Informing Evidence-based Maternal Weight Gain Guidelines for Twin Pregnancies

描述（由申请人提供）：在过去的30年里，美国出生的双胞胎数量前所未有地增加，这是一个主要的公共卫生问题，因为双胞胎妊娠严重的孕产妇和新生儿并发症的发生率很高。妊娠期体重增加（GWG）是双胎妊娠常见的不良结局的潜在可改变的风险因素。不幸的是，双胎妊娠最佳GWG的数据非常有限。2009年，医学委员会研究所发布了临时GWG指南，该指南仅基于在一项对2234名自我选择的母亲进行的研究中观察到的GWG的四分位数范围，这些母亲在妊娠e36周时分娩了体重至少2500 g的双胞胎。这项拟议的研究将通过评估与母亲和后代的最佳健康结果相关的双胞胎妊娠体重增加的总量和模式，为双胞胎妊娠的循证GWG指南提供信息。该项目直接响应PA-12-061，研究产妇营养对母亲、婴儿和儿童的影响。我们的研究设计将使用来自宾夕法尼亚州匹兹堡Magee-Women's Hospital的2880例双胞胎妊娠的现有电子记录;来自宾夕法尼亚州12，300例双胞胎妊娠的人口队列的生命记录;以及来自全国代表性的1658对双胞胎纵向出生队列的数据。我们的项目旨在确定总GWG与母亲（妊娠期糖尿病，先兆子痫，计划外剖宫产，产后5年体重保持）和后代（死产，婴儿死亡率，自发性早产<32周，胎儿生长异常，儿童超重和认知发育不良）的不良结局之间的关系。将开发一种评估总GWG的创新方法，该方法消除了现有测量与妊娠持续时间相关性的偏倚。该项目还将研究产妇GWG轨迹和不良围产期结局之间的关系。一种新的生长曲线分析方法将用于确定GWG的时间，数量和速度对不良妊娠和分娩结局的贡献。这些目标的成功完成将为迄今为止所有BMI类别的双胎妊娠妇女提供最全面的GWG和不良结局评估。这项研究将是第一个评估双胞胎妊娠高GWG对产后母亲及其子女肥胖长期风险的后果，并将填补严重肥胖妇女最佳GWG知识的主要空白。这项研究将为未来的循证指南提供坚实的基础，这些指南将指导这些高危妊娠的医疗实践和公共卫生政策。

DESCRIPTION (provided by applicant): The unprecedented rise in the number of twins born in the U.S. over the past 30 years is a major public health concern because twin pregnancies have high rates of serious maternal and neonatal complications. Gestational weight gain (GWG) is a potentially modifiable risk factor for adverse outcomes common to twin gestations. Unfortunately, data on optimal GWG for twin pregnancies is extremely limited. The 2009 Institute of Medicine Committee published provisional GWG guidelines based only on the interquartile range of GWG observed in a single study of 2234 self-selected mothers who delivered twins weighing at least 2500 g at e36 weeks gestation. The proposed study will inform evidence-based GWG guidelines for twin gestations by evaluating the total amount and pattern of weight gain in twin pregnancies that is associated with optimal health outcomes for mothers and offspring. This project directly responds to PA-12-061 for research on the effects of maternal nutrition on mothers, infants and children. Our study design will employ existing electronic records from 2880 twin pregnancies at Magee-Women's Hospital in Pittsburgh, Pennsylvania; vital records from a population-based cohort of 12,300 twin pregnancies in Pennsylvania; and data from a nationally-representative longitudinal birth cohort of 1658 twins. Our project seeks to determine the association between total GWG and adverse outcomes for mothers (gestational diabetes, preeclampsia, unplanned cesarean delivery, weight retention at 5 years postpartum) and offspring (stillbirth, infant mortality, spontaneous preterm birth <32 weeks, abnormal fetal growth, child overweight, and poor cognitive development). An innovative method to assess total GWG will be developed that removes the bias in the existing measures' correlation with gestational duration. 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 contribution of timing, amount, and velocity of GWG to poor pregnancy and birth outcomes. Successful completion of these aims will provide the most comprehensive evaluation of GWG and adverse outcomes for women carrying twin pregnancies across all BMI categories to-date. This study will be the first to assess the consequences of high GWG in twin pregnancies on longer-term risks of obesity in postpartum mothers and their children, and will fill major gaps in knowledge on the optimal GWG for severely obese women. This research will provide a strong foundation for future evidence-based guidelines, which will guide medical practice and public health policy for these high risk pregnancies.