PUB 460 Lecture 4 - Life Course Perspective On MCH - II PDF

LIFE COURSE PERSPECTIVE ON MCH - II PUB 460 Dr. Gauri Desai Recap: Five Defining Principles of Life Course Theory 1. Principle of Life Span Development: suggests that health and wellbeing are lifelong processes and can only be fully understood within the context of experiences across one’s entire...

LIFE COURSE PERSPECTIVE ON MCH - II PUB 460 Dr. Gauri Desai Recap: Five Defining Principles of Life Course Theory 1. Principle of Life Span Development: suggests that health and wellbeing are lifelong processes and can only be fully understood within the context of experiences across one’s entire lifespan 2. Principle of Human Agency: highlights central roles of personal control and behavior in health and illness 3. Principle of Timing: suggests that our health is shaped not only by what happens to us but also by when it happens, duration and sequencing 4. Principle of Linked Lives: explains notion of interdependent lives 5. Principle of Historical Time and Place: highlights the ways in which period, cohort, and contextual factors influence the life course (Elder, 2006) Recap: Three Exposure Models in Life Course Epidemiology Mechanistic models that may explain how exposures over the life course shape subsequent health: 1. Critical/sensitive period model 2. Accumulation of risk model 3. Chain of risks model Recap: Three Exposure Models in Life Course Epidemiology Mishra GD, Cooper R, Kuh D. A life course approach to reproductive health: theory and methods. Maturitas. 2010 Feb;65(2):92-7. doi: 10.1016/j.maturitas.2009.12.009. Epub 2010 Jan 15. PMID: 20079587; PMCID: PMC3504662. Recap: Three Exposure Models in Life Course Epidemiology Mishra GD, Cooper R, Kuh D. A life course approach to reproductive health: theory and methods. Maturitas. 2010 Feb;65(2):92-7. doi: 10.1016/j.maturitas.2009.12.009. Epub 2010 Jan 15. PMID: 20079587; PMCID: PMC3504662. Contemporary Applications of Life Course Theory to MCH • Three main areas of MCH scholarship have arisen based on our current understanding of the Life Course Theory: 1. The role of preconception health and wellbeing on birth outcomes 2. The life course impact of adverse childhood experiences 3. The fetal origins of adult disease Contemporary Applications of Life Course Theory to MCH 1. The role of preconception health and wellbeing on birth outcomes • Pregnancy now viewed as part of an integrated continuum or trajectory of health rather than a detached stage of development • Birth outcomes may be affected by maternal development across the life span prior to pregnancy • Preconception and interconception health impact birth outcomes Contemporary Applications of Life Course Theory to MCH 1. The role of preconception health and wellbeing on birth outcomes • Sparse amount of evidence exists on the relationship between preconception maternal exposures and birth outcomes • Commonly studied relationships: • Pre-pregnancy folic acid intake and risk of neural tube defects in infants • Pre-pregnancy chronic stress and restricted birth weight and preterm birth • Pre-pregnancy obesity and fetal deaths, preterm birth • Pre-conception smoking, poor physical health, and depression with several birth outcomes • Such studies have focused on modifiable risk factors to a large extent Contemporary Applications of Life Course Theory to MCH 1. The role of preconception health and wellbeing on birth outcomes “If I’d known the impact of carrying all this extra weight when I was pregnant, like getting pre-eclampsia and having a really difficult birth then I might have tried to lose weight before. They didn’t tell me. This time, the doctor said it would be good to lose weight but he didn’t explain why” “I did plan to have a baby but I didn’t take the vitamins [folic acid] until I knew I was pregnant… It’s hard to know how long it will take to get pregnant”. - From a focus group for Public Health England: Making the Case for Preconception Care Contemporary Applications of Life Course Theory to MCH 1. The role of preconception health and wellbeing on birth outcomes • Healthcare interventions need to be in place for improving prepregnancy health • Awareness among people as well as healthcare providers is essential • Focus on population subgroups that have lack of access to essential services and have a high rate of adverse birth outcomes to reduce the disparities in MCH outcomes • UK Health Security Agency [4:20]: • https://www.youtube.com/watch?v=CK_g9j9AobE&ab_channel=UK HealthSecurityAgency Contemporary Applications of Life Course Theory to MCH 1. The role of preconception health and wellbeing on birth outcomes • CDC’s webpage on pre-pregnancy health: https://www.cdc.gov/ncbddd/birthdefects/prevention.html Contemporary Applications of Life Course Theory to MCH 1. The role of preconception health and wellbeing on birth outcomes • CDC’s webpage on pre-pregnancy health: https://www.cdc.gov/ncbddd/birthdefects/prevention.html Contemporary Applications of Life Course Theory to MCH 2. The life course impact of adverse childhood experiences • Adverse Childhood Experiences (ACEs) are potentially traumatic events that occur in childhood. • ACEs can include violence, abuse, and growing up in a family with mental health or substance use problems. • Toxic stress from ACEs can change brain development and affect how the body responds to stress. • ACEs are linked to chronic health problems, mental illness, and substance misuse in adulthood. • ACEs video [4:16]: https://www.youtube.com/watch?v=VMpIi4CZK0&ab_channel=PublicHealthScotland Contemporary Applications of Life Course Theory to MCH 2. The life course impact of adverse childhood experiences • The CDC-Kaiser Permanente adverse childhood experiences (ACE) study on childhood abuse and neglect and household challenges and later-life health and well-being • The original ACE study - 1995 to 1997 with two waves of data collection. • Over 17,000 Health Maintenance Organization members from Southern California receiving physical exams completed confidential surveys regarding their childhood experiences and current health status and behaviors. Contemporary Applications of Life Course Theory to MCH 2. The life course impact of adverse childhood experiences • ACE “exposures” include the following: https://www.ncsl.org/research/health/adverse-childhood-experiences-aces.aspx Prevalence of ACEs by Category for CDC-Kaiser ACE Study Participants by Sex, Waves 1 and 2. ACE Women Men Total Category Percent Percent Percent (N = 9,367) (N = 7,970) (N = 17,337) ABUSE Emotional 13.1% 7.6% 10.6% Abuse Physical 27% 29.9% 28.3% Abuse Sexual Abuse 24.7% 16% 20.7% HOUSEHOLD CHALLENGES Mother 13.7% 11.5% 12.7% Treated Violently Substance 29.5% 23.8% 26.9% Abuse Mental Illness 23.3% 14.8% 19.4% Parental 24.5% 21.8% 23.3% Separation or Divorce Incarcerated 5.2% 4.1% 4.7% Household Member NEGLECT Emotional 16.7% 12.4% 14.8% 3 Neglect Physical 9.2% 10.7% 9.9% 3 Neglect 2. The life course impact of adverse childhood experiences • ACE study major findings (descriptive) 2. The life course impact of adverse childhood experiences • ACE study major findings (descriptive): ACE Score Prevalence for CDC-Kaiser ACE Study Participants by Sex, Waves 1 and 2. Number of Adverse Childhood Experiences (ACE Score) Women Percent(N = 9,367) Men Percent (N = 7,970) Total Percent (N = 17,337) 0 34.5% 38.0% 36.1% 1 24.5% 27.9% 26.0% 2 15.5% 16.4% 15.9% 3 10.3% 8.5% 9.5% 4 or more 15.2% 9.2% 12.5% Contemporary Applications of Life Course Theory to MCH 2. The life course impact of adverse childhood experiences • ACE study major findings (analytical): ACEs have implications on health and wellbeing in adulthood and throughout life https://www.cdc.gov/violenceprevention/aces/about.html Contemporary Applications of Life Course Theory to MCH 2. The life course impact of adverse childhood experiences • • Since 2018, at least 37 states and the District of Columbia have enacted or adopted legislation related to ACEs • Include laws that address childhood trauma, child adversity, toxic stress or ACEs specifically Many of these bills create a new taskforce or work group, implement training for educators and others on ACEs or trauma-informed practices, or strengthen behavioral health supports for children https://www.ncsl.org/research/health/adverse-childhood-experiences-aces.aspx Contemporary Applications of Life Course Theory to MCH 3. The fetal origins of adult disease • Conceived by Dr. David Barker and associates in the 1980s and 1990s, also called the “Barker hypothesis” • The fetal origins of adult disease hypothesis suggests that adult disease cannot be fully understood without considering early life exposures at critical or sensitive periods • Consistent with the principle of timing and the critical/sensitive period model of exposure Dr. David Barker (1938 – 2013) Contemporary Applications of Life Course Theory to MCH 3. The fetal origins of adult disease • There exist specific developmental periods whereby an organism is “plastic” or “sensitive” to its environment • Much of the work on this hypothesis has focused on the role of fetal undernutrition in adult health outcomes • Suggests that fetal undernutrition in mid- to late gestation is consequential for adult disease risk • Fetal nutrition is closely related to maternal nutrition (principle of linked lives) Contemporary Applications of Life Course Theory to MCH 3. The fetal origins of adult disease • Examples: Fetal undernutrition has been associated with increased risk of these adverse health outcomes in adulthood: • Chronic kidney disease • Hypertension • Diabetes • In the presence of inadequate nutrition, the fetus may give priority to the development of the brain and other vital organs over the kidneys, for example • Results in less # nephrons in kidneys Contemporary Applications of Life Course Theory to MCH 3. The fetal origins of adult disease • Dutch famine (1944-1945): https://www.youtube.com/watch?v=ThSnx2Etegc&ab_channel=Interestingl yInteresting (stop at 3:52) • Dutch famine birth cohort study Bleker, L. S., et al. (2021). "Cohort profile: the Dutch famine birth cohort (DFBC)—a prospective birth cohort study in the Netherlands." BMJ Open 11(3): e042078. Contemporary Applications of Life Course Theory to MCH 3. The fetal origins of adult disease Bleker, L. S., et al. (2021). "Cohort profile: the Dutch famine birth cohort (DFBC)—a prospective birth cohort study in the Netherlands." BMJ Open 11(3): e042078. Contemporary Applications of Life Course Theory to MCH 3. The fetal origins of adult disease • Dutch famine birth cohort study main findings Study finds PTSD effects may linger in body chemistry of next generation of Holocaust survivors [6:16]: https://www.youtube.com/watch?v=zV9sya4F5KQ&ab_channel=calgaryunitedway Boekelheide, K., et al. (2012). "Predicting later-life outcomes of early-life exposures." Environmental health perspectives 120(10): 1353-1361. Contemporary Applications of Life Course Theory to MCH 3. The fetal origins of adult disease • Dutch famine birth cohort study main findings Grandfather Exposed to Dutch Famine as an adult Father Exposed to Dutch Famine as a fetus Grandson Higher weights and BMIs in adulthood than those born to unexposed No such association was found for children of mothers exposed to the famine as a fetus Policy Implications • Need to expand strategies for improving perinatal health to a focus on the overall health of women, regardless of childbearing history or plans • Focusing on early life health and development regardless of gender is essential • Need for comprehensive health care services for women and their families over the entire life span • Integration with community-based programs may be necessary to reach women without access to the health care system who are often at highest risk • Intensive services should be focused on specific lifespan points/periods Question Bank • Why are adverse childhood experiences important to study in the MCH context? Housekeeping • Short HW 1 open; due 14th Sept., 1:00 pm