Key to infant health: reducing stress on mom before pregnancy

A consistent theme has emerged from the federal Healthy Start program since its founding in 1991: Infant mortality is not tackled during the 9 months of a woman’s pregnancy alone.

“If we really want to improve pregnancy outcomes and reduce infant mortality in this country, we need to start improving women’s health before pregnancy,” said Dr. Michael Lu, the program’s director. 

Accordingly, Lu is listening to program managers nationwide to chart a course for the third major reboot of the program, “Healthy Start 3.0.”

Healthy Start is the federal government’s signature program focused on reducing infant mortality. Not to be confused with the state education program of the same name, it is funded at just under $105 million nationwide and was reauthorized through 2013 with solid bipartisan support.

Lu, a medical doctor and former UCLA professor who has been a leading researcher on infant mortality, says much of the discussion with Health Start programs has centered on a reduction of “allostatic load.” He and other experts believe African American women have shouldered it in disproportion to other women.

Allostatic load is essentially stress, and Lu’s work joins a body of research over many years tracing the reproductive health of women directly to such anxiety. Many women don’t need research to tell them that familial, social and economic worry can affect a pregnancy. 

Lu emphasizes, with other researchers, that the burden is not only generated during child-bearing years. He says it begins when women are children themselves.

If a child grows up in a community where there are few protections and many risks, the load takes shape. If puberty is disproportionately marked by dangerous peer pressure and lack of opportunity, the load gets heavier. If pregnancy is dominated by worry over how you will give your child a safer upbringing than your own, the load can become too heavy. 

Coupled with poor access to health care, it can result in fetal loss, premature birth, low birth weights, and poor health behaviors, all directly tied to high infant mortality rates, said Lu.

Lu’s bid to influence that life course starts with emphasis on the expanded medical coverage offered by health reform. He says consistent medical coverage that offers care before child-bearing years, as well as between pregnancies, is the most direct path to reducing infant deaths.

“I really think it’s going to be the game changer,” Lu said of the health law. 

“Millions of women will gain access to health care when they are not pregnant, improving women’s health not only during their nine months of pregnancy, but across their entire life course.”

Further, Lu has urged establishing development zones in communities with high infant mortality rates -- using business promotion, job training, financial literacy and asset development for families to build a more promising community.

Alameda County health officials have shared his enthusiasm for the approach and are already planning a framework to establish such development zones. 

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