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Pregnancy-Related Risk Factors and Glucose Intolerance in Women during Midlife

中年女性妊娠相关危险因素和葡萄糖不耐受

基本信息

批准号：
8943543
负责人：
Erica Pauline Gunderson
金额：
$ 68.04万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-08-27 至 2019-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8943543
关键词：
Affect Age Ancillary Study Area Behavior Birth Birth Weight Body Weight Body Weight Changes Central obesity Coronary Artery Risk Development in Young Adults Study Coronary artery Data Data Collection Data Set Deterioration Development Diabetes Mellitus Diabetes prevention Dyslipidemias Elderly Enrollment Funding Future Gestational Age Glucose Intolerance Glycosylated hemoglobin A Goals Health Heart Diseases High Risk Woman Hour Individual Influentials Institute of Medicine (U.S.)Insulin Resistance Intervention Life Style Link Lipids Measurement Measures Medical Records Metabolic Monitor Morbidity - disease rate National Heart, Lung, and Blood Institute Non-Insulin-Dependent Diabetes Mellitus OGTT Obesity Outcome Overweight Perinatal Preconception Care Prediabetes syndrome Pregnancy Pregnancy Outcome Premature Birth Prevention Prevention strategy Randomized Recording of previous events Reporting Research Risk Risk Factors Site-Directed Mutagenesis Stratification Testing Time Translating Weight Weight Gain Woman Women&apos s Health cardiometabolic risk child bearing cohort diabetes risk disorder risk fasting glucose gestational weight gain glucose tolerance high risk insight men middle age mortality obesity prevention obesity risk offspring oral glucose tolerance perinatal outcomes prevent prospective public health relevance reproductive young adult

项目摘要

DESCRIPTION (provided by applicant): Over 50% of U.S. women enter pregnancy overweight or obese, and almost 50% gain more weight during pregnancy than is recommended. Maternal excess adiposity not only leads to greater perinatal morbidity and mortality, but higher weight retention and greater disease risk. Randomized interventions to modify gestational weight gain (GWG), especially among overweight or obese women, have been largely ineffective. Excess maternal adiposity before, during and after pregnancy may result in worse cardiometabolic health for women during the childbearing years. These periods are referred to as "pregnancy-related risk factor changes" that involve increased adiposity, as well as alterations in metabolic risk factors during the preconception, gestational, and post-pregnancy periods. We hypothesize that maternal cardiometabolic risk factor changes (i.e., "trajectories") before pregnancy may increase the risk of excessive GWG and adverse perinatal outcomes (APOs), and that maternal BMI and subsequent weight changes throughout the childbearing years may adversely affect maternal cardiometabolic risk factor development post-pregnancy, and thereby accelerate the progression to glucose intolerance in women during midlife. We propose an ancillary study to the NHLBI funded CARDIA Study, a multi-center longitudinal cohort of 5,115 black and white women and men (18-30 y) enrolled in 1985-1986, and re-examined up to 8 times as of 2011 with retention of 72% of the surviving cohort. Exams included metabolic risk factor (body weight, waist girth, fasting glucose and lipids) measurements every 2-5 years (both before and after pregnancies) in 1986-2011, including oral glucose tolerance testing via 2-hr 75 g OGTTs up to four times from 1996-2011. Women also reported GWG and perinatal outcomes (birth weight, gestational age, GDM, preterm birth) which were validated via medical record abstractions. The proposed study will coincide with the Year 30 CARDIA exam (June 2015-2016) to collect new data on reproductive and offspring health histories, administer a fifth 2-hr 75 g OGTT and measure HbA1c. This study leverages the unique CARDIA datasets that include prospective risk factor measurements from before to after pregnancies, existing GWG and APO data, and additional new data collection to assess progression to glucose tolerance in women. The specific aims are: 1) To evaluate the impact of pre-pregnancy cardiometabolic risk factor trajectories on pregnancy outcomes; 2) To characterize the contributions of weight changes from before, during and after pregnancy to the development of cardiometabolic risk factors for glucose intolerance and 3) To evaluate the independent associations of maternal pre-pregnancy BMI, GWG, and post-pregnancy weight changes on the progression to glucose intolerance. These findings can be translated into individual risk stratification to optimize prevention efforts by identifying women at high- risk fo perinatal morbidity, and subsequent progression to glucose intolerance during the reproductive years.