Innovative approaches to inform evidence-based pregnancy weight gain guidelines

项目总结/摘要 大量的研究表明，过度的怀孕体重增加有助于产妇 产后体重保持、儿童肥胖、剖宫产、妊娠期糖尿病和先兆子痫，而低 妊娠期体重增加与胎儿生长受限、早产和围产期死亡有关。然而，少校 我们将这些发现转化为基于证据的最佳建议的能力仍然存在差距。 怀孕体重增加。现状是单独评估每个结果，而不考虑其 感知的严重性。此外，主观方法已被用于选择建议的临界点， 体重增加范围。政策制定者迫切需要关于怀孕体重增加的最佳范围的证据， 同时考虑多个不良结局，解释了 不同的结果，并使用系统和可重复的方法建立临界点。 在这个应用程序中，我们将开发和应用先进的方法，支持创建强大的， 以证据为基础的公共卫生建议怀孕期间体重增加。首先，我们将生成权重 反映利益攸关方对相互竞争的孕产妇和儿童健康结果的相对严重性的看法 与妊娠期体重增加有关。一个德尔菲共识过程将总结感知的严重性， 由60名妇女和60名内容专家组成的不同小组竞争孕产妇和儿童健康成果。 其次，我们将使用一个庞大的、多样化的美国孕妇队列来确定 妊娠期体重增加和母亲不良事件的复合结局（先兆子痫，妊娠期 糖尿病、剖宫产、长期肥胖、亚临床心血管疾病）和儿童（围产期 死亡、早产、小于胎龄儿和大于胎龄儿），并对每个组成部分进行加权 因为它的相对严重性然后，我们将使用我们以前发表的定量方法来确定最佳的 根据不同的体重指数值，妇女怀孕体重增加的范围，定义为 体重增加与综合严重程度加权母婴结局风险最低相关。 这些目标的成功实现将为决策者提供关于复杂权衡的证据 低体重增加和高体重增加对短期和长期孕产妇和儿童健康的影响 怀孕体重增加指南。我们同时研究多种不良结局的创新方法 并说明其相对严重性，将使我们能够克服以前阻碍我们的挑战， 将现有的研究综合成一个系统的、以证据为基础的体重增加指南。我们的工作将 通过为优化营养护理提供高质量的证据，影响公共卫生和医疗实践 怀孕的母亲和孩子。

PROJECT SUMMARY / ABSTRACT A large volume of research has shown that excessive pregnancy weight gain contributes to maternal postpartum weight retention, child obesity, cesarean delivery, gestational diabetes and preeclampsia, while low gestational weight gain is linked with fetal growth restriction, preterm birth, and perinatal death. However, major gaps remain in our ability to convert these findings into evidence-based recommendations on optimal pregnancy weight gain. The status quo is to evaluate each outcome separately, and without regard to its perceived severity. Further, subjective approaches have been used to select the cut-points of recommended weight gain ranges. Policy-makers urgently need evidence on the optimal range of pregnancy weight gain that considers multiple adverse outcomes simultaneously, accounts for differences in the relative severity of different outcomes, and establishes cut-points using systematic and reproducible methods. In this application, we will develop and apply advanced methodologies that support the creation of robust, evidence-based public health recommendations for weight gain in pregnancy. First, we will generate weights reflecting stakeholder perspectives on the relative severity of competing maternal and child health outcomes associated with gestational weight gain. A Delphi-consensus process will summarize the perceived severity of competing maternal and child health outcomes from diverse panels of 60 women and 60 content experts. Second, we will use a large, diverse cohort of U.S. pregnant women to determine the relationship between gestational weight gain and a composite outcome of adverse events for mothers (preeclampsia, gestational diabetes, cesarean delivery, longer-term obesity, subclinical cardiovascular disease) and children (perinatal death, preterm birth, and small- and large-for-gestational-age birth), with each component weighted to account for its relative severity. Then, we will use our previously-published quantitative approach to identify the optimal range of pregnancy weight gain for women according to different body mass index values, defined as the weight gain associated with the lowest risks of combined, severity-weighted maternal and child outcomes. Successful completion of these aims will provide policy makers with evidence on the complex trade-offs between low and high weight gain on short- and longer-term maternal and child health in order to inform pregnancy weight gain guidelines. Our innovative approach to study multiple adverse outcomes simultaneously and account for their relative severity will enable us to overcome challenges that have previously impeded the synthesis of existing research studies into a systematic, evidence-based weight gain guideline. Our work will impact public health and medical practice by providing high quality evidence for optimizing the nutritional care of pregnant mothers and children.