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

项目总结/摘要： 妊娠期体重指数（BMI）升高和妊娠期体重过度增加（GWG）是 与不良妊娠和儿童结局一致相关。饮食和生活方式干预 妊娠在减少GWG或产后体重保留（PPWR）方面的成功有限， 改善围产期或儿童期结果。因此，多个组织建议妇女 在怀孕前达到健康的体重。然而，母亲和孩子的利益和风险， 除了分娩，孕前体重变化的最佳时机，以及 孕前体重减轻在临床亚组之间的差异目前尚不清楚。我们的初步数据 这表明，女性进入妊娠期的体重轨迹（损失，维持或增加）可能 影响早期妊娠的激素环境以及GWG和PPWR的量。的目标 本研究的目的是探讨在直接孕前阶段（2 妊娠前10年）对GWG、PPWR、妊娠结局和儿童生长的影响。我们的核心假设是 孕前体重向正常BMI的变化降低了不良妊娠和分娩的风险， 结果通过改善孕前体重状况，但可能会增加GWG，然后增加风险 对GWG敏感的结局（PPWR、大于胎龄儿、婴儿体重增加、儿童BMI）。我们进一步 假设这些关联在BMI更极端的女性中最强， 体重的变化更接近怀孕。为了验证这一假设，我们将利用一个横贯大陆的 临床数据仓库跨越近20年，体重和妊娠数据超过13万 种族、族裔和社会经济背景不同的妇女及其子女的体重和身长/身高数据 到3岁。我们将确定母亲孕前体重轨迹之间的关系， 产后6周和12个月时的GWG（总体和孕期特异性）和PPWR， 妊娠结局（妊娠期糖尿病、妊娠期高血压/先兆子痫和剖宫产） 和儿童结局（早产、出生时胎龄大小、婴儿生长轨迹和3岁时BMI） 年龄）;以及在何种程度上，这些协会是由GWG调解。对于每个目标，我们将测试 孕前BMI分类、高风险临床亚组（例如，预先存在 糖尿病、高血压）和人种/种族亚组。我们的发现将告知孕前体重 管理建议和塑造未来的孕前和产前体重管理 research.

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.