Relationship of Loss of Control Eating to Excessive Gestational Weight Gain

描述（由申请人提供）：超过45%的女性超过了医学研究所（IOM）为妊娠期体重增加（GWG）制定的指导方针。怀孕时超重或肥胖的妇女比正常体重的妇女更有可能超过国际医学协会的指导方针。过量（GWG）与消极的产科结局有关，增加后代肥胖的风险，并导致更大的产后体重潴留。预防过量的GWG可以改善产科结果，并可能导致改善妇女肥胖的治疗。然而，防止过度GWG的干预措施并不总是成功的，有必要确定与GWG相关的可改变行为，以支持有效干预措施的发展，以防止过度GWG。对饮食失去控制（LOC），或摄入食物并伴有无法控制食量的感觉，与体重增加密切相关，并且是可以改变的。LOC还与抑郁症状和社会心理困扰有关，这也与体重增加有关。因此，本研究的目的是评估GWG、LOC和心理社会困扰之间的关系。将从当地一家妇女医院的产科诊所招募怀孕前超重或肥胖的孕妇（N = 300）（即孕前体重指数bbbb25）。妇女将完成结构化的临床访谈，包括饮食失调检查（EDE）和DSM- IV诊断结构化临床访谈（SCID），以记录妊娠前三个月末的LOC和抑郁症状。测量感知压力、社会支持、卡路里摄入量、身体活动和其他与GWG相关的因素也将在妊娠早期收集。在怀孕第20周至第36周期间，将每月通过电话对LOC、心理社会困扰、饮食和活动进行评估。为了记录产后体重保持情况，女性将在产后6个月再次接受采访。将在每次亲自访问时评估体重，并从妇女怀孕结束时的医疗图表中提取GWG。拟议的研究是调查小组先前工作的延伸，并将为过度GWG的可修改机制提供重要数据。了解过量GWG的行为机制可能为干预措施提供信息，以防止过量GWG，从而改善母亲和儿童的健康。

DESCRIPTION (provided by applicant): More than 45% of women exceed guidelines established by the Institute of Medicine (IOM) for gestational weight gain (GWG). Women who begin pregnancy overweight or obese are more likely to exceed the IOM guidelines than are normal weight women. Excessive (GWG) is associated with negative obstetric outcomes, increases the risk of obesity in offspring and leads to greater postpartum weight retention. Preventing excessive GWG can improve obstetric outcomes and may lead to improvements in the treatment of obesity for women. However, interventions to prevent excessive GWG have not been consistently successful, and there is a need to identify modifiable behaviors related to GWG to support the development of effective interventions to prevent excessive GWG. Loss of control over eating (LOC), or the ingestion of food coupled with a sense of being unable to control the quantity eaten, is strongly associated with weight gain and is modifiable. LOC also is related to depressive symptoms and psychosocial distress which also are associated with weight gain. Thus, the goal of the proposed study is to assess relationships among GWG, LOC and psychosocial distress. Pregnant women (N = 300) who are overweight or obese prior to pregnancy (i.e., pregravid BMI>25) will be recruited from obstetric clinics at a local women's hospital. Women will complete structured, clinical interviews including the Eating Disorder Examination (EDE) and the Structured Clinical Interview for DSM- IV diagnoses (SCID) to document LOC and depressive symptoms at the end of the first trimester of pregnancy. Measures of perceived stress, social support, calorie intake, physical activity, and other factors related to GWG also will collected in first trimester. Assessments of LOC, psychosocial distress, eating and activity will be repeated monthly by telephone between weeks 20 and 36 of pregnancy. To document postpartum weight retention, women will be interviewed again at 6 months postpartum. Weight will be assessed at each in person visit and GWG abstracted from women's medical charts at the end of pregnancy. The proposed research is an extension of previous work conducted by the investigative team, and will provide important data on modifiable mechanisms for excessive GWG. Understanding behavioral mechanisms of excessive GWG is likely to inform interventions to prevent excessive GWG and thereby improve the health of mothers and children.