The role of impulsive phenotypes on weight trajectories and response to behavioral interventions during pregnancy and the postpartum period

摘要 围产期，定义为从怀孕到产后第一年，是一个关键时期。 体重管理干预的时间，并提供了解相关因素的独特机会 与体重和进食行为有关。为了回应PAR-16-304，我们建议利用我们正在进行的努力 通过评估以下因素对围产期体重管理顺序的影响 围产期肥胖的行为表型。具体地说，我们建议研究冲动性之间的联系 表型和围产儿体重。冲动的表型与更高的体重指数、更大的 随着时间的推移体重增加，对体重管理干预的反应不佳。冲动的影响 体重变化的表型也是双向的。然而，冲动表型对体重的作用 围产期的轨迹，以及这些表型如何影响对围产期体重的反应 干预措施，是未知的。我们和其他人的工作都证明了体重和体重之间的密切联系 冲动表型的特征是：(1)不受抑制的行为，(2)注意力缺陷，(3)冲动决策-- 以及(4)认知不灵活，尽管目前尚不清楚这些冲动表型是否以及如何 预测围产期的体重轨迹和饮食行为，或对围产期干预的反应。 因此，我们计划评估超重或肥胖女性的这些冲动表型。 在围产期体重试验中。怀孕前超重或肥胖的女性目前正在被招募 随后进行了一项旨在评估围产期体重序列的顺序多重分配试验 产后一年与改善产妇体重和健康相关的管理干预 (R01HL132578)。妇女在产前护理开始时被登记，并随机分配到干预组 它解决了怀孕期间体重的独特挑战或比较情况，包括 照常治疗。在分娩时，妇女再次随机接受产后体重干预或治疗 像往常一样。我们建议增加冲动表型的行为任务和问卷评估，并 饮食行为，以利用在这项父母试验中收集的数据。具体目标是：(1)审查 冲动表型作为产后一年围产儿体重轨迹的预测因子，以及(2) 评估冲动表型、围产期干预措施和减肥结果之间的关系 进食行为。我们还将探索孕期体重和冲动表型的联合轨迹。 一直持续到产后12个月。围产期体重干预研究中的冲动表型评估 将加强对与体重轨迹相关的行为和认知因素的理解 产后一年。这些数据将支持个性化体重管理干预的努力，并 有助于开发新的围产期行为干预措施，以改善长期健康。

ABSTRACT The perinatal period, defined as the period from pregnancy through the first postpartum year, is a critical time for weight management intervention and provides a unique opportunity to understand factors associated with weight and eating behaviors. In response to PAR-16-304, we propose to leverage our ongoing efforts to evaluate sequences of weight management across the perinatal period by evaluating the contribution of behavioral phenotypes to perinatal obesity. Specifically, we propose to examine the link between impulsive phenotypes and perinatal weight. Impulsive phenotypes are associated with higher body mass index, greater weight gain over time, and poor response to weight management interventions. The effects of impulsive phenotypes on weight changes also are bidirectional. However, the role of impulsive phenotypes on weight trajectories over the perinatal period, and how these phenotypes may affect response to perinatal weight interventions, is unknown. Our work, and that of others, has documented strong links between weight and impulsive phenotypes characterized by: (1) disinhibited behavior, (2) attentional deficits, (3) impulsive decision- making, and (4) cognitive inflexibility, though it remains unclear whether and how these impulsive phenotypes predict weight trajectories and eating behavior over the perinatal period or response to perinatal intervention. Accordingly, we plan to assess these impulsive phenotypes among women with overweight or obesity enrolled in a perinatal weight trial. Women with overweight or obesity before pregnancy are currently being recruited and followed in a sequential multiple assignment trial designed to evaluate sequences of perinatal weight management interventions associated with improved maternal weight and health one year postpartum (R01HL132578). Women are enrolled at the beginning of prenatal care and randomly assigned to intervention that addresses the unique challenges of weight during pregnancy or a comparison condition involving treatment as usual. At delivery, women again are randomized to postpartum weight intervention or treatment as usual. We propose to add behavioral tasks and questionnaire assessments of impulsive phenotypes and eating behaviors to capitalize on the data collected in this parent trial. The specific aims are to (1) examine impulsive phenotypes as predictors of perinatal weight trajectories across the postpartum year, and (2) evaluate relationships among impulsive phenotypes, perinatal interventions and weight loss outcomes and eating behaviors. We also will explore the joint trajectories of weight and impulsive phenotypes from pregnancy through 12-months postpartum. Assessing impulsive phenotypes within a study of perinatal weight intervention will enhance the understanding of behavioral and cognitive factors associated with weight trajectories across the postpartum year. These data will support efforts to personalize weight management interventions and contribute to the development of novel behavioral perinatal interventions to improve longer-term health.