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

项目总结 患有严重肥胖症的妇女有很高的不良生育和儿童结局风险，包括儿童肥胖。 作为以下方面的一部分，迫切需要降低患有严重肥胖的怀孕妇女的风险 产前护理，但几乎没有证据表明患有糖尿病的女性的适当妊娠体重增加(GWG)目标 严重肥胖。此外，严重的孕前母体肥胖、不良生育结局和儿童肥胖症 在低收入和种族/少数民族群体中最为普遍，他们在 产科和儿科肥胖研究。 这项拟议的研究解决了一个关键问题，即GWG指南对患有 严重肥胖，使儿童处于肥胖的高风险中，并加剧了儿童肥胖症的差异。这个 这项研究的总体目标是确定总体和特定于妊娠的GWG与最低 母亲患有严重孕前肥胖的孩子有不良分娩和长期结局的风险。这 这项研究利用了高级早期生活队列，这是一个独特的低收入、种族和民族多样性的队列 母亲和儿童，由来自美国社区健康的电子健康记录(EHR)数据构建 中锋。与大多数其他基于eHR的研究相比，该研究人群主要包括公开的 已投保和未投保的患者。 这项拟议的研究将对居住在3个州(或州、加利福尼亚州、马萨诸塞州)的37,000名母亲及其母亲进行调查 孩子们要进行3个具体目标。目标1：确定总体和特定于三个月的GWG 儿童不良出生结局的风险最低(胎龄、早产、出生体重) 患有严重孕前肥胖的母亲。假设：在母亲患有严重早衰的孩子中 妊娠肥胖，当总GWG和特定于三个月的GWG低于当前水平时，出生结局最佳 建议。目标2：确定与最低风险相关的总体和特定于妊娠的GWG 重度肥胖母亲的孩子的长期肥胖相关结局(婴儿生长，5岁时体重指数) 怀孕前肥胖。假设：在母亲患有严重孕前肥胖的孩子中，早期 儿童肥胖风险指标随着总GWG和每三个月特定GWG低于当前水平而降低 建议。目标3：确定总体和特定于妊娠的GWG在多大程度上调解 人种/民族与5岁儿童体重指数的关系假设：相当一部分(&gt；10%) 以前观察到的儿童肥胖的种族/民族差异可归因于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指南提供指导，这些指南是为患有严重疾病的妇女量身定做的 孕前肥胖，这两种方法都需要降低患有严重肥胖的女性怀孕的风险。这 研究发生在发展中良好的协作研究环境中 俄勒冈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.