Innovative Approaches to Inform Evidence-Based Pregnancy Weight Gain Guidelines

描述(由研究人员提供)：妊娠期体重增加(GWG)是一些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一些重要结果的影响的情况下建立的，如死产、婴儿死亡、儿童神经认知状况、先兆子痫和长期母子肥胖。此外，移徙组织委员会强调，除了评估全球工作组总数之外，还必须评估全球工作组的模式和时间安排。这一应用直接回应了这些研究需要，通过检查全球工作组的总体和全球工作组的模式对广泛的短期和长期母子结局的影响。我们的研究设计将使用来自两个追溯队列的现有电子记录(宾夕法尼亚州匹兹堡马吉妇女医院的124,590个单胎出生和加利福尼亚州伯克利阿尔塔·贝茨峰会医疗中心的36,384个单胎出生)，以及来自马吉妇女医院出生的471对母婴并跟踪22年的前瞻性队列的数据。该项目旨在确定GWG总量与母亲(妊娠期糖尿病、先兆子痫和产后22年的产妇体重指数变化)和子女(死产、婴儿死亡率、自然早产、小于胎龄儿和大胎儿、神经认知缺陷、6岁儿童肥胖、22岁成人肥胖)的12项不良后果之间的关系。为了研究这种关联，将开发一种创新的方法来评估GWG总量，消除现有测量方法与妊娠长度相关性的偏差。该项目还将研究孕妇GWG轨迹和不良围产儿结局之间的关系。一种新的生长曲线分析方法将被用来确定GWG的时机、数量和速度对不良妊娠和出生结果的独立贡献。这些目标的成功实现将填补与最佳妇幼健康相关的体重增加范围和模式方面的主要知识空白。创新方法的使用与同时研究多种不良结果的能力相结合，将促进我们对GWG的理解，从而努力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的研究的概括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.