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

项目摘要/摘要： 妊娠开始时体重指数（BMI）升高和妊娠期体重过度增加（GWG）是 始终与不良妊娠和儿童结局相关。期间的饮食和生活方式干预 怀孕在减少 GWG 或产后体重滞留 (PPWR) 方面取得的成功有限，没有 围产期或儿童期结局的改善。因此，多个组织建议女性 怀孕前达到健康的体重。然而，延长母亲和孩子的利益和风险 除了分娩之外，孕前体重变化的最佳时机，以及风险和收益如何 不同临床亚组的孕前体重减轻差异目前尚不清楚。我们的初步数据 表明女性进入怀孕期的体重轨迹（减轻、维持或增加）可能 影响妊娠早期的荷尔蒙环境以及 GWG 和 PPWR 的量。的目标 本研究旨在探讨体重轨迹对孕前期（2 天内）的影响。 怀孕前几年）关于 GWG、PPWR、妊娠结局和儿童生长。我们的中心假设是 孕前体重向正常体重指数变化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果，但可能会增加 GWG，从而增加风险 对 GWG 敏感的结果（PPWR、大于胎龄、婴儿体重增加、儿童 BMI）。我们进一步 假设这些关联在 BMI 更极端且速度更快的女性中最为强烈 接近怀孕时体重发生变化。为了检验这个假设，我们将利用横贯大陆的 跨越近20年的临床数据仓库，体重和妊娠数据超过13万条 种族、民族和社会经济多样化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 个月的 GWG（总妊娠期和妊娠期特定）和 PPWR，不良风险 妊娠结局（妊娠糖尿病、妊娠高血压/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 时的体重指数 岁）；以及这些关联由 GWG 调节的程度。对于每个目标，我们都会测试 孕前 BMI 分类、高风险临床亚组（例如，先前存在的 糖尿病、高血压）和种族/民族亚组。我们的研究结果将为孕前体重提供信息 管理建议并塑造孕前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.