Preconception obesity treatment: maternal bariatric surgery and long-term child health outcomes

项目摘要/摘要 在过去的三十年里，美国的肥胖率一直在稳步上升，包括孕妇 妇女、儿童和少数族裔。越来越多的证据表明，母亲肥胖--尤其是严重肥胖-- 增加了他们后代患肥胖症和其他慢性病的风险。此外，干预策略 以产前为目标的研究结果令人失望，将重点转移到先入为主的时期。 减肥手术程序的使用已经变得更加普遍，包括在 育龄，因为它的体重平均减少了总体重的20%到30%(大致 比生活方式干预有效3-4倍)，并且是长期的(七年或更长时间)。 然而，通过减肥手术对儿童进行先入为主的减肥的风险和好处很少。 理解，特别是在较长期内。 这项拟议的研究的总体目标是确定手术诱导的早孕减肥是否可以 减少他们后代肥胖的长期风险和肥胖相关的健康。我们将利用收集到的信息 来自一大群肥胖女性(n=2120)，她们在成为 怀孕的人和他们的孩子。我们将比较体重和体重相关的健康状况(根据胎龄、婴儿的大小 体重增加，BMI至6岁)之前接受减肥手术的妇女的孩子 未接受减肥手术的妇女所生的两个对照组(n=21,200)怀孕。第一 对照组将与母亲手术前的BMI相匹配；第二组将与 母亲孕前体重指数(手术后)。然后我们将确定怀孕情况的程度 (妊娠期糖尿病、高血压疾病、贫血、妊娠期体重增加)中介关联 减肥手术和孩子结局之间的关系。我们将进一步检查是否较小的尺寸适用于一岁妊娠 减肥手术后的已知风险--与母亲所生的孩子的结局相似 有或没有进行减肥手术，以及没有和没有妊娠贫血。 我们由Kaiser Permanente和Oregon Health&Science组成的财团创建的大型、独特的数据集 大学网站，将使我们能够在不同的研究人群中解决这些问题，代表 严重肥胖风险最高的种族和少数民族妇女。研究结果将提供对 先入为主的减肥对儿童长期健康结局的作用，实现 通过减肥手术减肥对这些结果的影响，并指导未来的结果研究，重点是 通过生活方式、内科和外科手段改善产妇先入为主的体重。

Project Summary/Abstract Obesity prevalence has been steadily rising in the U.S. over the past three decades, including among pregnant women, children, and minorities. Accumulating evidence links maternal obesity – particularly severe obesity – to increased risk for obesity and other chronic diseases in their offspring. Moreover, intervention strategies targeting the prenatal period have yielded disappointing results, shifting focus to the preconception period. Utilization of bariatric surgery procedures have become more common, including among women of childbearing age, as it achieves weight losses averaging between 20% and 30% of total body weight (roughly 3-4 times more effective than lifestyle interventions) and is sustained long-term (seven years and longer). However, the risks and benefits of preconception weight loss by bariatric surgery to children are poorly understood, particularly in the longer-term. The overall goal of the proposed research is to determine if surgically-induced preconception weight loss can reduce their offspring's long-term risk of obesity and obesity-related health. We will utilize information collected from a large cohort (n=2120) of women with obesity who lost weight by bariatric surgery before becoming pregnant and their children. We will compare weight and weight related health (size for gestational age, infant weight gain, BMI through 6 years of age) in children of women who received bariatric surgery prior to pregnancy to two control groups born to women who did not undergo bariatric surgery (n=21,200). The first control group will be matched to the mother's pre-surgical BMI; the second control group will be matched to the mother's pre-pregnancy BMI (after surgery). We will then determine the extent to which pregnancy conditions (gestational diabetes mellitus, hypertensive disorders, anemia, gestational weight gain) mediate associations between bariatric surgery and child outcomes. We will further examine if smaller size for gestational age – one known risk following bariatric surgery – is associated with child outcomes similarly in children born to mothers with and without bariatric surgery, and without and without pregnancy anemia. Our large, unique dataset created by a consortium of Kaiser Permanente and Oregon Health & Science University sites, will allow us to address these questions in a diverse study population, with representation of racial and ethnic minority women at highest risk of severe obesity. Study findings will provide understanding of the role of preconception weight loss on long-term child health outcomes, the specific influence of achieving this weight loss by bariatric surgery on these outcomes, and guide future outcome studies that focus on improving maternal preconception weight by lifestyle, medical, and surgical means.