PrepareD: Examining post-Delivery maternal-offspring obesity and metabolic risk after a prepregnancy weight-loss intervention

项目摘要/摘要： 肥胖症是一种全国性的流行病，通常始于儿童早期，已知是从 母亲对子女的影响，但人们对如何有效地中断这种多代循环知之甚少。 尽管医学研究所建议肥胖女性在怀孕前减肥，但我们 目前还没有研究怀孕前有意减肥对未来肥胖影响的数据。 风险。美国国立卫生研究院2011年肥胖研究战略计划强调了对新肥胖症研究的必要性 预防和治疗计划，我们在2014年响应了这一呼吁，推出了一项随机 孕前减肥干预的对照试验(NIDDK R01DK0099882)。 根据新出现的数据，妊娠早期的宫内环境主要由孕前和孕期决定。 怀孕体重可能是肥胖传播的关键，Prepare的目标是帮助 超重或肥胖前通过改善饮食和体力活动习惯来减肥 怀孕了。该计划有效地帮助妇女在怀孕前减肥，并改善了 早孕时的代谢环境，并受到参与者的高度好评。关键的是，我们没有 但知道该计划是否对长期肥胖和代谢风险或饮食和身体状况有影响 母亲及其子女的活动习惯。将Prepare延长至其当前结束日期之后-交付- 提供了一个独特的机会来检验这一假说，即怀孕前对女性进行干预会影响 他们的长期肥胖和代谢风险以及他们孩子的风险。 在准备好的，我们建议在分娩后对母亲和她们的后代进行为期3年的跟踪调查，以便 确定准备干预对体重和其他人体测量的长期影响； 代谢标记物；母亲及其子女的饮食和体力活动模式。这项研究包括 孩子3岁后的面对面研究访问以及医疗记录的收集和分析 三年期间的体重和自我报告的问卷数据。我们将储存生物样本 在访问中收集在生物信息库中，以便进行关于潜在的表观遗传学和 可能将孕前体重减轻与长期肥胖风险降低联系起来的微生物组途径 母亲和她们的后代。通过NIDDK过渡性资金(R56 DK099882)，我们没有任何突破 在随机对照试验和后续队列研究之间。我们已经开始登记并收集人体测量数据 来自母子二人组的测量和生物样本。这笔额外的资金将使我们能够 完成登记和数据收集，并确定通常推荐的肥胖的影响 孕前减肥对母亲长期体重和代谢健康的预防策略 他们的后代。如果我们的结果证明了孕前减肥的长期有效性， 准备干预可能是防止肥胖症代际传播的关键工具。

PROJECT SUMMARY/ABSTRACT: Obesity is a national epidemic that frequently begins in early childhood and is known to be passed from mothers to their children, but little is known about how to effectively interrupt this multigenerational cycle. Although the Institute of Medicine recommends that women with obesity lose weight prior to pregnancy, we know of no data that have examined the effects of intentional pre-pregnancy weight loss on future obesity risk. The 2011 Strategic Plan for NIH Obesity Research stressed the need for research on new obesity prevention and treatment programs, and we responded to this call in 2014 with Prepare, a randomized controlled trial of a pre-pregnancy weight loss intervention (NIDDK R01DK0099882). Based on emerging data that the 1st trimester intrauterine environment, determined primarily by pre- pregnancy weight, may be key in obesity transmission, the goal of Prepare was to help women who were overweight or had obesity lose weight by improving their diet and physical activity habits prior to becoming pregnant. The program was effective in helping women lose weight before pregnancy and improving the metabolic milieu in early pregnancy, and was regarded highly favorably by participants. Critically, we do not yet know whether the program has an influence on long-term obesity and metabolic risk or diet and physical activity habits of mothers and their offspring. Extending Prepare beyond its current end date—delivery— offers a unique opportunity to test the hypothesis that intervening on women before pregnancy can affect their long-term obesity and metabolic risk and that of their children. In PrepareD, we propose to follow mothers and their offspring for 3 years after delivery in order to determine the longer-term effect of the Prepare intervention on weight and other anthropometric measures; metabolic markers; and diet and physical activity patterns of mothers and their offspring. The study includes an in-person research visit after the children turn 3 as well as collection and analysis of medical record weights and self-reported questionnaire data over the 3-year period. We will store biological samples collected at the visit in a biorepository in order to conduct future studies about potential epigenetic and microbiome pathways that might link pre-pregnancy weight loss to decreased long-term obesity risk in mothers and their offspring. Through NIDDK bridge funding (R56 DK099882), we have had no break between the RCT and follow-up cohort study. We have begun enrolling and collecting anthropometric measures and biological samples from mother-offspring dyads. This additional funding will enable us to complete enrollment and data collection and determine the effects of the commonly recommended obesity prevention strategy, pre-pregnancy weight loss, on long-term weight and metabolic health of mothers and their offspring. Should our results demonstrate efficacy of pre-pregnancy weight loss over the long term, the Prepare intervention could be a critical tool for preventing the generational transmission of obesity.