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

在过去的几十年里，肥胖在美国的流行率不断上升，随之而来的是对健康的长期不利影响的蔓延，造成了严重的公共卫生和经济后果。至少有一半的育龄妇女现在以高身体质量指数（BMI, kg/m2）进入妊娠期，并且大多数人的妊娠相关体重增加超过了医学研究所（IOM）的指导方针，导致母婴围产期和慢性健康风险增加。有限的干预研究表明，短期产妇饮食和妊娠期体重增加有适度改善，但很少有证据表明长期坚持。这些和传统的依赖于现有范例的减肥干预措施的充分证明的不足表明，需要创新，以允许改变饮食行为决定因素的理论框架。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该理论框架中缺失的一个关键因素。然而，到目前为止，这一迅速扩大的工作尚未纳入以人口为基础的研究。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。本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干预措施提供信息，从而改善孕产妇和儿童的健康轨迹。

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.