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

• 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
• 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' 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

 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.

 描述（由申请人提供）：超过50%的美国妇女进入怀孕超重或肥胖，几乎50%的人在怀孕期间体重增加超过推荐。母亲过度肥胖不仅导致围产期发病率和死亡率增加，而且体重保持率增加，疾病风险增加。改变妊娠期体重增加（GWG）的随机干预措施，特别是在超重或肥胖妇女中，基本上是无效的。在怀孕前、怀孕期间和怀孕后，母亲过度肥胖可能会导致育龄期妇女的心脏代谢健康状况恶化。这些时期被称为“妊娠相关的风险因素变化”，涉及肥胖增加，以及在孕前，妊娠期和妊娠后期间代谢风险因素的改变。我们假设母体心脏代谢危险因素的变化（即，在妊娠前，孕妇的BMI和随后的体重变化（“轨迹”）可能会增加过度GWG和不良围产期结局（APO）的风险，并且在整个生育年龄期间，孕妇的BMI和随后的体重变化可能会对孕妇妊娠后的心脏代谢风险因素的发展产生不利影响，从而加速中年妇女向葡萄糖耐受不良的进展。我们建议对NHLBI资助的CARDIA研究进行一项辅助研究，该研究是一项多中心纵向队列研究，纳入了1985-1986年入组的5，115名黑人和白色女性和男性（18-30岁），截至2011年重新检查了8次，保留了72%的存活队列。检查包括1986-2011年每2-5年（怀孕前后）测量一次代谢风险因素（体重、腰围、空腹血糖和血脂），包括1996-2011年通过2小时75 g OGTT进行的口服葡萄糖耐量试验，最多4次。女性还报告了GWG和围产期结局（出生体重、胎龄、GDM、早产），这些结果通过病历摘要进行了验证。拟议的研究将与30年的心脏检查（2015-2016年6月）相吻合，以收集有关生殖和后代健康史的新数据，进行第五次2小时75 g OGTT并测量HbA 1c。这项研究利用独特的CARDIA数据集，包括从怀孕前到怀孕后的前瞻性风险因素测量，现有的GWG和APO数据，以及额外的新数据收集，以评估女性葡萄糖耐量的进展。具体目标是：1）评价孕前心脏代谢危险因素轨迹对妊娠结局的影响; 2）描述妊娠前、妊娠期间和妊娠后体重变化对葡萄糖耐受不良心脏代谢危险因素发展的贡献; 3）评价母体孕前BMI、GWG和妊娠后体重变化对葡萄糖耐受不良进展的独立相关性。这些发现可以转化为个体风险分层，以通过识别围产期发病率高风险的妇女以及随后在生育期进展为葡萄糖耐受不良的妇女来优化预防工作。