Innovative Approaches to Inform Evidence-Based Pregnancy Weight Gain Guidelines

描述（由研究者提供）：妊娠期体重增加 (GWG) 是许多重要孕产妇和婴儿健康结果的潜在可改变风险因素。 2009 年，医学研究所 (IOM) 重新评估妊娠期体重增加指南委员会发布了重新提交的体重增加建议。然而，重新提交的指南是在没有明确了解其对死产、婴儿死亡、儿童神经认知状态、先兆子痫以及长期母亲和后代肥胖等许多重要结局的影响的情况下制定的。此外，IOM 委员会强调了除了总 GWG 之外评估 GWG 模式和时间安排的重要性。该应用程序通过检查总 GWG 和 GWG 模式对广泛的短期和长期母亲和后代结果的影响，直接响应这些研究需求。我们的研究设计将采用来自两个回顾性队列的现有电子记录（宾夕法尼亚州匹兹堡 Magee-Women's Hospital 的 124,590 例单胎分娩和加利福尼亚州伯克利 Alta Bates Summit 医疗中心的 36,384 例单胎分娩），以及来自 Magee-Women's Hospital 出生并跟踪 22 年的 471 名母子二人组的前瞻性队列数据。该项目旨在确定总 GWG 与母亲（妊娠糖尿病、先兆子痫和母亲产后 22 年体重指数变化）和后代（死产、婴儿死亡率、自发性早产、小于和大于胎龄儿出生、神经认知缺陷、6 岁儿童肥胖、22 岁时成人肥胖）的 12 种不良后果之间的关联。为了研究这种关联，将开发一种评估总孕周体重的创新方法，消除现有测量值与孕周长度相关性的偏差。该项目还将研究孕产妇 GWG 轨迹与不良围产期结局之间的关系。将使用一种新颖的生长曲线分析方法来确定 GWG 的时间、数量和速度对不良妊娠和出生结果的独立影响。这些目标的成功实现将填补有关与最佳孕产妇和儿童健康相关的体重增加范围和模式的主要知识空白。创新方法的使用与同时研究多种不良结果的能力相结合，将增进我们对 GWG 的理解，从而为未来的循证指南提供信息。我们使用两个不同的队列将增加我们研究的普遍性和影响医疗实践和公共卫生政策的潜力。

DESCRIPTION (provided by investigator): Gestational weight gain (GWG) is a potentially modifiable risk factor for a number of important maternal and infant health outcomes. In 2009, the Institute of Medicine (IOM) Committee to Reevaluate Gestational Weight Gain Guidelines published resubmitted weight-gain recommendations. However, the resubmitted guidelines were established without a clear understanding of their impact on a number of important outcomes such as stillbirth, infant death, child neurocognitive status, preeclampsia, and long-term maternal and offspring obesity. Further, the IOM committee highlighted the importance of assessing pattern and timing of GWG in addition to total GWG. This application directly responds to those research needs by examining the influence of total GWG and pattern of GWG on a broad range of short- and long-term maternal and offspring outcomes. Our study design will employ existing electronic records from two retrospective cohorts (124,590 singleton births at Magee-Women's Hospital in Pittsburgh, Pennsylvania and 36,384 singleton births at Alta Bates Summit Medical Center in Berkeley, California), as well as data from a prospective cohort of 471 mother-child dyads born at Magee-Women's Hospital and followed for 22 years. This project seeks to determine the association between total GWG and 12 adverse outcomes for mothers (gestational diabetes, preeclampsia, and maternal postpartum body mass index change at 22 years postpartum) and offspring (stillbirth, infant mortality, spontaneous preterm birth, small- and large-for-gestational-age births, neurocognitive deficits, child obesity at age 6 adult obesity at age 22). To study this association, an innovative method to assess total GWG will be developed that removes the bias in the existing measures' correlation with gestational length. This project will also examine the relationship between maternal GWG trajectory and adverse perinatal outcomes. A novel growth curve analysis method will be used to determine the independent contribution of timing, amount, and velocity of GWG to poor pregnancy and birth outcomes. The successful completion of these aims will fill major gaps in knowledge about the weight gain ranges and patterns associated with optimal maternal and child health. The use of innovative methodology combined with the ability to study multiple adverse outcomes simultaneously will advance our understanding of GWG in an effort to inform future evidence-based guidelines. Our use of two diverse cohorts will increase our study's generalizability and potential to impact medical practice and public health policy.