Stress before and during pregnancy leads to chronic diseases

Health officials said on Sept. 8. that there are grave differences in women and babies’ health in Multnomah County and those differences cause chronic disease and health problems far into adulthood.

In a presentation that the Board of County commissioners called “compelling’’ and a “rallying cry,’’  Dr. Larry Wallack of the Moore Institute for Health said the risk of disease is established much earlier than previously thought. The way the environment affects a developing baby  gets “under our skin,’’ from poor nutrition to the stress of poor housing and joblessness.

“We all thought disease was a product of the genes we inherited and our lifestyle as adults. So with heart disease, for instance, a lot of our programs are focused on middle-aged and older people,’’ said Wallack, a Portland State University professor who is developing a program with Oregon Health & Sciences University.  “But the reality is, the risk of heart disease is set in the first 1,000 days. This is revolutionary.’’

Wallack spoke at a briefing of the County’s

One of the Health Department’s core roles in Multnomah County is to track the health of individuals and groups to identify and address community health problems. The presentation focused on how stressors like racism and poverty lead to poorer birth outcomes -- and lifelong health problems.

The Health Department reviewed thousands of data points settling on 37 indicators. The findings, delivered by Aileen Alfonso Duldulao, an epidemiologist with the Health Department, revealed racial and ethnic disparities in almost every measure, from family planning to preconception, from birth outcomes to infant care. Among the findings:

• Two in three pregnancies are intended, but a lower percentage of women of color had intended pregnancies.
• Compared to white babies, more babies of color had low birthweight, were small for their age, and arrived before term.
• Infant mortality rate among college educated African American women is higher than women who do not have a high school diploma.

“As a woman of color, who is contemplating becoming a mother, when I review these findings, my heart breaks over and over again,’’ Duldulao said. “This is despite the fact that these numbers have been reflected in my own reality of growing up and living in immigrant communities of color where babies are born too small and too soon despite individual and communal efforts.”

Duldulao says the risk isn’t from being African American, Latino or being Pacific Islander, but historic legacies of racism and trauma that have fostered health disparities. Yet, these same communities also have a wealth of protective factors and cultural pride, social support and traditional ways of living, eating and sharing knowledge.

Dr. Paul Lewis, the Multnomah County Health Officer and a practicing pediatrician, said when he arrived to practice in Portland, he was still remembers being struck by feeling like most of his patients in the neonatal intensive care unit were of color and all of them were poor.

“It would be easy to blame the mom for living in poverty or having less education, but even if you take that into account, outcomes are still worse for even educated women of color. Something else is going on.”

Lewis said that pregnancy and early childhood does not occur in a vacuum and that everyday, we are all interacting with families, close friends, and where we shop, work and go to school.

He called the Board of County Commissioners "a critical part'' of the issue as nearly all the public policy decisions they face ultimately influence health.

Health Department Director Joanne Fuller said the county's role in making Multnomah County a healthy place for mothers and children goes far beyond the Health Department and must be a cross-department, government-wide effort.

“The healthy development of our children and the health of their moms and families is the most critical work,’’ Fuller said.