MatTrack: The impact of preconception maternal weight trajectories on maternal, pregnancy, and child outcomes

MatTrack：孕前母亲体重轨迹对孕产妇、妊娠和儿童结局的影响

• 批准号: 10653956
• 负责人: Janne Boone-Heinonen
• 金额: $ 64.09万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10653956
• 关键词: 3 year old; Academy; Affect; Benefits and Risks; Birth; Birth Weight; Body Weight Changes; Body Weight decreased; Body mass index; Caring; Cesarean section; Child; Childhood; Classification; Clinical; Conceptions; Data; Diabetes Mellitus; Diagnosis; Dietary Intervention; Environment; Ethnic Origin; Ethnic Population; Future; Gestational Age; Gestational Diabetes; Growth; Guidelines; Health; Height; Hormonal; Hypertension; Infant; Intervention; Intervention Trial; Length; Literature; Longterm Follow-up; Maintenance; Maternal and Child Health; Measures; Mediating; Medical Records; Medicine; Metabolic; Mothers; Obesity; Observational Study; Outcome; Overweight; Pattern; Perinatal; Population; Postpartum Period; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Premature Birth; Race; Recommendation; Research; Research Personnel; Risk; Risk Reduction; Sampling; Shapes; Small for Gestational Age Infant; Spontaneous abortion; Subgroup; Testing; Underweight; Weight; Weight Gain; Weight maintenance regimen; Weights and Measures; Woman; Women' s Health; Work; adverse birth outcomes; adverse outcome; adverse pregnancy outcome; antenatal; clinical data warehouse; clinical risk; critical period; early pregnancy; evidence base; experience; follow-up; gestational weight gain; healthy weight; high body mass index; high risk; improved; improved outcome; lifestyle intervention; maternal weight; post pregnancy; postpartum weight; pregnancy disorder; pregnancy hypertension; pregnant; prepregnancy; programs; risk minimization; socioeconomics; success; treatment arm

PROJECT SUMMARY/ABSTRACT: Elevated body mass index (BMI) at pregnancy onset and excessive gestational weight gain (GWG) are consistently associated with adverse pregnancy and child outcomes. Diet and lifestyle interventions during pregnancy have had limited success in reducing GWG or postpartum weight retention (PPWR), with no improvement in perinatal or childhood outcomes. Therefore, multiple organizations recommend that women attain a healthy weight before pregnancy. However, the benefit and risks for mother and child extending beyond delivery, optimal timing of preconception weight change, and how risks and benefits of preconception weight loss differ across clinical subgroups are currently unknown. Our preliminary data suggest that the weight trajectories upon which women enter pregnancy (loss, maintenance, or gain) may impact the hormonal milieu of early pregnancy as well as the amount of GWG and PPWR. The objective of this study is to examine the impact of weight trajectories in the immediate preconception period (within 2 years before pregnancy) on GWG, PPWR, pregnancy outcomes, and child growth. Our central hypothesis is that preconception weight change toward a normal BMI reduces risk of adverse pregnancy and birth outcomes by improving pre-pregnancy weight status, but may increase GWG, which then increases risks of outcomes sensitive to GWG (PPWR, large for gestational age, infant weight gain, child BMI). We further hypothesize that these associations are strongest among women with more extreme BMI and for more rapid weight change occurring closer to pregnancy. To test this hypothesis, we will leverage a transcontinental clinical data warehouse spanning almost 20 years with the weight and pregnancy data of more than 130,000 racially, ethnically, and socioeconomically diverse women, and weight and length/height data of their children through age 3 years. We will determine the relationship between maternal preconception weight trajectories and GWG (total and trimester-specific) and PPWR at 6 weeks and 12 months postpartum, risk of adverse pregnancy outcomes (gestational diabetes, gestational hypertension/preeclampsia, and cesarean section) and child outcomes (preterm birth, size for gestational age at birth, infant growth trajectory, and BMI at 3 years of age); and the degree to which these associations are mediated by GWG. For each aim, we will test the hypotheses within pre-pregnancy BMI classifications, high risk clinical subgroups (e.g., pre-existing diabetes, hypertension) and racial/ethnic subgroups. Our findings will inform preconception weight management recommendations and shape the future of preconception and antenatal weight management research.

项目摘要/摘要： 妊娠发作时体重指数（BMI）升高，妊娠体重增加过多（GWG）为 始终与不良怀孕和儿童结局有关。饮食和生活方式干预 怀孕在减少GWG或产后保留（PPWR）方面取得了有限的成功，没有 围产期或童年结局的改善。因此，多个组织建议女性 怀孕前会达到健康的体重。但是，延长母亲和儿童的利益和风险 除了交付，预选重量重量的最佳时机以及如何风险和好处 目前尚不清楚临床亚组的预雄性体重减轻不同。我们的初步数据 建议女性进入怀孕的体重轨迹（损失，维护或增益）可能 影响早期怀孕的激素环境以及GWG和PPWR的数量。目的 这项研究是在直接的先入时期检查体重轨迹的影响（在2个之内 怀孕前几年）在GWG，PPWR，妊娠结局和儿童成长方面。我们的中心假设是 预配在正常的BMI变化会降低妊娠和出生的风险 通过提高孕前体重状况的结果，但可能会增加GWG，从而增加 对GWG敏感的结果（PPWR，胎龄，婴儿体重增加，儿童BMI）。我们进一步 假设这些关联在BMI更极端的女性中最强，并且更快 体重变化更接近怀孕。为了检验这一假设，我们将利用跨陆 临床数据仓库跨越近20年，重量和妊娠数据超过130,000 在种族，种族和社会经济上多样化的妇女以及孩子的体重和长度/身高数据 到3岁。我们将确定孕产妇先入重量轨迹之间的关系 以及GWG（总特定于三个月）和PPWR，在产后6周零12个月，不良风险 妊娠结局（妊娠糖尿病，妊娠高血压/先兆子痫和剖宫产） 和儿童成果（早产，出生时胎龄的大小，婴儿生长轨迹和BMI 3 年龄）；以及这些关联是由GWG介导的程度。对于每个目标，我们将测试 怀孕前BMI分类，高风险临床亚组中的假设（例如 糖尿病，高血压）和种族/族裔亚组。我们的发现将为先选的体重提供信息 管理建议并塑造祖先和产前体重管理的未来 研究。