MRC Unit for Lifelong Health and Ageing, Department of Epidemiology and Public Health, University College and Royal Free Medical School, 33 Bedford Place, London WC1B 5JU, United Kingdom.
Maturitas. 2010 Feb;65(2):92-7. doi: 10.1016/j.maturitas.2009.12.009. Epub 2010 Jan 15.
Taking a life course approach to the study of reproductive health involves the investigation of factors across life and, also across generations, that influence the timing of menarche, fertility, pregnancy outcomes, gynaecological disorders, and age at menopause. It also recognises the important influence of reproductive health on chronic disease risk in later life. Published literature supports the use of an integrated life course approach to study reproductive health, which examines the whole life course, considers the continuity of reproductive health and the interrelationship between the different markers of this. This is in contrast to more traditional approaches that tend to focus only on contemporary risk factors and which consider each marker of reproductive health separately. For instance, we found evidence linking early life factors such as growth, socioeconomic conditions, and parental divorce with ages at menarche and menopause, although the nature of the relationship differs. We discuss the different theoretical models that are used within life course epidemiology and which postulate pathways linking exposures across the life course to health outcomes, using examples of relevance to the study of reproductive health. These highlight the importance of examining timing of exposures, such as during critical periods in early life, and the temporal order of exposures. How life course frameworks of reproductive health can be developed to help identify hypotheses to be tested is also demonstrated. This approach has implications for the development of effective health policy that moves beyond identifying not only the type of intervention but also the most appropriate time across life to intervene.
采用生命历程方法研究生殖健康，需要调查影响初潮、生育力、妊娠结局、妇科疾病和绝经年龄的生命各阶段和代际因素。它还认识到生殖健康对晚年慢性疾病风险的重要影响。已发表的文献支持使用综合生命历程方法研究生殖健康，该方法检查整个生命历程，考虑生殖健康的连续性以及生殖健康不同标志之间的相互关系。这与更传统的方法形成对比，后者往往只关注当代风险因素，并分别考虑生殖健康的每个标志。例如，我们发现有证据表明，生命早期的因素，如生长、社会经济条件和父母离婚，与初潮和绝经年龄有关，尽管其关系的性质不同。我们讨论了生命历程流行病学中使用的不同理论模型，这些模型假设了将生命历程中的暴露因素与健康结果联系起来的途径，并用与生殖健康研究相关的例子来说明。这些例子强调了检查暴露时间（例如在生命早期的关键时期）和暴露时间顺序的重要性。还展示了如何开发生殖健康的生命历程框架来帮助确定需要检验的假设。这种方法对制定有效的卫生政策具有重要意义，因为它不仅要确定干预的类型，还要确定在生命各阶段进行干预的最合适时间。
