Weight management for improved pregnancy outcomes

体重管理可改善妊娠结局

• 批准号: 7840413
• 负责人: Victor J Stevens
• 金额: $ 74.6万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-05-12 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7840413
• 关键词: Address; Adoption; Adverse effects; Age; Applied Research; Benefits and Risks; Birth; Birth Weight; Birth trauma; Body Weight Changes; Body mass index; Caring; Cesarean section; Data; Developed Countries; Development; Diabetes Mellitus; Diet; Discipline of obstetrics; Eating; Energy Intake; Epidemic; Equilibrium; Fetal Growth; Fetal Macrosomia; Fetus; First Pregnancy Trimester; Future; Gestational Age; Gestational Diabetes; Goals; Health; High birth weight infant; Hypertension; Infant; Institute of Medicine (U.S.); Intake; Intervention; Lead; Long-Term Effects; Low Prevalence; Managed Care; Measures; Medical; Morbid Obesity; Morbidity - disease rate; Mothers; National Institute of Diabetes and Digestive and Kidney Diseases; Neonatal; Newborn Infant; Nutritional; Obesity; Outcome; Outcome Assessment; Outcome Measure; Overweight; Participant; Patients; Population; Postoperative Complications; Postpartum Period; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnant Women; Prevalence; Public Health; Randomized; Recommendation; Recruitment Activity; Research; Risk; Safety; Specific qualifier value; Spontaneous abortion; Testing; Treatment Efficacy; Ultrasonography; Underweight; United States; Vaginal delivery procedure; Weight; Weight Gain; Woman; design; follow up assessment; group intervention; improved; infant death; interest; member; mortality; neonate; nutrition; prevent; primary outcome; programs; public health relevance; reproductive; satisfaction; secondary outcome; stillbirth; treatment as usual; volunteer; weight maintenance

DESCRIPTION (provided by applicant): Historically, under nutrition has been a major health concern. Recently however, over nutrition has also become a serious public health problem in the United States and other industrialized countries. With the new obesity epidemic we see increasing morbidity, mortality, and public health burden, particularly among reproductive-aged women. Whereas morbid obesity was once rare among pregnant women, a rapidly increasing proportion of obstetrics patients now have levels of obesity which dramatically increase their risk of serious pregnancy complications. These complications include increased risk of miscarriage, stillbirth, having a fetus that is too large leading to cesarean section or birth injuries for mom and baby from vaginal delivery, and death of the infant in the newborn period. More than 1/3 of women in the U.S. are now starting their pregnancies with a body mass index or 30 or greater, a condition that was unusual to rare 50 years ago. Given the serious consequences of added weight gain during pregnancy for obese women, such as gestational diabetes, pre-eclampsia, or cesarean delivery, the best strategy during their pregnancy may be to maintain a steady weight rather than gaining 15 pounds or more. Unfortunately, there is little research on the efficacy and feasibility of minimizing weight gain during pregnancy. This study is designed to address that problem. Two hundred women with BMIs of 30 or greater at the start of their pregnancy will be recruited for this feasibility test. All participants will be members of a non-profit managed care organization that provides high-quality obstetrics care. Patients who volunteer to participate will be randomly assigned to either a weight maintenance intervention or to usual care. Participants assigned to the intervention will participate in a weight maintenance program designed to help them eat a nutritionally balanced diet and to also control energy intake to minimize weight gain during their pregnancy. Participants (and their babies) in both groups will participate in follow- up assessments at 2 weeks postpartum, 6 months postpartum and one year postpartum. The primary outcome measures will be mothers' weight gain during pregnancy, the amount of weight retained after delivery, and the proportion of large for gestational age infants. Secondary outcomes will include multiple safety measures of the mothers and their babies. In addition to measures of safety, our secondary analyses will address the feasibility and acceptability of a weight management intervention among obese pregnant women. PUBLIC HEALTH RELEVANCE: Obesity and excessive weight gain during pregnancy lead to increased risks of high blood pressure, gestational diabetes, large infants, and cesarean section. This study will test an intensive, weight management program for obese pregnant women to prevent too much weight gain and reduce risk of pregnancy complications. Given that pregnancy is one of the primary reasons women seek medical care, interventions that prevent excessive weight gain during pregnancy could have significant public health impact by preventing worsening obesity and its long-term effects on mothers and their babies.

描述（由申请人提供）：从历史上看，营养不良一直是一个主要的健康问题。然而，近年来，在美国和其他工业化国家，营养过剩也已成为一个严重的公共卫生问题。随着新的肥胖症流行，我们看到发病率、死亡率和公共卫生负担不断增加，特别是在育龄妇女中。虽然病态肥胖曾经在孕妇中很少见，但现在迅速增加的产科患者比例具有肥胖水平，这大大增加了严重妊娠并发症的风险。这些并发症包括流产、死产、胎儿过大导致剖宫产或阴道分娩对母亲和婴儿造成伤害以及新生儿死亡的风险增加。在美国，超过三分之一的女性现在开始怀孕时的体重指数为30或更高，这种情况在50年前是不寻常的。考虑到肥胖女性怀孕期间体重增加的严重后果，如妊娠糖尿病，先兆子痫或剖宫产，怀孕期间的最佳策略可能是保持稳定的体重，而不是增加15磅或更多。不幸的是，很少有关于减少怀孕期间体重增加的有效性和可行性的研究。本研究旨在解决这一问题。将招募200名在妊娠开始时BMI为30或更高的女性进行该可行性试验。所有参与者都将是一个提供高质量产科护理的非营利性管理式护理组织的成员。自愿参加的患者将被随机分配到体重维持干预或常规护理。被分配到干预的参与者将参加一个体重维持计划，旨在帮助他们吃营养均衡的饮食，并控制能量摄入，以尽量减少怀孕期间的体重增加。两组的参与者（和他们的婴儿）将在产后2周、产后6个月和产后一年参加随访评估。主要结局指标将是母亲在怀孕期间的体重增加、产后保留的体重以及大于胎龄婴儿的比例。次要结果将包括母亲及其婴儿的多种安全措施。除了安全性措施，我们的二次分析将解决肥胖孕妇体重管理干预的可行性和可接受性。公共卫生关系：怀孕期间肥胖和体重过度增加会导致高血压、妊娠糖尿病、大婴儿和剖宫产的风险增加。这项研究将测试一种针对肥胖孕妇的强化体重管理计划，以防止体重增加过多，降低妊娠并发症的风险。鉴于怀孕是妇女寻求医疗保健的主要原因之一，预防怀孕期间体重过度增加的干预措施可能会通过防止肥胖恶化及其对母亲和婴儿的长期影响而产生重大的公共卫生影响。