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Integrated perinatal health framework
Abstract
Background Despite great strides in improving prenatal care utilization among American women, key perinatal indicators have remained stagnant or worsened in the past decade, and the United States continues to rank near the bottom compared to other developed countries. A new approach is needed if we are to achieve improvements in perinatal health.Methods To propose a new framework that integrates a "life span" approach with a multiple determinants model.Results We recognize that (1) powerful influences on outcome occur long before pregnancy begins; (2) pregnancy outcome is shaped by social, psychological, behavioral, environmental, and biological forces; and (3) the demography of pregnancy has changed dramatically in the last few decades with more women delaying their first birth. Approaches that simultaneously consider the entire life span as well as multiple determinants may need to be adopted. We propose a framework that integrates these approaches and is supported by the research literature. The life span perspective focuses attention toward the preconceptional and interconceptional periods as targets for intervention in improving perinatal health. The multiple determinants model distinguishes among concepts of disease, health and functioning, and well-being for both women and their offspring.Conclusions Our intent is to influence how policymakers, public health professionals, clinicians, and researchers approach perinatal health.
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“High levels of stress and associated mental illnesses affect maternal and fetal outcomes, and also long-term offspring health into adulthood.”
From Perinatal mental illness: Definition, description and aetiology (2014) · cites this paper as [6]
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Metadata
- Authors
- Misra, D. P., Guyer, B., & Allston, A.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Misra, Dawn P
- Venue
- American Journal of Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 2003-07
- Volume
- 25
- Issue
- 1
- Pages
- 65-75
- ISSN
- 0749-3797 (ISSN-L)
- OpenAlex
- W2105986652
- Cited by
- 235
- References
- 199
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 6 · 2023: 10 · 2022: 9 · 2021: 8 · 2020: 9 · 2019: 15 · 2018: 13 · 2017: 17 · 2016: 11 · 2015: 14 · 2014: 13 · 2013: 14 · 2012: 13
- FWCI
- 9.92
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Preventive Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Public Health Service (U93 MC 00101)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- perinatal health, preconception care, pregnancy outcomes, social determinants of health, maternal health, child health, health policy framework
- MeSH terms
- Family Planning Services, Female, Health Promotion, Humans, Life Expectancy, Maternal Health Services, Maternal Welfare, Policy Making, Pregnancy, Pregnancy Outcome, United States, Preconception Care, Models, Organizational
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