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

项目总结/摘要： 肥胖是一种全国性的流行病，通常始于幼儿期， 目前，许多人对母亲和子女之间的关系感到关切，但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妇女在怀孕前减肥， 据我所知，没有数据表明有意的孕前减肥对未来肥胖的影响 风险2011年美国国立卫生研究院肥胖研究战略计划强调了对新肥胖研究的必要性 我们在2014年响应了这一呼吁，准备，一个随机的 孕前减肥干预的对照试验（NIDDK R01DK0099882）。 根据新的数据，第一个三个月的子宫内环境，主要由前 怀孕体重，可能是肥胖传播的关键，准备的目标是帮助那些 超重或肥胖者通过改善饮食和体育活动习惯来减肥， 怀孕了该计划有效地帮助妇女在怀孕前减肥， 代谢环境在怀孕早期，并认为高度有利的参与者。关键是，我们不 但还不知道该计划是否对长期肥胖和代谢风险或饮食和身体健康有影响， 母亲及其子女的活动习惯。将Prepare扩展到当前结束日期之后-交付- 提供了一个独特的机会来检验这一假设，即在怀孕前对妇女进行干预会影响 他们及其子女的长期肥胖和代谢风险。 在PrepareD中，我们建议在分娩后跟踪母亲及其后代3年，以便 确定Prepare干预对体重和其他人体测量指标的长期影响; 代谢标志物;母亲及其后代的饮食和体力活动模式。该研究包括 在孩子满3岁后进行一次面对面的研究访问，并收集和分析医疗记录 权重和自我报告的问卷数据在3年期间。我们会储存生物样本 在访问时收集的生物储存库，以进行未来的研究，潜在的表观遗传和 微生物组途径可能将孕前体重减轻与长期肥胖风险降低联系起来， 母亲和他们的孩子。通过NIDDK桥梁资金（R56 DK099882），我们没有休息 RCT和随访队列研究之间的差异。我们已经开始招募和收集人体测量数据 测量和生物样本。这笔额外的资金将使我们能够 完成招募和数据收集，并确定通常推荐的肥胖的影响 预防战略，孕前减肥，对母亲长期体重和代谢健康的影响， 他们的后代。如果我们的研究结果证明了孕前减肥的长期有效性， 准备干预可能是预防肥胖代际传播的重要工具。

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.