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Informing Evidence-based Maternal Weight Gain Guidelines for Twin Pregnancies

为双胎妊娠提供循证母亲体重增加指南

基本信息

批准号：
9103897
负责人：
Lisa M Bodnar
金额：
$ 44.88万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-08-01 至 2018-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9103897
关键词：
Acceleration Accounting Age Assisted Reproductive Technology Birth Birth Weight Categories Cesarean section Characteristics Child Cognitive deficits Data Databases Death Records Electronics Evaluation Fetal Death Fetal Growth Foundations Future Gestational Age Gestational Diabetes Goals Growth Guidelines Health Health Policy High-Risk Pregnancy Hospitals Infant Infant Mortality Institute of Medicine (U.S.)Knowledge Link Longitudinal Studies Maternal Complication of Pregnancy Maternal and Child Health Measurement Measures Medical Medical Economics Methodology Methods Modeling Mothers Neonatal Obesity Outcome Overweight Pattern Pennsylvania Perinatal mortality demographics Postpartum Period Pre-Eclampsia Pregnancy Pregnancy Outcome Premature Birth Public Health Publishing Records Research Research Design Risk Factors Time Twin Multiple Birth Weight Weight Gain Woman Work abstracting adverse outcome base child bearing cognitive development cohort cost efficient early childhood evidence base evidence based guidelines experience follow-up gestational weight gain improved infant death innovation modifiable risk mother nutrition novel obesity in children obesity risk offspring perinatal health perinatal outcomes population based public health relevance stillbirth

项目摘要

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.

描述（由申请人提供）：过去 30 年来，美国出生的双胞胎数量空前增加，这是一个重大的公共卫生问题，因为双胎妊娠严重孕产妇和新生儿并发症的发生率很高。妊娠期体重增加 (GWG) 是双胎妊娠常见不良后果的潜在可改变风险因素。不幸的是，有关双胎妊娠最佳 GWG 的数据极其有限。 2009 年医学研究所委员会发布的临时 GWG 指南仅基于在一项对 2234 名自选母亲进行的研究中观察到的 GWG 四分位数范围，这些母亲在妊娠第 36 周生下了体重至少为 2500 克的双胞胎。拟议的研究将通过评估与母亲和后代最佳健康结果相关的双胎妊娠体重增加总量和模式，为双胎妊娠的循证 GWG 指南提供信息。该项目直接响应 PA-12-061，研究孕产妇营养对母亲、婴儿和儿童的影响。我们的研究设计将采用宾夕法尼亚州匹兹堡马吉妇女医院 2880 例双胎妊娠的现有电子记录；来自宾夕法尼亚州 12,300 例双胎妊娠的人口队列的重要记录；以及来自 1658 名双胞胎的全国代表性纵向出生队列的数据。我们的项目旨在确定总 GWG 与母亲（妊娠糖尿病、先兆子痫、计划外剖腹产、产后 5 年体重滞留）和后代（死产、婴儿死亡率、<32 周自发性早产、胎儿生长异常、儿童超重和认知发育不良）不良后果之间的关系。将开发一种评估总孕周体重的创新方法，消除现有测量值与孕期相关性的偏差。该项目还将研究孕产妇 GWG 轨迹与不良围产期结局之间的关系。将使用一种新颖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出生结果的影响。成功完成这些目标将为迄今为止所有 BMI 类别的双胎妊娠妇女的 GWG 和不良后果提供最全面的评估。这项研究将首次评估双胎妊娠中高 GWG 对产后母亲及其子女长期肥胖风险的影响，并将填补严重肥胖女性最佳 GWG 方面的重大知识空白。这项研究将为未来的循证指南奠定坚实的基础，从而指导这些高风险妊娠的医疗实践和公共卫生政策。