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 Pregnancy Reproductive Potential Age

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

4. Life Course Perspective  Early programming  Cumulative pathways

5. Early Programming

7. Barker Hypothesis Birth Weight and Coronary Heart Disease Age Adjusted Relative Risk Rich-Edwards 1997

8. Barker Hypothesis Birth Weight and Hypertension Law 1993

9. Barker Hypothesis Birth Weight and Insulin Resistance Syndrome Odds ratio adjusted for BMI Barker 1993

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

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

13. Scientific American 2003

14. Epigenetics

15. Cumulative Pathways

16. Allostasis McEwen 1998

17. Allostasis McEwen 1998

18. Stress and Allostastic Load McEwen 1998

19. Allostasis Chikanza 2000

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

21. Life Course Perspective Prenatal Care Poor Birth Outcome 05 Pregnancy Puberty Internatal Care Primary Care for Women Early Intervention Prenatal Care Primary Care for Children Age White African American Lu 2003

22. Closing Black-White Gap in Birth Outcomes A 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

23. Prenatal Programming  How to make a smart and healthy baby for life?

24. Prenatal Programming  Brain development  Immune development  Metabolic development

25. Prenatal Programming  Is there prenatal programming of school readiness?

26. Prenatal Programming  Is there prenatal programming of obesity?