Sedentary behavior, physical activity, and 24-hour behavior in pregnancy and offspring health: the Pregnancy 24/7 Offspring Study

摘要 在过去的三十年里，儿童肥胖症的发病率有了惊人的增长。 儿童期肥胖导致心血管危险因素的早发，肥胖和心血管风险 这些因素会持续到成年期，并导致心血管疾病（CVD）的流行。发育 健康与疾病起源理论认为，肥胖和心血管疾病的风险部分是在子宫内编程的。到 预防这种早期的肥胖和心血管疾病，在怀孕期间识别可改变的母体因素， 怀孕以后影响幼儿期的后代风险至关重要。令人惊讶的是， 产前久坐行为（SED）、中等强度至剧烈强度的体力活动（MVPA）以及 新的24小时行为模式（SED，体力活动和睡眠的组成）对这些不良反应的影响。 后代的结果。这是一个关键的研究空白，因为有很强的生理学原理， MVPA、孕期24小时行为对子代健康有影响，且这些行为是可以改变的 怀孕期间的干预目标。本提案的总体目标是研究SED的关联 (Aim 1）和MVPA（目标2）在整个怀孕与后代肥胖风险和CVD风险通过24个月。我们 还将使用新的统计方法来确定最佳的24小时行为组成（目标3）， 妊娠与这些不良后代结果的风险降低有关。我们可以通过以下方式实现这些目标： 利用我们正在进行的多中心队列研究妊娠24/7（R 01 HL 153095），我们前瞻性地 使用最先进的技术测量500名妇女在怀孕的每个三个月的SED、身体活动和睡眠。 显示器（activPAL 3 micro和Actiwatch Spectrum Plus）。怀孕24/7还评估了其他相关的产前检查 可能与后代肥胖和CVD风险相关的暴露，即，孕前肥胖，妊娠期体重 增重、饮食、吸烟和不良妊娠结局。在直接回应NHLBI的特别通知 兴趣（NOT-HL-19-695），我们建议通过在以下人群中进行单独的队列研究来扩展妊娠24/7 参与者的后代在后代研究中，我们建议将联合收割机的母体暴露数据 妊娠24/7，对产后暴露、肥胖和CVD风险指标进行新的全面评估 通过医疗记录摘要、问卷调查和24岁时的亲自研究访问， 个月我们假设，在整个怀孕期间，SED较高或MVPA较低的女性的后代将有 BMI Z评分（主要结局）增加更快，肥胖、血压和脉搏波更大 24个月的速度。此外，我们假设，在统计学上重新分配时间在SED体力活动， 而不是睡眠（在足够长时间的睡眠者中）将与更优的后代结果相关联。通过 结合产前和产后暴露数据，我们的方法独特地使我们能够分离出 妊娠SED、MVPA和24小时行为对儿童早期肥胖和CVD风险测量的影响。这 该项目将告知急需的基本预防干预措施，以降低肥胖和心血管疾病的风险。

ABSTRACT Over the past three decades, there has been an alarming increase in the incidence of childhood obesity. Childhood obesity leads to early onset of cardiovascular risk factors, and both obesity and cardiovascular risk factors track into adulthood and contribute to the epidemic of cardiovascular disease (CVD). The Developmental Origins of Health and Disease theory posits that risk for obesity and CVD is, in part, programmed in utero. To prevent this early entrenchment into obesity and CVD, identification of modifiable maternal factors during pregnancy that later impact offspring risk in early childhood is essential. A surprising lack of research investigates the role of prenatal sedentary behavior (SED), moderate-to-vigorous-intensity physical activity (MVPA), and the novel 24-hour behavior paradigm (the composition of SED, physical activity, and sleep) on these adverse offspring outcomes. This is a critical research gap because there is strong physiological rationale that SED, MVPA, and 24-hour behavior in pregnancy could influence offspring health, and these behaviors are modifiable targets for intervention during pregnancy. The overall goal of this proposal is to examine the associations of SED (Aim 1) and MVPA (Aim 2) across pregnancy with offspring obesity risk and CVD risk through 24 months. We will also use novel statistical methods to determine the optimal 24-hour behavior compositions (Aim 3) during pregnancy associated with reduced risk of these adverse offspring outcomes. We can achieve these aims by leveraging our ongoing, multi-center cohort study Pregnancy 24/7 (R01 HL153095), where we are prospectively measuring SED, physical activity, and sleep in 500 women in each trimester of pregnancy using state-of-the-art monitors (activPAL3 micro and Actiwatch Spectrum Plus). Pregnancy 24/7 also assesses other relevant prenatal exposures that may associate with offspring obesity and CVD risk, i.e., pre-pregnancy obesity, gestational weight gain, diet, smoking, and adverse pregnancy outcomes. In direct response to the NHLBI’s Notice of Special Interest (NOT-HL-19-695), we propose to expand Pregnancy 24/7 by conducting a separate cohort study among the offspring of its participants. In the Offspring Study, we propose to combine maternal exposure data from Pregnancy 24/7 with new, comprehensive assessments of postnatal exposures, obesity, and CVD risk measures in the child through 24 months via medical record abstraction, questionnaires, and an in-person study visit at 24 months. We hypothesize that offspring of women with higher SED or lower MVPA across pregnancy will have more rapid increases in BMI Z-score (primary outcome), and greater adiposity, blood pressure, and pulse wave velocity through 24 months. Further, we hypothesize that statistically reallocating time in SED to physical activity, but not sleep (among adequate duration sleepers) will be associated with more optimal offspring outcomes. By combining prenatal and postnatal exposure data, our approach uniquely allows us to isolate the effects of pregnancy SED, MVPA, and 24-hr behavior on offspring obesity and CVD risk measures in early childhood. This project will inform critically needed primordial prevention interventions to decrease the risk of obesity and CVD.