Prenatal Care to the Life Course Perspective

1
(No Transcript)
2
(No Transcript)
3
(No Transcript)
4
(No Transcript)
5
(No Transcript)
6
(No Transcript)
7
(No Transcript)
8
Diabetes
Mild
Severe
Mother Fetus Adult Pregnant Fetus Adult
Hyperactive B-cells Hyperinsulinemia Macrosomia
Overstimulated B-cells Hypoinsulinemia Microsomia
Deficient insulin response Impaired glucose
tolerance
Excessive insulin response Insulin resistance
Gestational Diabetes
Hyperinsulinemia Macrosomia
Impaired glucose tolerance
Aerts L et al. Intra-uterine transmission of
disease. Placenta 200324905-911.
9
Nurses Health Study
Curhan et al., Rich-Edwards et al.
10
From Life Course Health Development A
Framework to Guide Research, Practice and
Reform Neal Halfon, MD, MPH Helen M. DuPlessis,
MD, MPH
11

• Stressed
• Increased cardiac output
• Increased available
• Glucose
• Enhanced immune
• Functions
• Growth of neurons in
• hippocampus
• prefrontal cortex

• Stressed Out
• Hypertension
• cardiovascular diseases
• Glucose intolerance
• insulin resistance
• Infection inflammation
• Atrophy death of
• neurons in hippocampus
• prefrontal cortex

12
It is unreasonable to expect that people will
change their behavior easily when so many forces
in the social, cultural, and physical
environment conspire against such
change. --Institute of Medicine
13
(No Transcript)
14
(No Transcript)
15

• Prospective Evaluation and Record
• Health profile summary
• Current health status
• Health risk analysis
• Genetic
• Environmental
• Lifestyle
• 1-year health plan
• 5-year health plan

• Traditional medical evaluation and record
• Chief complaint
• History of illness
• Past medical history
• Family history
• Social History
• Physical exam
• Diagnostic tests
• Assessment and plan

16
Source Snyderman R. AAP presidential address
the AAP and the transformation of medicine.
Journal of Clinical Investigation. 2004114(8)
1169-1173 (suppl)
17
(No Transcript)