Reducing intergenerational obesity and diabetes risk.
Reducing intergenerational obesity and diabetes risk.
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降低代际肥胖和糖尿病风险。
DOI：
10.1007/s00125-020-05341-y
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发表时间：
2021-03
期刊：
影响因子：
8.2
通讯作者：
Ritchie ND
中科院分区：
文献类型：
--
作者：
Sauder KA;Ritchie ND
为了解决肥胖症和糖尿病的代际传播问题，似乎迫切需要促进育龄妇女健康的战略。在这篇叙述性综述中，我们总结了从许多产前临床试验中学到的东西，讨论了从孕前临床试验中获得的新证据，并强调了持续存在的差距和关键的未来方向。大多数试验测试了产前干预，导致妊娠期体重增加约1 kg，并将妊娠期糖尿病减少20- 30%。这些干预措施也减少了20-40%的巨大儿，但对出生时或以后的其他后代结果几乎没有影响。测试孕前干预措施的试验要少得多，几乎所有的试验都是为了提高超重或肥胖不孕妇女的受孕率或活产率，而不是降低不同人群的代际风险。孕前试验成功地减轻了3-9公斤的体重，并在干预结束时改善了葡萄糖稳态和胰岛素抵抗的标志物，但效果是否持续到受孕尚不清楚。很少有研究报告出生时及以后的后代结果，迄今为止没有证据表明对后代肥胖或糖尿病风险有有益影响。应优先考虑进一步努力制定有效和可扩展的战略，以降低怀孕前肥胖和糖尿病的风险，特别是对于肥胖和糖尿病风险极高的多样化和资源不足的人群。未来的临床试验应包括具有高传播潜力的干预措施，多样化的人群，从招募到受孕和怀孕的彻底的母体表型，以及从出生开始，包括到第三代的后代肥胖和糖尿病风险的严格评估。
To address the intergenerational transmission of obesity and diabetes, strategies promoting the health of women of reproductive age appear to be urgently needed. In this narrative review, we summarise what has been learned from many prenatal clinical trials, discuss the emerging evidence from preconception clinical trials and highlight persistent gaps and critical future directions. Most trials tested prenatal interventions that resulted in a limited gestational weight gain of ~1 kg and reduced gestational diabetes by 20–30%. These interventions also reduced macrosomia by 20–40% but had little-to-no impact on other offspring outcomes at birth or beyond. Far fewer trials tested preconception interventions, with almost all designed to improve conception or live-birth rates in overweight or obese women with infertility rather than reduce intergenerational risks in diverse populations. Preconception trials have successfully reduced weight by 3–9 kg and improved markers of glucose homeostasis and insulin resistance by the end of the intervention but whether effects were sustained to conception is unclear. Very few studies have reported offspring outcomes at birth and beyond, with no evidence thus far of beneficial effects on offspring obesity or diabetes risks. Further efforts to develop effective and scalable strategies to reduce risk of obesity and diabetes before conception should be prioritised, especially for diverse and under-resourced populations at disparately high risk of obesity and diabetes. Future clinical trials should include interventions with high potential for dissemination, diverse populations, thorough maternal phenotyping from enrolment through to conception and pregnancy, and rigorous assessment of offspring obesity and diabetes risks from birth onwards, including into the third generation.
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影响因子：
33.9
作者：
Divers, Jasmin;Mayer-Davis, Elizabeth J.;Wagenknecht, Lynne E.
通讯作者：
Wagenknecht, Lynne E.
DOI：
10.1016/s0002-9378(03)00828-7
发表时间：
2003-12-01
影响因子：
9.8
作者：
Catalano, PM;Thomas, A;Amini, SB
通讯作者：
Amini, SB
影响因子：
7.7
作者：
Dabelea, D;Hanson, RL;Knowler, WC
通讯作者：
Knowler, WC
DOI：
10.1111/1471-0528.13796
发表时间：
2016-01-01
影响因子：
5.8
作者：
Dodd, J. M.;Deussen, A. R.;Robinson, J. S.
通讯作者：
Robinson, J. S.
影响因子：
15.8
作者：
Akhter, Zainab;Rankin, Judith;Heslehurst, Nicola
通讯作者：
Heslehurst, Nicola