Innovative approaches to inform evidence-based pregnancy weight gain guidelines

为循证妊娠体重增加指南提供信息的创新方法

• 批准号: 9789055
• 负责人: Lisa M Bodnar
• 金额: $ 53.22万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-19 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9789055
• 关键词: Accounting; Address; Adverse event; Agreement; Birth; Body mass index; Cardiovascular Diseases; Cesarean section; Child; Communities; Complex; Consensus; Data; Decision Making; Enrollment; Equilibrium; Eye; Fetal Growth Retardation; Funding; Future; Gestational Age; Gestational Diabetes; Government; Guidelines; Health; Individual; Institute of Medicine (U.S.); Knowledge; Link; Literature; Maternal and Child Health; Medical; Medical Economics; Methodology; Methods; Monitor; Mothers; Neonatal; Nulliparity; Nurses; Nutritional Support; Obesity; Outcome; Outcome Study; Patients; Perinatal mortality demographics; Policy Maker; Policy Making; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Pregnant Women; Premature Birth; Primary Care Physician; Process; Prospective cohort; Public Health; Publishing; Recommendation; Reproducibility; Research; Research Personnel; Risk; Risk Factors; Serious Adverse Event; Severities; Specific qualifier value; Testing; United States National Institutes of Health; Weight; Weight Gain; Woman; Work; adverse outcome; care providers; child bearing; cohort; evidence base; evidence based guidelines; gestational weight gain; high risk; improved; innovation; modifiable risk; obesity in children; offspring; pediatrician; perinatal health; postpartum weight; prevent; research study; risk minimization

PROJECT SUMMARY / ABSTRACT A large volume of research has shown that excessive pregnancy weight gain contributes to maternal postpartum weight retention, child obesity, cesarean delivery, gestational diabetes and preeclampsia, while low gestational weight gain is linked with fetal growth restriction, preterm birth, and perinatal death. However, major gaps remain in our ability to convert these findings into evidence-based recommendations on optimal pregnancy weight gain. The status quo is to evaluate each outcome separately, and without regard to its perceived severity. Further, subjective approaches have been used to select the cut-points of recommended weight gain ranges. Policy-makers urgently need evidence on the optimal range of pregnancy weight gain that considers multiple adverse outcomes simultaneously, accounts for differences in the relative severity of different outcomes, and establishes cut-points using systematic and reproducible methods. In this application, we will develop and apply advanced methodologies that support the creation of robust, evidence-based public health recommendations for weight gain in pregnancy. First, we will generate weights reflecting stakeholder perspectives on the relative severity of competing maternal and child health outcomes associated with gestational weight gain. A Delphi-consensus process will summarize the perceived severity of competing maternal and child health outcomes from diverse panels of 60 women and 60 content experts. Second, we will use a large, diverse cohort of U.S. pregnant women to determine the relationship between gestational weight gain and a composite outcome of adverse events for mothers (preeclampsia, gestational diabetes, cesarean delivery, longer-term obesity, subclinical cardiovascular disease) and children (perinatal death, preterm birth, and small- and large-for-gestational-age birth), with each component weighted to account for its relative severity. Then, we will use our previously-published quantitative approach to identify the optimal range of pregnancy weight gain for women according to different body mass index values, defined as the weight gain associated with the lowest risks of combined, severity-weighted maternal and child outcomes. Successful completion of these aims will provide policy makers with evidence on the complex trade-offs between low and high weight gain on short- and longer-term maternal and child health in order to inform pregnancy weight gain guidelines. Our innovative approach to study multiple adverse outcomes simultaneously and account for their relative severity will enable us to overcome challenges that have previously impeded the synthesis of existing research studies into a systematic, evidence-based weight gain guideline. Our work will impact public health and medical practice by providing high quality evidence for optimizing the nutritional care of pregnant mothers and children.

项目概要/摘要 大量研究表明，孕期体重增加过多会导致孕妇体重增加。 产后体重滞留、儿童肥胖、剖腹产、妊娠糖尿病和先兆子痫，而低 妊娠期体重增加与胎儿生长受限、早产和围产期死亡有关。然而，主要 我们将这些发现转化为基于证据的最佳建议的能力仍然存在差距 怀孕期间体重增加。现状是单独评估每个结果，而不考虑其本身 感知到的严重性。此外，主观方法已被用来选择推荐的切点 体重增加范围。政策制定者迫切需要证据证明妊娠期体重增加的最佳范围 同时考虑多种不良结果，解释了相对严重程度的差异 不同的结果，并使用系统和可重复的方法建立切点。 在此应用程序中，我们将开发和应用先进的方法来支持创建强大的、 针对妊娠期体重增加的基于证据的公共卫生建议。首先，我们将生成权重 反映利益相关者对相互竞争的孕产妇和儿童健康结果的相对严重性的看法 与妊娠期体重增加有关。德尔菲共识流程将总结所感知到的严重性 由 60 名女性和 60 名内容专家组成的不同小组相互竞争孕产妇和儿童健康成果。 其次，我们将使用大量不同的美国孕妇群体来确定两者之间的关系 妊娠期体重增加和母亲不良事件的综合结果（先兆子痫、妊娠期 糖尿病、剖腹产、长期肥胖、亚临床心血管疾病）和儿童（围产期 死亡、早产以及小于胎龄和大于胎龄的分娩），每个组成部分都经过加权考虑 因为其相对严重性。然后，我们将使用之前发布的定量方法来确定最佳的 不同体重指数值下女性孕期体重增加范围，定义为 体重增加与严重程度加权的孕产妇和儿童结局的最低风险相关。 成功完成这些目标将为政策制定者提供有关复杂权衡的证据 低体重增加和高体重增加对短期和长期孕产妇和儿童健康的影响，以便提供信息 怀孕体重增加指南。我们同时研究多种不良后果的创新方法 并考虑到它们的相对严重性将使我们能够克服以前阻碍我们发展的挑战 将现有研究综合成系统的、基于证据的体重增加指南。我们的工作将 通过提供优化营养护理的高质量证据来影响公共健康和医疗实践 怀孕的母亲和儿童。