Diet, Weight Change, and Obesity in Pregnancy / Pregnancy Eating Attributes (PEAS)

过去几十年来，美国肥胖症的流行率不断上升，伴随而来的长期不良健康影响的蔓延，造成了严重的公共卫生和经济后果。目前，至少有一半育龄妇女在怀孕时体重指数（BMI，kg/m2）较高，大多数妇女怀孕后体重增加超过医学研究所（IOM）的指导方针，导致母亲和儿童的围产期和慢性健康风险增加。有限的干预研究表明，在短期内产妇饮食和妊娠期体重增加适度改善，很少有长期坚持的证据。这些和传统的减肥干预依赖于现有的范例，有据可查的不足之处表明，需要创新，允许在饮食行为的决定因素的基础上的理论框架的转变。神经科学基础研究的最新发现表明，大脑对食物的奖励反应是目前这一理论框架中缺乏的关键因素。然而，这一迅速扩大的工作机构迄今尚未纳入基于人口的研究。这项观察性研究将通过研究食物奖励反应对理解和影响母亲饮食和体重变化的重要性的影响来解决这一知识差距。这项研究的总体目标是促进对饮食行为决定因素的理解，以便为未来开发和测试改善孕产妇饮食和体重变化的新型干预措施提供信息，从而改善孕产妇和儿童健康轨迹。 这项观察性队列研究的主要目的是检查食物奖励在怀孕和产后期间母亲饮食和体重变化中的作用。该研究将进一步研究食物奖励在行为控制和饮食行为的其他相关方面的重要性，以及与体重相关的生物医学，心理社会和行为因素，包括遗传，体力活动，压力，睡眠和抑郁症。450名不同基线体重状态的妇女在怀孕早期（产后12周前）入组，并随访至产后1年。评估发生在基线（产后<12周）、妊娠期间妊娠13-18周、16-22周和28-32周以及产后4-6周、6个月、9个月和12个月。 测量包括食物奖励和相关结构的评估，饮食摄入量，其他健康行为和人体测量学。获得临床数据和生物标本。婴儿人体测量和喂养方法也进行了评估。主要暴露包括食物奖励和行为控制方面，将以多种方式进行评估，以最大限度地提高信息和效用。主要结果包括妊娠期体重增加，产后体重保持和饮食质量。

The rising prevalence of obesity in the U.S. over the past several decades and the accompanying spread of adverse long-ranging health effects pose serious public health and economic consequences. At least half of women of reproductive age now enter pregnancy at a high body mass index (BMI, kg/m2), and the majority experience pregnancy-associated weight gains in excess of Institute of Medicine (IOM) guidelines, leading to increased perinatal and chronic health risks for both mother and child. Limited intervention research has indicated moderate improvement in short-term maternal diet and gestational weight gain, with little evidence of long-term adherence. The well-documented inadequacies of these and traditional weight-loss interventions relying on existing paradigms suggest the need for innovations that allow for a shift in the theoretical framework underlying the determinants of eating behavior. Recent findings from basic research in neuroscience suggest that the brain reward response to food is a critical element that is currently absent in this theoretical framework. However, this quickly-expanding body of work has not been incorporated into population-based research to date. This observational study will address this knowledge gap by examining the implications of findings on the importance of the food reward response for understanding and influencing maternal diet and weight change. The overarching goal of this research is to advance understanding of the determinants of eating behavior in order to inform future development and testing of novel interventions for improving maternal diet and weight change, leading to improved maternal and child health trajectories. The primary purpose of this observational cohort study is to examine the role of food reward in maternal diet and weight change during pregnancy and postpartum. The study will further examine the importance of food reward in the context of behavioral control and other related aspects of eating behavior, as well as weight-related biomedical, psychosocial and behavioral factors including genetics, physical activity, stress, sleep and depression. Four hundred and fifty women of varying baseline weight status were enrolled early in pregnancy (before 12 weeks postpartum) and followed until 1 year postpartum. Assessments occur at baseline (<12 weeks postpartum), during pregnancy at 13-18 weeks gestation, 16-22 weeks, and 28-32 weeks, and postpartum at 4-6 weeks, 6 months, 9 months and 12 months. Measures include assessments of food reward and related constructs, dietary intake, other health behaviors, and anthropometrics. Clinical data and biological specimens are obtained. Infant anthropometrics and feeding practices are also assessed. Primary exposures include aspects of food reward and behavioral control, which will be assessed in multiple ways to maximize information and utility. Primary outcomes include gestational weight gain, postpartum weight retention and dietary quality.