BIRTHWEIGHT AND GESTATIONAL AGE AND CHRONIC DISEASE RISK

几项研究表明，出生时身材矮小或瘦弱的人成年后患胰岛素抵抗综合征（IRS）、非胰岛素依赖型糖尿病（NIDDM）和心血管疾病（CVD）的风险增加。 这些观察结果导致了“胎儿起源”假说-对这些慢性成人疾病的易感性可能在子宫内编程。 妊娠期发生的代谢和血流动力学的深刻变化使妊娠成为葡萄糖耐受不良、高血压和其他IRS相关异常的生理应激试验。妊娠期糖尿病（GDM）和妊娠高血压（PIH）是妊娠期的两种常见并发症，它们具有IRS的许多特征，并且还预测了女性后期发展为NIDDM和CVD的风险。 我们建议调查一个女人的生长在她自己的出生前（由她自己的出生体重和胎龄）对她的风险在年轻的成年妊高征或GDM的影响。 除了我们最近在科罗拉多完成的有希望的初步工作外，这是一个以前没有探索过的调查领域。 这项计划是根据纽约州和纽约市的出生登记和出院数据进行一项病例对照研究，这些数据与一代人的计算机数据相关联。 受试者将是1959年以后出生于纽约并于1990年至1996年期间在纽约分娩活产单胎婴儿的女性。 病例为在最近妊娠期间（1990-1996年）诊断为PIH和/或GDM的受试者，而对照组为与住院和分娩年份病例频率匹配但未诊断为PIH或GDM的受试者。 将每例受试者最近妊娠（1990-1996年）的记录与其自身出生（12-36年前）的记录进行匹配。 我们将使用多元逻辑回归来估计母亲自身的早期生长，如出生体重和胎龄，对她以后发展为GDM或PIH的风险的独立影响。 该分析将考虑潜在的混杂因素和影响因素，包括人种/种族、母亲年龄和吸烟。 我们还将对出生记录中GDM和PIH诊断的有效性进行子研究。 因此，这项研究将提供一个强大的和具有成本效益的方式来调查胎儿起源的GDM和妊高征的假设，这两种常见的，但仍然知之甚少的妊娠并发症，这是与慢性疾病的风险增加以后的生活。

Several studies have shown that people born small or thin have increased risk for developing Insulin Resistance Syndrome (IRS), non-insulin dependent diabetes mellitus (NIDDM), and cardiovascular disease (CVD) as adults. These observations have led to the "fetal origins" hypothesis - that susceptibility to these chronic adult conditions may be programmed in utero. The profound metabolic and hemodynamic changes that occur in gestation make pregnancy a physiologic stress test for glucose intolerance, hypertension, and other IRS-related abnormalities. Gestational diabetes (GDM) and pregnancy-induced hypertension (PIH) are two common complications of pregnancy that share many characteristics of IRS, and also predict a woman's risk for the later development of NIDDM and CVD. We propose to investigate the effects of a woman's growth before her own birth (indicated by her own birthweight and gestational age) on her risk in young adulthood for PIH or GDM. Apart from promising preliminary work we have recently completed in Colorado, this is an area of investigation that has not previously been explored. The proposal is to conduct a case-control study based on birth registry and hospital discharge data from New York State and New York City, computer-linked across a generation. Subjects will be women who were born in NY after 1959 and delivered a live singleton infant in New York between 1990 and 1996. Cases will be subjects who had PIH and/or GDM diagnosed during a recent pregnancy (1990-1996), while controls will be subjects frequency matched to cases on hospital and year of delivery, but without a diagnosis of PIH or GDM. The records of each subject's recent pregnancy (1990-1996) will be matched to those of her own birth (12-36 years earlier). We will use multiple logistic regression to estimate the independent effects of a mother's own early growth, as indicated by birth weight and gestational age, on her later risk of developing GDM or PIH. The analysis will account for potential confounding and effect-modifying factors, including race/ethnicity, maternal age, and smoking. We will also conduct a sub-study of the validity of the diagnoses of GDM and PIH on the birth records. This study will thus offer a powerful and cost-efficient way to investigate the hypothesis of the fetal origins of GDM and PIH, two common but still poorly understood complications of pregnancy which are associated with increased risk for chronic disease later in life.