Limiting Weight Gain in Overweight Pregnant Women: Effects on Mother and Child

描述(由申请人提供)： 孕妇进入孕期的肥胖和妊娠体重的过度增加会导致相当大的发病率，在过去20年中，这两种情况的发病率都在上升。澳大利亚阿德莱德大学的研究人员现在获得了资金，开始了最大规模的RCT--增加了10倍--以限制超重和肥胖女性的妊娠体重增加。这项试验将包括最先进的饮食和体力活动干预成分，以在2500名不同人口的孕妇中将怀孕期间的体重增加限制在0至5公斤。这项试验是基于常规收集的临床数据来检测重要的孕产妇和婴儿的病态结果。不幸的是，这项试验的资金不足以收集关于母亲和孩子的身体成分和心脏代谢结果的数据。然而，这些生物标记物数据对于阐明干预产生效果的生理途径、确定干预对中间母体结局的影响，以及可能最重要的是长期调查对子代身体成分和心脏代谢结果的影响，将是非常宝贵的。这项建议的总体目标是评估限制超重和肥胖孕妇过度妊娠体重增加的干预措施对母亲、胎儿和新生儿肥胖标志物和心脏代谢风险的影响。结果测量将包括母亲：在怀孕28周时，评估胰岛素抵抗、糖耐量以及甘油三酯、瘦素、脂联素和C反应蛋白水平。胎儿：18-28周和28-36周估计胎儿体重的变化。新生儿：通过空气置换体积描记和皮褶厚度测定体脂，以及脐带血瘦素和脂联素水平。这一建议反映了哈佛医学院和阿德莱德大学的研究人员之间的新的跨学科合作，他们在涉及行为变化和怀孕的随机对照试验、对孕妇及其后代的大量研究以及对母亲和孩子的身体成分、生理和心脏代谢数据的测量和解释方面的专业知识相结合。通过从这项辅助研究中获得数据，这项试验将不仅为拟议的目标提供答案，而且还将为后续行动提供额外资金，并利用存储的生物样本来解决有关母亲和成长中的孩子长期健康的许多问题。限制超重和肥胖妇女在怀孕期间的超重增加可能有助于防止对母婴造成严重的健康后果，一项为期4年的大型随机对照试验将于2008年年中开始验证这一理论。作为父母试验的一项辅助研究，拟议的项目将增加有关母亲生理、胎儿发育和新生儿身体成分的关键信息。这项研究将通过检查父母试验的效果和效果，并建立一个生物资源，科学家可以利用该资源来解决有关母亲和儿童长期健康的其他关键问题，从而多次回报投资。(摘要结束)

DESCRIPTION (provided by applicant): Maternal obesity entering pregnancy and excessive gestational weight gain produce substantial morbidity, and both have been rising in prevalence in the past 2 decades. Researchers at the University of Adelaide, Australia, are now funded to begin the largest-by a factor of 10-RCT to limit gestational weight gain among overweight and obese women. The trial will involve state-of-the-art diet and physical activity intervention components to limit weight gain during pregnancy to 0 to 5 kg among a diverse population of 2500 pregnant women. The trial is powered to detect important maternal and infant morbid outcomes based on routinely collected clinical data. Unfortunately, the funding for this trial is not sufficient to collect data on body composition and cardio-metabolic outcomes for mother and child. Yet these biomarker data would be invaluable in elucidating physiologic pathways by which the intervention has its effects, in determining the intervention effect on intermediate maternal outcomes, and perhaps most importantly for the long-term, investigating effects on body composition and cardio-metabolic outcomes among the offspring. The overall goal of this proposal is to assess the effects of an intervention to limit excessive gestational weight gain among overweight and obese pregnant women on markers of adiposity and cardio-metabolic risk in mother, fetus, and newborn. Outcome measures will include Mother: At 28 weeks' gestation, estimated insulin resistance, glucose tolerance, and levels of triglycerides, leptin, adiponectin, and C-reactive protein. Fetus: Change in estimated fetal weight from 18-28 and 28-36 weeks. Newborn: Body fat by air displacement plethysmography and skinfold thicknesses, and cord blood levels of leptin and adiponectin. This proposal reflects a new interdisciplinary collaboration between researchers at Harvard Medical School and the University of Adelaide, with combined expertise in RCTs involving behavior change and in pregnancy, numerous studies of pregnant women and their offspring, and measurement and interpretation of body composition, physiologic, and cardio-metabolic data in mother and child. By obtaining the data from this ancillary study, the trial will be set up not only to provide answers to the proposed aims, but also-with additional funding for follow-up and to take advantage of the stored biosamples-to address numerous questions on long-term health of the mother and the growing child. Limiting excess weight gain during pregnancy among overweight and obese women could help prevent serious health consequences in the mother and child, and a large 4-year randomized controlled trial will begin in mid- 2008 to test this theory. As an ancillary study to the parent trial, the proposed project will add crucial information about the physiology of the mother, the growth of the fetus, and the body composition of the newborn baby. This study will repay its investment many times over by examining how and how well the parent trial works, and by setting up a biological resource that scientists could use to address additional key questions about long-term health of the mothers and children. (End of Abstract)