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）是许多重要的母婴健康结局的潜在可改变的危险因素。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许多重要结果的影响的情况下制定的，如死产、婴儿死亡、儿童神经认知状态、先兆子痫和母亲和后代的长期肥胖。此外，IOM委员会强调了评估GWG模式和时间的重要性，以及GWG总量。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体和后代结果的影响，直接响应了这些研究需求。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麦基妇女医院的124,590名单胎婴儿和加利福尼亚州伯克利阿尔塔贝茨Summit医疗中心的36,384名单胎婴儿），以及来自麦基妇女医院出生的471对母子的前瞻性队列数据，随访22年。本项目旨在确定总GWG与母亲（妊娠期糖尿病、先兆子痫和产后22年产妇产后体重指数变化）和后代（死产、婴儿死亡率、自发性早产、胎龄小和胎龄大的分娩、神经认知缺陷、6岁儿童肥胖、22岁成人肥胖）的12种不良结局之间的关系。为了研究这种关联，将开发一种评估总胎重的创新方法，以消除现有测量方法与妊娠长度相关的偏差。该项目还将研究产妇GWG轨迹与不良围产期结局之间的关系。将采用一种新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分娩结局的独立贡献。这些目标的成功实现将填补关于与最佳妇幼健康相关的体重增加范围和模式的知识方面的重大空白。创新方法的使用与同时研究多种不良后果的能力相结合，将促进我们对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.