Preconception and Prenatal Health Impacting Factors and Child Health

摘要 近几十年来，儿童肥胖症和神经发育障碍有所增加，其中 普遍存在的威胁儿童健康和福祉的疾病。这些情况的后果意味着 需要确定可修改的因素，以针对上游预防。新出现的证据表明 出生前暴露于心理困扰、物质使用和生活方式因素的关键时期 胎儿发育可用于儿童肥胖和神经发育(ND)的发育规划。 然而，很少有研究采取多重暴露的方法来理解个体和关节 这些暴露的影响。在目标1中，我们将研究宫内暴露在心理痛苦中的作用。 和物质使用对儿童生长、肥胖、肥胖和ND的影响，以及产前生活方式因素的程度 而社区因素可能会缓解这些关联。此外，虽然产妇的饮食和体力活动 影响婴儿生长和肥胖，在不同人群中很少有研究评估机制途径 关于它们对新城疫的影响，人们知之甚少。我们提出了24小时运动图谱和代谢组学 我们对生活方式的专门测量，以及肥胖和ND作为我们的专门结果。24小时 移动配置文件结合了基于设备的物理测量之间的相互依赖关系 怀孕期间的活动和睡眠，以更好地为干预措施提供信息。代谢组学可以阐明机制 并将根据ECHO协议(产前)收集的样本进行重复测量 血液、脐带血、出生后儿童血液和母乳)。在目标2中，我们将阐明母体的联合影响 产前饮食模式和24小时运动与儿童生长发育、肥胖和ND是否 代谢组签名在产前、出生时和出生后都会调节这些联系。对于目标1和目标2，我们 还将研究社区特征和出生时指定的婴儿性别之间的关联如何变化。在……里面 目标3我们将通过实施注重以下方面的循证战略，最大限度地扩大招聘和留住 动员不同群体参与临床研究并应用系统实施ECHO队列方案 质量控制方法和最佳做法。我们建议通过招募一名员工为ECHO计划做出贡献 来自Kaiser Permanente Northern两个医疗中心的1800名孕妇的不同队列 加州服务于多样化的人口(约70%的种族/少数民族群体，50%的人收入较低)， 怀孕的伴侣，他们所生的孩子，并在孩子出生后多次访问他们。在AIM 4我们将探索先入为主的母亲和父亲的生活方式因素对婴儿出生大小的影响，以确定 预防儿童肥胖和新城疫上游危险因素的关键时间段。所有成员 我们多样化的研究团队的成员将有平等的机会为我们项目的各个方面做出贡献，并成为 参与了新的回声阶段。这项研究的发现将对以下信息具有重要意义 干预措施、预防战略和政策，以确保所有儿童的最佳健康和福祉。

Abstract Childhood obesity and neurodevelopmental impairments have increased in recent decades and are the most prevalent conditions threatening child’s health and well-being. The consequences of these conditions signify the need to identify modifiable factors to target for upstream prevention. Emerging evidence suggests that prenatal exposures to psychological distress, substance use, and lifestyle factors during critical windows of fetal development may operate to developmentally program childhood obesity and neurodevelopment (ND). However, few studies have taken a multiple exposure approach to understand the individual and joint effects of these exposures. In Aim 1 we will examine the role of in utero exposure to psychological distress and substance use on child growth, adiposity, obesity, and ND and the extent to which prenatal lifestyle factors and neighborhood factors may mitigate these associations. Further, while maternal diet and physical activity impact infant growth and adiposity, few studies in diverse populations have assessed mechanistic pathways and little is known about their impact on ND. We propose the 24-hour movement profile and metabolomics as our specialized measures of lifestyle, and obesity and ND as our specialized outcomes. The 24-hour movement profile incorporates the interdependent relationships between device-based measures of physical activity and sleep during pregnancy to better inform interventions. Metabolomics can elucidate mechanistic pathways and will be measured repeatedly on the samples collected according to the ECHO protocol (prenatal blood, cord blood, postnatal child’s blood, and breastmilk). In Aim 2 we will clarify the joint effects of maternal prenatal dietary patterns and the 24-hour movement and child growth, obesity, and ND and whether metabolomic signatures prenatally, at birth, and postnatally mediate these associations. For Aims 1 and 2 we will also examine how associations vary by neighborhood characteristics and infant sex assigned at birth. In Aim 3 we will maximize recruitment and retention by implementing evidence-based strategies focused on engaging diverse groups in clinical research and implementing the ECHO Cohort Protocol applying systematic quality control approaches and best practices. We propose to contribute to the ECHO Program by recruiting a diverse cohort of 1,800 pregnant individuals from two medical centers at Kaiser Permanente Northern California serving a diverse population (~70% racial/ethnic minority groups with 50% having a low income), the conceiving partner, their resulting child, and to follow all of them at multiple visits after the child is born. In Aim 4 we will explore the role of preconception maternal and paternal lifestyle factors on infant birth size to identify critical time periods to intervene on to prevent upstream risk factors for childhood obesity and ND. All members of our diverse research team will have equal opportunity to contribute to all aspects of our project and to be involved in the new ECHO phase. Findings from this study will have important implications for informing interventions, prevention strategies and policies to ensure optimal health and well-being for all children.