MatTrack: The impact of preconception maternal weight trajectories on maternal, pregnancy, and child outcomes

项目摘要/摘要： 怀孕时体重指数(BMI)升高和妊娠体重过度增加(GWG)是 一直与不良妊娠和儿童结局有关。饮食和生活方式干预期间 怀孕在减少GWG或产后体重滞留(PPWR)方面的成功有限，没有 围产期或儿童期结局的改善。因此，多个组织建议女性 在怀孕前达到健康的体重。然而，母婴推广的好处和风险 超越分娩，先入为主的体重变化的最佳时机，以及 先入为主的体重减轻在临床亚组之间存在差异，目前尚不清楚。我们的初步数据 提示女性怀孕时的体重轨迹(减重、维持体重或增加体重)可能 影响妊娠早期的荷尔蒙环境以及GWG和PPWR的量。的目标是 本研究旨在考察体重轨迹在即时未孕期(2)的影响。 怀孕前几年)对GWG、PPWR、妊娠结局和儿童生长的影响。我们的中心假设是 怀孕前体重改变为正常BMI可降低不良妊娠和分娩的风险 通过改善孕前体重状况来改善结局，但可能会增加GWG，从而增加患 结果对GWG敏感(PPWR，胎龄较大，婴儿体重增加，儿童BMI)。我们进一步 假设这些关联在BMI更极端和更快的女性中最强 孕期临近时体重发生变化。为了检验这一假设，我们将利用横贯大陆的 跨越近20年的临床数据仓库，体重和怀孕数据超过130,000 种族、民族和社会经济不同的妇女及其子女的体重和身高/身高数据 一直到3岁。我们将确定母亲先孕体重轨迹之间的关系 产后6周和12个月的GWG(总的和三个月特有的)和PPWR，不良反应的风险 妊娠结局(妊娠期糖尿病、妊娠期高血压/先兆子痫和剖宫产) 和孩子的结局(早产、出生时胎龄的大小、婴儿生长轨迹和3岁时的BMI 年龄)；以及这些关联在多大程度上受到GWG的调解。对于每个目标，我们都会测试 孕前BMI分类中的假设、高危临床亚组(例如，预先存在 糖尿病、高血压)和人种/民族亚群。我们的发现将告诉我们先入为主的体重 管理建议和塑造先入为主和产前体重管理的未来 研究。

PROJECT SUMMARY/ABSTRACT: Elevated body mass index (BMI) at pregnancy onset and excessive gestational weight gain (GWG) are consistently associated with adverse pregnancy and child outcomes. Diet and lifestyle interventions during pregnancy have had limited success in reducing GWG or postpartum weight retention (PPWR), with no improvement in perinatal or childhood outcomes. Therefore, multiple organizations recommend that women attain a healthy weight before pregnancy. However, the benefit and risks for mother and child extending beyond delivery, optimal timing of preconception weight change, and how risks and benefits of preconception weight loss differ across clinical subgroups are currently unknown. Our preliminary data suggest that the weight trajectories upon which women enter pregnancy (loss, maintenance, or gain) may impact the hormonal milieu of early pregnancy as well as the amount of GWG and PPWR. The objective of this study is to examine the impact of weight trajectories in the immediate preconception period (within 2 years before pregnancy) on GWG, PPWR, pregnancy outcomes, and child growth. Our central hypothesis is that preconception weight change toward a normal BMI reduces risk of adverse pregnancy and birth outcomes by improving pre-pregnancy weight status, but may increase GWG, which then increases risks of outcomes sensitive to GWG (PPWR, large for gestational age, infant weight gain, child BMI). We further hypothesize that these associations are strongest among women with more extreme BMI and for more rapid weight change occurring closer to pregnancy. To test this hypothesis, we will leverage a transcontinental clinical data warehouse spanning almost 20 years with the weight and pregnancy data of more than 130,000 racially, ethnically, and socioeconomically diverse women, and weight and length/height data of their children through age 3 years. We will determine the relationship between maternal preconception weight trajectories and GWG (total and trimester-specific) and PPWR at 6 weeks and 12 months postpartum, risk of adverse pregnancy outcomes (gestational diabetes, gestational hypertension/preeclampsia, and cesarean section) and child outcomes (preterm birth, size for gestational age at birth, infant growth trajectory, and BMI at 3 years of age); and the degree to which these associations are mediated by GWG. For each aim, we will test the hypotheses within pre-pregnancy BMI classifications, high risk clinical subgroups (e.g., pre-existing diabetes, hypertension) and racial/ethnic subgroups. Our findings will inform preconception weight management recommendations and shape the future of preconception and antenatal weight management research.