Preconception obesity treatment: maternal bariatric surgery and long-term child health outcomes

孕前肥胖治疗：孕产妇减肥手术和长期儿童健康结果

• 批准号: 10502182
• 负责人: Janne Boone-Heinonen
• 金额: $ 67.38万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-19 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10502182
• 关键词: 6 year old; Address; Adult; Affect; Age; Anemia; Animals; Anthropometry; Benefits and Risks; Birth; Birth Weight; Blood Pressure; Body Weight; Body Weight decreased; Body mass index; Characteristics; Child; Child Health; Childhood; Chronic Disease; Clinical Data; Control Groups; Cost Analysis; Costs and Benefits; Data; Data Set; Female of child bearing age; Future; General Population; Gestational Age; Gestational Diabetes; Goals; Growth; Health; Health Sciences; High Risk Woman; Human; Hypertension; Infant; Interdisciplinary Study; Intervention; Life Style; Link; Literature; Mediating; Medical; Meta-Analysis; Metabolic; Micronutrients; Minority; Morbid Obesity; Mothers; Obesity; Operative Surgical Procedures; Oregon; Outcome; Outcome Study; Pathway interactions; Pharmaceutical Preparations; Population Heterogeneity; Pregnancy; Pregnant Women; Prevalence; Procedures; Reporting; Research; Risk; Role; Sample Size; Site; Small for Gestational Age Infant; Subgroup; Time; Universities; Weight; Weight Gain; Woman; absorption; bariatric surgery; child bearing; cohort; comorbidity; disorder risk; ethnic diversity; ethnic minority; fetal; gestational weight gain; high risk; improved; interest; lifestyle intervention; maternal obesity; maternal risk; maternal weight; neonatal outcome; next generation; obesity management; obesity risk; obesity treatment; offspring; postnatal; pregnancy disorder; pregnant; prenatal; prepregnancy; primary outcome; racial diversity; racial minority; secondary outcome; study population

Project Summary/Abstract Obesity prevalence has been steadily rising in the U.S. over the past three decades, including among pregnant women, children, and minorities. Accumulating evidence links maternal obesity – particularly severe obesity – to increased risk for obesity and other chronic diseases in their offspring. Moreover, intervention strategies targeting the prenatal period have yielded disappointing results, shifting focus to the preconception period. Utilization of bariatric surgery procedures have become more common, including among women of childbearing age, as it achieves weight losses averaging between 20% and 30% of total body weight (roughly 3-4 times more effective than lifestyle interventions) and is sustained long-term (seven years and longer). However, the risks and benefits of preconception weight loss by bariatric surgery to children are poorly understood, particularly in the longer-term. The overall goal of the proposed research is to determine if surgically-induced preconception weight loss can reduce their offspring's long-term risk of obesity and obesity-related health. We will utilize information collected from a large cohort (n=2120) of women with obesity who lost weight by bariatric surgery before becoming pregnant and their children. We will compare weight and weight related health (size for gestational age, infant weight gain, BMI through 6 years of age) in children of women who received bariatric surgery prior to pregnancy to two control groups born to women who did not undergo bariatric surgery (n=21,200). The first control group will be matched to the mother's pre-surgical BMI; the second control group will be matched to the mother's pre-pregnancy BMI (after surgery). We will then determine the extent to which pregnancy conditions (gestational diabetes mellitus, hypertensive disorders, anemia, gestational weight gain) mediate associations between bariatric surgery and child outcomes. We will further examine if smaller size for gestational age – one known risk following bariatric surgery – is associated with child outcomes similarly in children born to mothers with and without bariatric surgery, and without and without pregnancy anemia. Our large, unique dataset created by a consortium of Kaiser Permanente and Oregon Health & Science University sites, will allow us to address these questions in a diverse study population, with representation of racial and ethnic minority women at highest risk of severe obesity. Study findings will provide understanding of the role of preconception weight loss on long-term child health outcomes, the specific influence of achieving this weight loss by bariatric surgery on these outcomes, and guide future outcome studies that focus on improving maternal preconception weight by lifestyle, medical, and surgical means.

项目总结/摘要 在过去的三十年里，美国的肥胖患病率一直在稳步上升，包括孕妇。 妇女、儿童和少数民族。越来越多的证据表明，母亲肥胖，特别是严重肥胖， 会增加后代患肥胖症和其他慢性疾病的风险。此外，干预战略 针对产前阶段的研究取得了令人失望的结果，将重点转移到了孕前阶段。 减肥手术的使用已经变得越来越普遍，包括在20岁以下的妇女中。 生育年龄，因为它实现了体重减轻平均在20%和30%的总体重（大约 3-4比生活方式干预措施有效两倍），并可长期维持（7年或更长时间）。 然而，通过减肥手术对儿童进行孕前减肥的风险和益处都很差， 理解，特别是从长远来看。 这项拟议研究的总体目标是确定，如果怀孕引起的孕前体重减轻， 降低后代肥胖和肥胖相关健康的长期风险。我们将利用收集的信息 从一个大型队列（n=2120）的肥胖妇女谁失去了减肥手术之前，成为 怀孕和他们的孩子我们将比较体重和体重相关的健康（胎龄大小，婴儿 体重增加，BMI至6岁）的妇女谁接受减肥手术前的儿童 两个对照组的孕妇谁没有接受减肥手术（n= 21，200）。第一 对照组将与母亲的术前BMI匹配;第二对照组将与母亲的术前BMI匹配。 母亲怀孕前的BMI（手术后）。然后我们将确定怀孕条件 （妊娠期糖尿病、高血压疾病、贫血、妊娠期体重增加）介导相关性 减肥手术和儿童结局之间的关系我们将进一步检查是否小于胎龄-一个 减肥手术后的已知风险-与母亲所生儿童的结局相似 有或没有减肥手术，有或没有妊娠贫血。 我们的大型独特数据集由Kaiser Permanente和俄勒冈州健康与科学联盟创建 大学网站，将使我们能够解决这些问题，在一个多样化的研究人口，与代表 种族和少数民族妇女严重肥胖的风险最高。研究结果将有助于了解 孕前体重减轻对长期儿童健康结果的作用， 这种减肥手术对这些结果的影响，并指导未来的结果研究，重点是 通过生活方式、医疗和手术手段改善孕妇孕前体重。