Spina Bifida and Maternal Weight: Moving from Association to Prevention

 描述（由申请人提供）：脊柱裂，一种涉及脊髓的出生缺陷，是常见的，危及生命和永久致残。虽然食品中强制性的叶酸强化与脊柱裂患病率的降低有关（在美国为38%），但脊柱裂远未被根除。因此，确定额外的干预措施，以减少脊柱裂的患病率仍然是公共卫生的优先事项。母亲体重是这种干预的潜在目标，因为：（i）一直观察到肥胖妇女的后代患脊柱裂的风险增加（BMI > 30 kg/m2），与BMI正常女性的后代相比（18.5<BMI<25.0 kg/m2）;（ii）超重和肥胖是常见的-在怀孕前存在于大约50%的妇女中;和（iii）体重可以改变。然而，由于所观察到的相关性不足以建立脊柱裂和母体体重之间的因果关系，因此尚不清楚孕前体重减轻是否会降低脊柱裂的风险。缺乏强有力的证据表明，产妇体重减轻将导致脊柱裂的风险降低，这是预防工作的一个重大障碍。拟议的研究将有助于建立体重减轻和脊柱裂之间的因果关系，因此直接响应RFA-DD-001，“脊柱裂可改变风险因素的公共卫生研究”。这些研究利用了德克萨斯州出生缺陷登记处（TBDR）的现有数据，该登记处是美国最大的主动监测登记处。具体而言，将使用TBDR和德克萨斯州生命统计数据进行病例对照研究，以评价母体妊娠间体重指数变化与脊柱裂之间的相关性。这项研究将有助于确定孕妇怀孕前体重变化是否是降低脊柱裂风险的潜在目标。这些分析的成功完成将填补我们对产妇体重和脊柱裂之间关系的理解的一个主要空白，从而为未来的预防工作提供重要的方向。

 DESCRIPTION (provided by applicant): Spina bifida, a birth defect involving the spinal cord, is common, life-threatening and permanently disabling. Although mandatory folic acid fortification of food supplies has been associated with reductions in the prevalence spina bifida (38% in the United States), spina bifida is far from being eradicated. Consequently, identifying additional interventions to reduce the prevalence of spina bifida remains a public health priority. Maternal weight is a potential target for such an intervention because: (i) the risk of spina bifida has consistently been observed to be increased in the offspring of obese women (BMI > 30 kg/m2), as compared to the offspring of women who fall in the normal BMI category (18.5<BMI<25.0 kg/m); (ii) overweight and obesity are common - present in approximately 50% of women prior to pregnancy and; (iii) weight can be modified. However, as the observed associations are insufficient to establish a causal connection between spina bifida and maternal weight, it is unclear whether pre-pregnancy weight loss will reduce the risk of spina bifida. The lack of strong evidence that maternal weight loss will result in decreased risk of spina bifida is a significant impediment to prevention efforts. The proposed studies will help to establish a causal connection between weight loss and spina bifida and are thus directly responsive to RFA-DD-001, "Public Health Research of Modifiable Risk Factors for Spina Bifida". These studies leverage existing data from the Texas Birth Defects Registry (TBDR), which is the largest, active surveillance Registry in the United States. Specifically, a case- control study, using data from the TBDR and Texas vital statistics, will be conducted to evaluate the association between maternal inter-pregnancy change in body mass index and spina bifida. This study will help to establish whether maternal weight change prior to pregnancy is a potential target for reducing the risk of spina bifida. The successful completion of these analyses will fill a major gap in our understanding of the association between maternal weight and spina bifida and will thus provide important direction for future prevention efforts.