Translating developmental origins of health and disease in practice: health care providers’ perspectives

A discussion of non-modifiable (or less easily modified factors) may cause undue stress to the parents, which in itself is associated or may be associated with undesirable DOHAD outcomes.2–4 Finally, there is a need to identify a clinical threshold to identify developmental vulnerability in the child by combining the effect size of each risk factor, perhaps in a similar fashion to the Framingham index for cardiac vulnerability. [...]a father should be aware at the pre-conception stage that older paternal age can increase developmental vulnerability to neurodevelopmental disorders in his offspring.5–7 Another example is the impact of depression, anxiety, and other psychiatric disorders on the baby’s well-being both in utero and later on during postnatal life.8,9 The risks and benefits of mental health treatments (e.g., antidepressants vs. psychotherapy) must also be weighed against the negative impact of mental health disorders on the function of the whole family.10 Not only should we, as clinicians, make particular efforts to provide balanced information to our patients that includes both risks and benefits, but we should also be aware of individual vs. societal responsibility in addressing reproductive risk factors and developmental outcomes. Targeting critical developmental windows of intervention in vulnerable populations Many biopsychosocial conditions can only be altered through major efforts from both individual families and changes in social policy. [...]the only option for many clinicians is to identify and follow vulnerable families, with a particular emphasis on critical developmental stages when intervention is most likely to yield the greatest benefits, because of enhanced neuroplasticity or because of a critical transition when mastery in a wide set of cognitive and behavioral skills is required of the child.