exposure at any level can harm a developing fetus.

Pediatric Diarrheal Diseases (PDD)

• Short-term consequences of PDD include fluid loss and death.
• Long-term consequences of PDD include stunted growth and cognitive delays.
• Prevention strategies for PDD include handwashing, improved sanitation, breastfeeding, and vaccination.

Explore the critical challenges facing Maternal and Child Health (MCH) policies, including disparities in health outcomes and the implications of maternal and infant mortality rates. Additionally, dive into the distinctions between descriptive and analytical studies in population health and epidemiology, discussing their respective methodologies and biases.