The UPBEAT RCT mother-child study. Stratifying and treating obese pregnant women to prevent adverse pregnancy, perinatal and longer term outcomes.

在英国，几乎五分之一的女性在怀孕时肥胖。虽然这些女性中的许多人会正常怀孕，但母亲和婴儿出现并发症的风险高于平均水平。糖尿病是最常见的，即使得到治疗，它也会使婴儿长得过大，从而导致分娩问题。肥胖女性也更容易患上一种叫做先兆子痫的疾病，这种疾病可能非常严重，经常导致医生不得不在预产期前给孩子接生。目前，我们还不能完全了解是什么导致了这些问题和其他问题。在这项研究中，我们将测量肥胖孕妇血液中的一些特定化学物质，我们之前的研究表明，这些化学物质可能是导致这些并发症的重要因素。我们还将使用一种新的非常精确的实验室技术，称为代谢组学，它提供了216种不同测量方法的概述，试图找出其他新的化学物质。我们将发现血液中这些化学物质的含量与不同并发症的发展之间的关系。当我们更多地了解这些关系时，我们希望能够开发出更好的测试和治疗方法。在这项研究中，我们的目标之一是开发怀孕早期的测试，它将足够准确地告诉我们哪些肥胖妇女在怀孕期间不会有任何问题，哪些妇女医生和助产士需要给予更多的关注，以确保她们有最好的健康怀孕的机会。这项研究将通过一项对1500多名女性进行的名为“乐观”的大型研究来实现。“乐观”的目的是发现，当肥胖母亲得到改善饮食和更多体育锻炼的帮助时，并发症是否会减少。“乐观”项目正在英国十多家医院开展，将于2014年结束。一半的孕妇在怀孕初期就从健康教练那里得到了特殊的饮食和体育活动建议，另一半则得到了正常的产前护理。参与者在怀孕期间的不同时间提供血液样本，我们将在这项研究中使用；这不仅有助于我们找出并发症的原因，而且非常有趣的是，我们可以看到那些接受过帮助改变生活方式的女性的血液化学成分是否比那些接受过正常护理的女性更好。最后，目前人们认为，肥胖母亲所生的婴儿在童年时期比苗条母亲所生的婴儿更容易肥胖。这是因为，如果婴儿在生命的最初阶段，即在子宫里，接触到母亲血液中化学物质水平的改变，他们就会受到永久性的影响。然后他们可能会增加体重，成为肥胖的儿童和成人。我们得到资助，测量乐观母亲的三岁孩子的肥胖程度，以及他们的饮食和体育活动。这被称为“欢快的节奏”研究。通过结合“欢快”和“欢快TEMPO”，我们将有一个独特的机会来确定怀孕期间母亲血液中的化学物质水平是否与孩子的肥胖水平有关。更重要的是，我们还将能够确定在怀孕期间改变生活方式的母亲的孩子是否更瘦。如果我们发现母亲的肥胖与其孩子的肥胖之间存在化学联系，这将是帮助我们找到预防儿童肥胖的新方法的重要一步。

In the UK almost one in five women are obese when they become pregnant. Whilst many of these women will have quite normal pregnancies there is a greater than average risk that the mother and her baby will develop complications. Diabetes is the most common, and even when treated it can make the baby grow too large which leads to problems at delivery. Obese women are also more prone to a disorder known as pre-eclampsia which can be very serious, and often leads to doctors having to deliver the baby before its due date. At present we do not have a complete picture of what causes these and other problems. In this study we are going to measure some specific chemicals in the blood of obese pregnant women, which our previous studies suggest may be important for causing these complications. We are also going to use a new and very accurate laboratory technique, known as metabolomics, which provides an overview of 216 different measures, to try to identify other novel chemicals that are responsible. We shall find out how the levels of these chemicals in the blood are related to development of the different complications. When we understand more about these relationships we hope we shall be able to develop better tests and treatments. In this study, one of our aims is to develop tests in early pregnancy that will be accurate enough to tell us which obese women will not have any problems in pregnancy and which women doctors and midwives will need to give more attention to in order to ensure they have the best possible chance of a healthy pregnancy.This research will be made possible by a large study of more than 1500 women, called UPBEAT. The aim of UPBEAT it to find out whether fewer complications occur when obese mothers are helped to improve their diet and engage in more physical activity. UPBEAT is taking place in more than ten hospitals in the UK and will finish in 2014. Half of the pregnant women get special dietary and physical activity advice from health trainers from early on in their pregnancy, and the other half have normal antenatal care. The participants are providing blood samples at different times during their pregnancy which we will use for this study; not only will these help us to find out about the causes of the complications but it will be very interesting to see whether the blood chemical profile in women who have been helped to change their lifestyle is better than women who have had normal care.Lastly, it is currently thought that babies born to obese mothers are more likely to become obese in childhood than babies born to thinner mothers. This is because if babies are exposed in the very earliest stage of life, i.e. in the womb, to the altered blood chemical levels of their mothers, that they are permanently affected. They are then likely to put on more weight and become obese children and adults. We have been funded to measure the fatness of the three year old children of the UPBEAT mothers, as well as their diet and physical activity. This is called the UPBEAT TEMPO study. By combining UPBEAT and UPBEAT TEMPO we will have a unique opportunity to determine whether the levels of the chemicals in the mother's blood in pregnancy are related to the levels of fatness in the children. Even more important is that we will also be able to determine whether the children of the mothers who changed their lifestyle during pregnancy are thinner. If we find out that there are chemical links between obesity in the mother and the development of obesity in her child that will be a major step in helping us work out new ways of helping to prevent obesity in children.