Maternal obesity, weight gain, and the black-white disparity in pregnancy outcome

描述（由申请人提供）：在美国，黑人婴儿的死亡率是白人婴儿的2.4倍，并且更有可能经历导致发病率和死亡率的不良出生结果。黑人女性在怀孕时比白人女性更容易肥胖，而且她们的体重增加幅度超出了医学研究所（IOM）建议的孕期体重增加范围。妊娠前肥胖会显著增加不良分娩结果的风险，但这些影响可以通过适当的体重增加来减轻。不幸的是，2009年医学委员会重新评估妊娠增重指南，由于缺乏研究数据，无法回答一些关于最佳妊娠增重的最重要问题。我们的项目旨在解决他的迫切需求。我们建议验证以下假设：最佳妊娠期体重增加随着孕前体重指数的增加而下降，以及体重指数和体重增加是导致婴儿死亡率和不良出生结局的黑人-白人差异的因素。我们的研究设计将采用现有的宾夕法尼亚州生命记录（2003-2008），反映了75.1万名黑人和白人母亲的新生儿。该项目旨在分别探索黑人和白人女性在每个BMI类别中与最佳结果相关的总体重增加范围，并平衡该人群中低体重增加和高体重增加的风险。该项目还将确定孕前体重指数和孕期体重增加对不良妊娠和婴儿结局（早产、小胎龄分娩、大胎龄分娩、计划外剖宫产和婴儿死亡率）的黑人-白人差异的影响。这些目标的成功完成将回答一个重要的问题：孕妇孕前体重和孕期体重增加——这两个潜在的可改变因素——是如何导致婴儿死亡率和不良出生结果的种族差异的？我们对生命记录数据的使用利用了尚未开发的资源来探索具有重大公共卫生重要性的研究问题。重要的是，这项研究还试图为关于严重肥胖妇女理想妊娠期体重增加的争论提供信息。它将明确检查婴儿在怀孕期间体重不增加或减少的安全性。

DESCRIPTION (provided by applicant): In the U.S., black infants are 2.4 times as likely to die as white infants, and are more likely to experience adverse birth outcomes that contribute to morbidity and mortality. Black women are also more likely than whites to be obese at conception and to gain outside the Institute of Medicine (IOM) recommended gestational weight gain ranges. Pregravid obesity dramatically increases risk of poor birth outcomes, but these effects may be lessened by appropriate weight gain. Unfortunately, the 2009 Institute of Medicine Committee to Reevaluate Pregnancy Weight Gain Guidelines was unable to answer some of the most important questions about optimal gestational weight gain because of a lack of research data. Our project seeks to address his urgent need. We propose to test the hypotheses that optimal gestational weight gain declines as prepregnancy BMI increases, and that BMI and weight gain are contributors to the black-white disparity in infant mortality and adverse birth outcomes. Our study design will employ existing Pennsylvania vital records (2003-2008) reflecting 751,000 births to black and white mothers. This project seeks to explore separately for black and white women in each BMI category the range of total weight gain that is associated with optimal outcomes and balances risks of low and high weight gain in this population. The project also will determine the contribution of prepregnancy BMI and pregnancy weight gain to the black-white disparity in adverse pregnancy and infant outcomes (preterm birth; small-for-gestational age birth; large-for-gestational age birth; unplanned Cesarean delivery; and infant mortality). The successful completion of these Aims will answer an important question: How do maternal pregravid weight and weight gain during pregnancy-two potentially modifiable factors-contribute to the racial disparity observed in infant mortality rates and adverse birth outcomes? Our use of vital records data leverages an untapped resource to explore a research question of major public health importance. Importantly, this study also seeks to inform the contentious debate regarding ideal gestational weight gain in severely obese women. It will explicitly examine the safety of no weight gain or weight loss during pregnancy for the infant.