PROMISE: PReventing Obesity through healthy Maternal gestational weight gain In the Safety nEt

项目摘要 患有严重肥胖症的妇女有很高的风险发生不良的生育和儿童结局，包括儿童肥胖症。 有一个深刻的需要，以减少风险的妇女谁进入怀孕与严重肥胖的一部分， 产前护理，但缺乏证据表明，适当的孕期体重增加（GWG）的目标， 严重肥胖。此外，严重的孕前母亲肥胖，不良的出生结果和儿童肥胖， 在低收入和种族/少数民族群体中最为普遍，这些群体在以下方面的代表性严重不足： 产科和儿科肥胖研究。 拟议的研究解决了一个关键问题，即GWG指南对女性来说可能太高， 严重肥胖，使儿童面临肥胖的高风险，并加剧了儿童肥胖的差异。的 本研究的总体目标是确定与最低GWG相关的总体和三个月特定GWG 严重孕前肥胖母亲的孩子出生不良和长期结局的风险。这 这项研究利用了ADVANCE早期生命队列，这是一个独特的低收入，种族和民族多样化的队列。 母亲和儿童，根据美国社区卫生的电子健康记录（EHR）数据构建 中心.与大多数其他基于EHR的研究相比，本研究人群主要包括公开的 有保险和无保险的病人。 拟议的研究将调查生活在3个州（OR，CA，MA）的37，000名母亲，以及他们的 孩子们有三个具体的目标。目标1：确定与妊娠相关的总体和妊娠期特定GWG 儿童不良出生结局（小于或大于胎龄、早产、出生体重）的风险最低 严重孕前肥胖的母亲。假设：在患有严重早产儿的母亲的子女中， 妊娠期肥胖，当总GWG和妊娠期特定GWG低于当前值时，出生结局最佳 建议.目标2：确定与最低风险相关的总体和三个月特定GWG 重度肥胖母亲的儿童的长期肥胖相关结局（婴儿生长，5岁时的BMI） 孕前肥胖假设：在患有严重孕前肥胖症的母亲的孩子中， 儿童肥胖风险的指标降低，总的和三个月特定的GWG低于当前水平 建议.目的3：确定总体和孕期特异性GWG介导 种族/民族与5岁时BMI之间的关系。假设：占很大份额（>10%） 先前观察到的儿童肥胖的种族/民族差异归因于GWG，确定了一个关键点 进行干预。研究结果将为临床实践和GWG指南提供信息， 孕前肥胖，两者都需要降低怀孕时严重肥胖的妇女的风险。这 研究发生在一个完善的合作研究环境中的发展 俄勒冈州健康与科学大学的疾病起源和OCHIN的EHR数据基础设施。

PROJECT SUMMARY Women with severe obesity have high risks of adverse birth and child outcomes, including childhood obesity. There is a profound need to reduce risks among women who enter pregnancy with severe obesity as part of prenatal care, but there is scant evidence on appropriate Gestational Weight Gain (GWG) goals in women with severe obesity. Moreover, severe pre-pregnancy maternal obesity, adverse birth outcomes, and child obesity are most prevalent in low-income and racial/ethnic minority groups, who are vastly under-represented in obstetric and pediatric obesity research. The proposed research addresses the critical problem that GWG guidelines are likely too high for women with severe obesity, placing children at high risk for obesity and exacerbating disparities in childhood obesity. The overall objective of this study is to determine overall and trimester-specific GWG associated with the lowest risk of adverse birth and longer-term outcomes in children of mothers with severe pre-pregnancy obesity. This study leverages the ADVANCE Early Life Cohort, a unique cohort of low-income, racially and ethnically diverse mothers and children, constructed from electronic health record (EHR) data from U.S. community health centers. In contrast with most other EHR-based studies, this study population includes predominately publicly insured and uninsured patients. The proposed research will examine >37,000 mothers in ADVANCE living in 3 states (OR, CA, MA), and their children to conduct 3 specific aims. Aim 1: Determine overall and trimester-specific GWG associated with the lowest risk of adverse birth outcomes (small or large for gestational age, preterm birth, birth weight) in children of mothers with severe pre-pregnancy obesity. Hypothesis: Among children of mothers with severe pre- pregnancy obesity, birth outcomes are optimized when total and trimester-specific GWG are below current recommendations. Aim 2: Determine overall and trimester-specific GWG associated with the lowest risk of longer-term obesity-related outcomes (infant growth, BMI at 5 years of age) in children of mothers with severe pre-pregnancy obesity. Hypothesis: Among children of mothers with severe pre-pregnancy obesity, early indicators in child obesity risk are reduced with total and trimester-specific GWG below current recommendations. Aim 3: Determine the extent to which overall and trimester-specific GWG mediate the relationship between race/ethnicity and BMI at 5 years of age. Hypothesis: A substantial share (>10%) of previously observed racial/ethnic disparities in childhood obesity is attributable to GWG, identifying a key point for intervention. Study findings will inform clinical practice and GWG guidelines tailored to women with severe pre-pregnancy obesity, both needed to reduce risk in women who enter pregnancy with severe obesity. This study occurs in the context of a well-established collaborative research environment in the developmental origins of disease at Oregon Health & Science University and EHR data infrastructure at OCHIN.