Pregnancy-Related Risk Factors and Glucose Intolerance in Women during Midlife

中年女性妊娠相关危险因素和葡萄糖不耐受

基本信息

批准号：
8943543
负责人：
Erica Pauline Gunderson
金额：
$ 68.04万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-08-27 至 2019-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8943543
关键词：
Affect Age Ancillary Study Area Behavior Birth Birth Weight Body Weight Body Weight Changes Central obesity Coronary Artery Risk Development in Young Adults Study Coronary artery Data Data Collection Data Set Deterioration Development Diabetes Mellitus Diabetes prevention Dyslipidemias Elderly Enrollment Funding Future Gestational Age Glucose Intolerance Glycosylated hemoglobin A Goals Health Heart Diseases High Risk Woman Hour Individual Influentials Institute of Medicine (U.S.)Insulin Resistance Intervention Life Style Link Lipids Measurement Measures Medical Records Metabolic Monitor Morbidity - disease rate National Heart, Lung, and Blood Institute Non-Insulin-Dependent Diabetes Mellitus OGTT Obesity Outcome Overweight Perinatal Preconception Care Prediabetes syndrome Pregnancy Pregnancy Outcome Premature Birth Prevention Prevention strategy Randomized Recording of previous events Reporting Research Risk Risk Factors Site-Directed Mutagenesis Stratification Testing Time Translating Weight Weight Gain Woman Women&apos s Health cardiometabolic risk child bearing cohort diabetes risk disorder risk fasting glucose gestational weight gain glucose tolerance high risk insight men middle age mortality obesity prevention obesity risk offspring oral glucose tolerance perinatal outcomes prevent prospective public health relevance reproductive young adult

项目摘要

DESCRIPTION (provided by applicant): Over 50% of U.S. women enter pregnancy overweight or obese, and almost 50% gain more weight during pregnancy than is recommended. Maternal excess adiposity not only leads to greater perinatal morbidity and mortality, but higher weight retention and greater disease risk. Randomized interventions to modify gestational weight gain (GWG), especially among overweight or obese women, have been largely ineffective. Excess maternal adiposity before, during and after pregnancy may result in worse cardiometabolic health for women during the childbearing years. These periods are referred to as "pregnancy-related risk factor changes" that involve increased adiposity, as well as alterations in metabolic risk factors during the preconception, gestational, and post-pregnancy periods. We hypothesize that maternal cardiometabolic risk factor changes (i.e., "trajectories") before pregnancy may increase the risk of excessive GWG and adverse perinatal outcomes (APOs), and that maternal BMI and subsequent weight changes throughout the childbearing years may adversely affect maternal cardiometabolic risk factor development post-pregnancy, and thereby accelerate the progression to glucose intolerance in women during midlife. We propose an ancillary study to the NHLBI funded CARDIA Study, a multi-center longitudinal cohort of 5,115 black and white women and men (18-30 y) enrolled in 1985-1986, and re-examined up to 8 times as of 2011 with retention of 72% of the surviving cohort. Exams included metabolic risk factor (body weight, waist girth, fasting glucose and lipids) measurements every 2-5 years (both before and after pregnancies) in 1986-2011, including oral glucose tolerance testing via 2-hr 75 g OGTTs up to four times from 1996-2011. Women also reported GWG and perinatal outcomes (birth weight, gestational age, GDM, preterm birth) which were validated via medical record abstractions. The proposed study will coincide with the Year 30 CARDIA exam (June 2015-2016) to collect new data on reproductive and offspring health histories, administer a fifth 2-hr 75 g OGTT and measure HbA1c. This study leverages the unique CARDIA datasets that include prospective risk factor measurements from before to after pregnancies, existing GWG and APO data, and additional new data collection to assess progression to glucose tolerance in women. The specific aims are: 1) To evaluate the impact of pre-pregnancy cardiometabolic risk factor trajectories on pregnancy outcomes; 2) To characterize the contributions of weight changes from before, during and after pregnancy to the development of cardiometabolic risk factors for glucose intolerance and 3) To evaluate the independent associations of maternal pre-pregnancy BMI, GWG, and post-pregnancy weight changes on the progression to glucose intolerance. These findings can be translated into individual risk stratification to optimize prevention efforts by identifying women at high- risk fo perinatal morbidity, and subsequent progression to glucose intolerance during the reproductive years.

描述（由申请人提供）：超过 50% 的美国女性在怀孕时体重超重或肥胖，几乎 50% 的女性在怀孕期间体重增加超过建议的体重，这不仅导致围产期发病率和死亡率更高，而且体重滞留和体重增加也更高。改变妊娠期体重增加（GWG）的随机干预措施，特别是对于超重或肥胖的女性，在产前、产中和产后基本上没有效果。怀孕可能会导致育龄妇女的心脏代谢健康状况恶化，这些时期被称为“妊娠相关危险因素变化”，包括肥胖增加以及孕前、妊娠和产后代谢危险因素的变化。我们发现，怀孕前母亲心脏代谢危险因素的变化（即“轨迹”）可能会增加 GWG 过多和不良围产期结局 (APO) 的风险，并且母亲整个育龄期的 BMI 和随后的体重变化可能会对孕后母亲心脏代谢危险因素的发展产生不利影响，从而加速女性中年期间葡萄糖不耐症的进展。我们建议对 NHLBI 资助的多中心 CARDIA 研究进行一项辅助研究。 1985-1986 年登记的 5,115 名黑人和白人女性和男性（18-30 岁）的纵向队列，截至目前重新检查了多达 8 次2011 年，72% 的幸存者在 1986 年至 2011 年期间每 2-5 年（怀孕前和怀孕后）进行一次代谢危险因素（体重、腰围、空腹血糖和血脂）测量，包括口服葡萄糖耐量。从 1996 年到 2011 年，女性还通过 2 小时 75 g OGTT 进行了四次测试，报告了 GWG 和围产期结局（出生体重、拟议的研究将与 30 年 CARDIA 考试（2015 年 6 月至 2016 年）同时进行，以收集有关生殖和后代健康史的新数据，并进行第五次 2 小时的检查。 75 g OGTT 并测量 HbA1c 本研究利用独特的 CARDIA 数据集，其中包括怀孕前后的前瞻性风险因素测量、现有的 GWG 和 APO 数据，以及收集额外的新数据来评估女性葡萄糖耐量的进展，具体目的是：1）评估孕前心脏代谢危险因素轨迹对妊娠结局的影响；2）描述孕前和孕期体重变化的影响。 3) 评估母亲孕前 BMI、GWG 和孕后体重变化与葡萄糖耐受不良进展的独立关联。这些发现可以转化为个体风险分层，通过识别围产期发病率高风险的妇女以及随后在育龄期进展为葡萄糖不耐受的妇女来优化预防工作。