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

在过去的几十年里，肥胖症在美国越来越普遍，随之而来的是对健康不利的长期影响的蔓延，造成了严重的公共健康和经济后果。现在至少有一半的育龄妇女是在高体重指数(BMI，kg/m2)的情况下进入怀孕的，而且大多数人因怀孕而增加的体重超过了医学研究所(IOM)的指导方针，导致母婴的围产期和慢性健康风险增加。有限的干预研究表明，短期母体饮食和孕期体重增加有适度改善，几乎没有长期坚持的证据。这些和依赖于现有范例的传统减肥干预措施的充分证明的不足表明，需要进行创新，允许改变饮食行为决定因素背后的理论框架。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所缺乏的一个关键因素。然而，到目前为止，这一迅速扩大的工作主体还没有被纳入基于人口的研究。这项观察性研究将通过检查关于食物奖励反应的重要性的发现对理解和影响母亲的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，以便为未来改善母亲饮食和体重变化的新干预措施的开发和测试提供信息，从而改善孕产妇和儿童的健康轨迹。 这项观察性队列研究的主要目的是检查食物奖励在孕期和产后母亲饮食和体重变化中的作用。这项研究将进一步考察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。450名基线体重状况不同的女性在怀孕早期(产后12周前)进行了跟踪调查，直到产后一年。评估发生在基线(产后12周)、孕期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。衡量标准包括对食物奖励和相关结构、饮食摄入量、其他健康行为和人体测量学的评估。获得了临床数据和生物标本。婴儿人体测量学和喂养实践也进行了评估。主要暴露包括食物奖励和行为控制方面，将通过多种方式进行评估，以最大限度地增加信息和效用。主要结果包括妊娠体重增加、产后体重保留和饮食质量。

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.