Abstract
Lifecourse-informed models of health fundamentally challenge simple biomedical models, introducing new ways of thinking about how diseases develop. This paper considers the broad implications of lifecourse theory for the maternal and child health (MCH) research agenda. The Lifecourse Health Development model provides an organizing framework for a synthesis of the existing literature on lifecourse health and identification of gaps in knowledge. Priority areas identified for MCH research in order to close these knowledge gaps include: epigenetic mechanisms and their potential mutability; peri-conception as a critical and sensitive period for environmental exposures; maternal health prior to pregnancy; the role of the placenta as an important regulator of the intra-uterine environment; and ways to strengthen early mother–child interactions. Addressing knowledge gaps will require an emphasis on longitudinal rather than cross-sectional studies, long-term (lifetime) rather than short-term perspectives, datasets that include socio-demographic, biologic and genetic data on the same subjects rather than discipline-specific studies, measurement and study of positive health as well as disease states, and study of multi-rather than single generational cohorts. Adoption of a lifecourse-informed MCH research agenda requires a shift in focus from single cause-single disease epidemiologic inquiry to one that addresses multiple causes and outcomes. Investigators need additional training in effective interdisciplinary collaboration, advanced research methodology and higher-level statistical modeling. Advancing a life course health development research agenda in MCH will be foundational to the nation’s long-term health.
Similar content being viewed by others
References
Elder, G. H. (1998). The life course as developmental theory. Child Development, 69(1), 1–12.
Smith, G. D., & Kuh, D. (2001). Commentary: William Ogilvy Kermack and the childhood origins of adult health and disease. International Journal of Epidemiology, 30(4), 696–703.
Elder, G. H., Johnson, M. K., & Crosnoe, R. (2003). The emergence and development of life course theory. In J. T. Mortimer & M. J. Shanahan (Eds.), Handbook of the life course. New York: Kluwer Academic/Plenum Publishers.
Barker, D. J., Osmond, C., Golding, J., et al. (1989). Growth in utero, blood pressure in childhood and adult life, and mortality from cardiovascular disease. British Medical Journal, 298(6673), 564–567.
Barker, D. J., Winter, P. D., Osmond, C., et al. (1989). Weight in infancy and death from ischaemic heart disease. Lancet, 2(8663), 577–580.
Barker, D. (2003). The midwife, the coincidence, and the hypothesis. British Medical Journal, 327(7429), 1428–1430.
Barker, D. J. (2007). The origins of the developmental origins theory. Journal of Internal Medicine, 261(5), 412–417.
Eriksson, J. G. (2011). Early growth and coronary heart disease and type 2 diabetes: Findings from the Helsinki Birth Cohort Study (HBCS). The American Journal of Clinical Nutrition, 94(6 Suppl), 1799S–1802S.
Osmond, C., Kajantie, E., Forsen, T. J., et al. (2007). Infant growth and stroke in adult life: The Helsinki Birth Cohort Study. Stroke, 38(2), 264–270.
Risnes, K. R., Vatten, L. J., Baker, J. L., et al. (2011). Birthweight and mortality in adulthood: A systematic review and meta-analysis. International Journal of Epidemiology, 40(3), 647–661.
Ben-Shlomo, Y., & Kuh, D. (2002). A life course approach to chronic disease epidemiology: Conceptual models, empirical challenges and interdisciplinary perspectives. International Journal of Epidemiology, 31(2), 285–293.
Gluckman, P. D., Hanson, M. A., Cooper, C., et al. (2008). Effect of in utero and early-life conditions on adult health and disease. New England Journal of Medicine, 359(1), 61–73.
Wadsworth, M. E. J. (1999). Early life. In M. Marmot & R. G. Wilkinson (Eds.), Social determinants of health (pp. 44–63). New York: Oxford Press.
Acheson, D., Barker, D., Chamber, J., et al. (1998). Report of the independent inquiry into inequalities in health (the acheson report). London: The Stationary Office.
Aylot, J., Brown, I., Copeland, R., et al. (2008). Tackling obesities: The Foresight Report and implications for local government. Sheffield, South Yorkshire: Sheffield Hallam University, Faculty of Health and Wellbeing.
Foresight Mental Capital and Wellbeing Project. (2008). Final project report—executive summary. London: The Government Office for Science.
Marmot, M. (2010). The Marmot review: Strategic review of health inequalities in England post-2010. London: The Marmot Review.
Committee on Breast Cancer and the Environment, Institute of Medicine. (2011). Breast cancer and the environment: A life course approach. Washington, DC: Institute of Medicine of the National Academy of Sciences. Available at: http://www.iom.edu/~/media/Files/Report%20Files/2011/Breast-Cancer-Environment/BreastCancerReportbrief_2.pdf.
Committee on Leading Health Indicators for Healthy People 2020, Institute of Medicine. (2011). Leading health indicators for Healthy People 2020: Letter report. Washington, DC: Institute of Medicine of the National Academy of Sciences. Available at: http://www.iom.edu/~/media/Files/Report%20Files/2011/Leading-Health-Indicators-for-Healthy-People-2020/Leading%20Health%20Indicators%202011%20Report%20Brief.pdf.
Hertzman, C. (1994). The lifelong impact of childhood experiences—a population health perspective. Daedalus, 123(4), 167–180.
Power, C., & Hertzman, C. (1997). Social and biological pathways linking early life and adult disease. British Medical Bulletin, 53(1), 210–221.
Hertzman, C. (1999). The biological embedding of early experience and its effects on health in adulthood. Annals New York Academy of Sciences, 896, 85–95.
Halfon, N., & Hochstein, M. (2002). Life course health development: An integrated framework for developing health, policy, and research. The Milbank Quarterly, 80(3), 433–479.
Lu, M. C., & Halfon, N. (2003). Racial and ethnic disparities in birth outcomes: A life-course perspective. Maternal and Child Health Journal, 7(1), 13–30.
Halfon, N., Russ, S. A., & Regalado, M. (2005). The life course health development model: A guide to children’s health care policy and practice. Zero to Three, 25(3), 4–12.
Schonkoff, J. P., Boyce, W. T., & McEwan, B. S. (2009). Neuroscience, molecular biology, and the childhood roots of health disparities: Building a new framework for health promotion and disease prevention. The Journal of the American Medical Association, 301(21), 2252–2259.
Fine, A., & Kotelchuck, M. (2010). Rethinking MCH: The life course model as an organizing framework. Washington, DC: U.S. Department of Health and Human Services Health Resources and Services Administration, Maternal and Child Health Bureau. Available at: http://mchb.hrsa.gov/lifecourse/rethinkingmchlifecourse.pdf.
Halfon, N., Inkelas, M., & Hochstein, M. (2000). The health development organization: An organizational approach to achieving child health development. The Milbank Quarterly, 78(3), 447–497 (341).
Institute of Medicine. (2004). Children’s health, the nation’s wealth. Washington, DC: The National Academies Press.
Hertzman, C., & Boyce, T. (2010). How experience gets under the skin to create gradients in developmental health. Annual Review of Public Health, 31, 329–347 (3p following 47).
Noble, K. G., Houston, S. M., Kan, E., et al. (2012). Neural correlates of socioeconomic status in the developing human brain. Developmental Science, 1–12.
Cicchetti, D. (2011). Allostatic load. Development and Psychopathology, 23(3), 723–724.
Cicchetti, D., Rogosch, F. A., Toth, S. L., et al. (2011). Normalizing the development of cortisol regulation in maltreated infants through preventive interventions. Development and Psychopathology, 23(3), 789–800.
Kuzawa, C. W., & Thayer, Z. M. (2011). Timescales of human adaptation: The role of epigenetic processes. Epigenomics, 3(2), 221–234.
Low, F. M., Gluckman, P. D., & Hanson, M. A. (2011). Developmental plasticity and epigenetic mechanisms underpinning metabolic and cardiovascular diseases. Epigenomics, 3(3), 279–294.
Meaney, M. J. (2001). Maternal care, gene expression, and the transmission of individual differences in stress reactivity across generations. Annual Review of Neuroscience, 24, 1161–1192.
Lester, B. M., Tronick, E., Nestler, E., et al. (2011). Behavioral epigenetics. Annals of the New York Academy of Sciences, 1226, 14–33.
Michels, K. B., & Waterland, M. R. (2012). The role of epigenetics in the developmental origins of health and disease. In K. B. Michels (Ed.), Epigenetic epidemiology (pp. 105–116). New York: Springer.
Borghol, N., Suderman, M., McArdle, W., et al. (2012). Associations with early-life socio-economic position in adult DNA methylation. International Journal of Epidemiology, 41(1), 62–74.
Breslau, N. (1995). Psychiatric sequelae of low birth weight. Epidemiologic Reviews, 17(1), 96–106.
Maccani, M. A., & Marsit, C. J. (2009). Epigenetics in the placenta. American Journal of Reproductive Immunology, 62(2), 78–89.
Bromer, C., Marsit, C. J., & Armstrong, D. A., et al. (2012). Genetic and epigenetic variation of the glucocorticoid receptor (nr3c1) in placenta and infant neurobehavior. Developmental Psychobiology.
Hochberg, Z., Feil, R., Constancia, M., et al. (2011). Child health, developmental plasticity, and epigenetic programming. Endocrine Reviews, 32(2), 159–224.
Gluckman, P. D., Hanson, M. A., & Buklijas, T. (2010). A conceptual framework for the developmental origins of health and disease. Journal of Developmental Origins of Health and Disease, 1(01), 6–18.
Cordero, M. I., Poirier, G. L., Marquez, C., et al. (2012). Evidence for biological roots in the transgenerational transmission of intimate partner violence. Translational Psychiatry, 2, e106.
Heijmans, B. T., Tobi, E. W., Lumey, L. H., et al. (2009). The epigenome: Archive of the prenatal environment. Epigenetics, 4(8), 526–531.
Reik, W., Dean, W., & Walter, J. (2001). Epigenetic reprogramming in mammalian development. Science, 293(5532), 1089–1093.
Reik, W., & Walter, J. (2001). Genomic imprinting: Parental influence on the genome. Nature Reviews Genetics, 2(1), 21–32.
Barker, D. J. P. (2002). Fetal programming of coronary heart disease. Trends in Endocrinology and Metabolism, 13(9), 364–368.
Adair, L. S., & Cole, T. J. (2003). Rapid child growth raises blood pressure in adolescent boys who were thin at birth. Hypertension, 41(3), 451–456.
Taveras, E. M., Rifas-Shiman, S. L., Belfort, M. B., et al. (2009). Weight status in the first 6 months of life and obesity at 3 years of age. Pediatrics, 123(4), 1177–1183.
Gillman, M. W. (2009). Childhood prevention of hypertensive cardiovascular disease. The Journal of Pediatrics, 155(2), 159–161.
Liu, S., Jones, R. N., & Glymour, M. M. (2010). Implications of lifecourse epidemiology for research on determinants of adult disease. Public Health Review, 32(2), 489–511.
Moffitt, T. E. (2005). Genetic and environmental influences on antisocial behaviors: Evidence from behavioral-genetic research. Advances in Genetics, 55, 41–104.
Jokela, M., Lehtimaki, T., & Keltikangas-Jarvinen, L. (2007). The influence of urban/rural residency on depressive symptoms is moderated by the serotonin receptor 2a gene. American Journal of Medical Genetics Part B, Neuropsychiatric Genetics, 144B(7), 918–922.
Gilbert, S. F. (2000). Developmental biology (6th ed.). Sunderland, MA: Sinauer Associates.
Gluckman, P. D., Hanson, M. A., Bateson, P., et al. (2009). Towards a new developmental synthesis: Adaptive developmental plasticity and human disease. Lancet, 373(9675), 1654–1657.
Bateson, P., & Gluckman, P. (2012). Plasticity and robustness in development and evolution. International Journal of Epidemiology, 41(1), 219–223.
Hochberg, Z. (2011). Evolutionary perspectives in child growth. Rambam Maimonides Medical Journal, 2(3), e0057.
Halfon, N., Verhoef, P. A., & Kuo, A. A. (2012). Childhood antecedents to adult cardiovascular disease. Pediatrics in Review, 33(2), 51–61.
Gottesman, I. I., & Gould, T. D. (2003). The endophenotype concept in psychiatry: Etymology and strategic intentions. The American Journal of Psychiatry, 160(4), 636–645.
Brotman, M. A., Guyer, A. E., Lawson, E. S., et al. (2008). Facial emotion labeling deficits in children and adolescents at risk for bipolar disorder. The American Journal of Psychiatry, 165(3), 385–389.
Arcaleni, E. (2006). Secular trend and regional differences in the stature of italians, 1854–1980. Economics and Human Biology, 4(1), 24–38.
Connor, N. E. (2011). Impact of fetal and neonatal malnutrition on the onset of puberty and associated noncommunicable disease risks. Adolescent Health, Medicine and Therapeutics, 2011, 15–25.
Martinson, M. L. (2012). Income inequality in health at all ages: A comparison of the United States and England. American Journal of Public Health, 102(11), 2049–2056.
Wilkinson, R. G., & Pickett, K. E. (2009). The spirit level: Why equality is better for everyone. New York: Bloomsbury Press.
Siddiqi, A., Kawachi, I., Berkman, L., et al. (2007). Variation of socioeconomic gradients in children’s developmental health across advanced capitalist societies: Analysis of 22 OECD nations. International Journal of Health Services, 37(1), 63–87.
Hertzman, C., Siddiqi, A., Hertzman, E., et al. (2010). Bucking the inequality gradient through early child development. British Medical Journal, 340, c468.
Goldman, D. P., Shang, B., Bhattacharya, J., et al. (2005). Consequences of health trends and medical innovation for the future elderly. Health Affairs, 24(Suppl 2), W5R5–W5R17.
Schadt, E. E., & Bjorkegren, J. L. (2012). New: Network-enabled wisdom in biology, medicine, and health care. Science Translational Medicine, 4(115), 115rv1.
Acknowledgments
The authors would like to thank Amy Graber for her assistance with manuscript preparation. This Research was supported in part by funding from HRSA-MCHB for the Lifecourse Research Network (LCRN) (cooperative agreement #UA6MC19803).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Russ, S.A., Larson, K., Tullis, E. et al. A Lifecourse Approach to Health Development: Implications for the Maternal and Child Health Research Agenda. Matern Child Health J 18, 497–510 (2014). https://doi.org/10.1007/s10995-013-1284-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-013-1284-z