Informing Evidence-based Maternal Weight Gain Guidelines for Twin Pregnancies

描述(申请人提供)：在过去的30年里，美国出生的双胞胎数量史无前例地上升，这是一个主要的公共卫生问题，因为双胞胎怀孕有很高的母亲和新生儿严重并发症的比率。妊娠体重增加(GWG)是双胎妊娠常见的不良结局的一个潜在的可改变的危险因素。不幸的是，有关双胞胎最佳GWG的数据极其有限。2009年医学研究所委员会发布的GWG临时指南只基于一项研究中观察到的GWG的四分位数范围，该研究对2234名自选的母亲进行了研究，这些母亲在E36周时生下了体重至少2500克的双胞胎。这项拟议的研究将通过评估双胞胎妊娠的体重增加总量和模式，为双胞胎妊娠提供基于证据的GWG指南，这与母亲和子女的最佳健康结果有关。该项目直接响应PA-12-061关于产妇营养对母亲、婴儿和儿童影响的研究。我们的研究设计将使用宾夕法尼亚州匹兹堡玛吉妇女医院2880例双胞胎怀孕的现有电子记录；宾夕法尼亚州12300例双胞胎妊娠的人口队列的重要记录；以及具有全国代表性的1658例双胞胎纵向出生队列的数据。我们的项目旨在确定GWG总量与母亲(妊娠期糖尿病、先兆子痫、计划外剖腹产、产后5年体重滞留)和子女(死产、婴儿死亡率、自然早产和32周、胎儿发育异常、儿童超重和认知发育不良)的不良后果之间的关系。将开发一种评估GWG总量的创新方法，消除现有测量方法与妊娠期相关性中的偏差。该项目还将研究孕妇GWG轨迹和不良围产儿结局之间的关系。一种新的生长曲线分析方法将被用来确定GWG的时机、数量和速度对不良妊娠和出生结果的贡献。这些目标的成功完成将为迄今为止所有BMI类别的双胞胎妊娠妇女提供最全面的GWG和不良后果评估。这项研究将首次评估双胞胎妊娠中高GWG对产后母亲及其子女患肥胖症的长期风险的影响，并将填补关于严重肥胖女性最佳GWG的主要知识空白。这项研究将为未来的循证指南提供坚实的基础，这些指南将指导这些高危妊娠的医疗实践和公共卫生政策。

DESCRIPTION (provided by applicant): The unprecedented rise in the number of twins born in the U.S. over the past 30 years is a major public health concern because twin pregnancies have high rates of serious maternal and neonatal complications. Gestational weight gain (GWG) is a potentially modifiable risk factor for adverse outcomes common to twin gestations. Unfortunately, data on optimal GWG for twin pregnancies is extremely limited. The 2009 Institute of Medicine Committee published provisional GWG guidelines based only on the interquartile range of GWG observed in a single study of 2234 self-selected mothers who delivered twins weighing at least 2500 g at e36 weeks gestation. The proposed study will inform evidence-based GWG guidelines for twin gestations by evaluating the total amount and pattern of weight gain in twin pregnancies that is associated with optimal health outcomes for mothers and offspring. This project directly responds to PA-12-061 for research on the effects of maternal nutrition on mothers, infants and children. Our study design will employ existing electronic records from 2880 twin pregnancies at Magee-Women's Hospital in Pittsburgh, Pennsylvania; vital records from a population-based cohort of 12,300 twin pregnancies in Pennsylvania; and data from a nationally-representative longitudinal birth cohort of 1658 twins. Our project seeks to determine the association between total GWG and adverse outcomes for mothers (gestational diabetes, preeclampsia, unplanned cesarean delivery, weight retention at 5 years postpartum) and offspring (stillbirth, infant mortality, spontaneous preterm birth <32 weeks, abnormal fetal growth, child overweight, and poor cognitive development). An innovative method to assess total GWG will be developed that removes the bias in the existing measures' correlation with gestational duration. This project will also examine the relationship between maternal GWG trajectory and adverse perinatal outcomes. A novel growth curve analysis method will be used to determine the contribution of timing, amount, and velocity of GWG to poor pregnancy and birth outcomes. Successful completion of these aims will provide the most comprehensive evaluation of GWG and adverse outcomes for women carrying twin pregnancies across all BMI categories to-date. This study will be the first to assess the consequences of high GWG in twin pregnancies on longer-term risks of obesity in postpartum mothers and their children, and will fill major gaps in knowledge on the optimal GWG for severely obese women. This research will provide a strong foundation for future evidence-based guidelines, which will guide medical practice and public health policy for these high risk pregnancies.