Applications of the integrated life-course theory to improve perinatal outcomes: A review of the literature

Issues: Key maternal and child health indicators show that the United States is lagging behind other developed countries in perinatal outcomes, with important implications for health care spending and quality of life. Emerging evidence suggests that timely access and adequate utilization of prenatal services are insufficient to improve and significantly reduce disparities in perinatal outcomes. This calls for new approaches to address the implications of this challenge. This project describes the application of the life course approach to perinatal health, focusing on preterm birth, low birth weight, and gestational diabetes to improve perinatal outcomes. Description: Following our review, we developed a modified life course model to illustrate the divergent reproductive trajectories, based on the cumulative effects of the risk or protective factors individuals experience throughout their life course, with each trajectory leading to either positive or negative perinatal outcomes. Lessons Learned: The life course perspective facilitates understanding of the complex intersections of underlying factors that influence health across the lifespan, and allows for weighting the effects of these factors in their ability to affect reproductive potential and perinatal outcomes. This review ascertains the usefulness of the life course approach in providing a more cogent and well rounded framework to improve perinatal outcomes in the United States. Recommendations: Integrated and targeted health and social policy interventions are needed as early as possible, and at certain critical periods in each individual's life in order to mitigate the underlying access barriers, resources deficiencies, and overarching disparities that drive poor perinatal outcomes.