The relationship between physical activity in early pregnancy and hypertensive disorders of pregnancy: a cohort study in Chinese women

doi:10.5847/wjem.j.1920-8642.2023.047

World Journal of Emergency Medicine ›› 2023, Vol. 14 ›› Issue (3): 204-208.doi: 10.5847/wjem.j.1920-8642.2023.047

• Original Articles • Previous Articles Next Articles

The relationship between physical activity in early pregnancy and hypertensive disorders of pregnancy: a cohort study in Chinese women

Qian Lu¹, Shi-jiao Yan¹^,², Huan-jun Chen¹, Xiong-fei Pan³, Yi-xiang Ye⁴, Xing-yue Song⁵(), Ri-xing Wang⁵(), Chuan-zhu Lyu⁶^,⁷()

¹International School of Public Health and One Health, Hainan Medical University, Haikou 570100, China
²Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences, Hainan Medical University, Haikou 570100, China
³Section of Epidemiology and Population Health, Ministry of Education Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital & West China Biomedical Big Data Center, West China Hospital, Sichuan University Shuangliu Institute of Women's and Children's Health, Shuangliu Maternal and Child Health Hospital, Chengdu 610041, China
⁴Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
⁵Department of Emergency, Hainan Clinical Research Center for Acute and Critical Diseases, the Second Affiliated Hospital of Hainan Medical University, Haikou 570100, China
⁶Emergency Medicine Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, China
⁷Ministry of Education Key Laboratory of Emergency and Trauma, Hainan Medical University, Haikou 570100, China

Received:2022-12-20 Online:2023-04-28 Published:2023-05-01
Contact: Xing-yue Song,Ri-xing Wang,Chuan-zhu Lyu E-mail:songxingyue2015@163.com;wangrixing903@126.com;lvchuanzhu677@126.com

1. Supplementary files.pdf(140KB)

Abstract

Abstract:

BACKGROUND: We aimed to examine prospective associations between different intensities and different types of physical activity (PA) in early pregnancy and hypertensive disorders of pregnancy (HDP) among Chinese women.

METHODS: A total of 6,820 pregnant women from the Tongji-Shuangliu Birth Cohort were included in this study. The pregnancy physical activity questionnaire (PPAQ) was used to assess PA, including household/caregiving, occupational, sports/exercise, and transportation activities in the first trimester of pregnancy. The diagnosis of HDP was collected, including gestational hypertension (GH) and preeclampsia (PE). Data were analyzed by unconditional multivariate logistic regression, and the odds ratio (OR) and 95% confidence interval (CI) were calculated.

RESULTS: A total of 178 (2.6%) of the 6,820 women were diagnosed with HDP, of which 126 (1.8%) were GH and 52 (0.8%) were PE. Overall, we found no association between PA in early pregnancy and PE. A trend toward lower risk was found only among women with GH and among those with higher levels of moderate-to-vigorous intensity physical activity (MVPA) (adjusted OR 0.54, 95% CI 0.31-0.96). No association was observed between PA and HDP in early pregnancy, regardless of different intensities or types of PA.

CONCLUSION: MVPA in the first trimester is an influencing factor of HDP. Encouraging pregnant women to engage in MVPA in the first trimester may help to prevent GH.

Key words: Physical activity, Gestational hypertension, Preeclampsia, Prospective cohort study

Qian Lu, Shi-jiao Yan, Huan-jun Chen, Xiong-fei Pan, Yi-xiang Ye, Xing-yue Song, Ri-xing Wang, Chuan-zhu Lyu. The relationship between physical activity in early pregnancy and hypertensive disorders of pregnancy: a cohort study in Chinese women[J]. World Journal of Emergency Medicine, 2023, 14(3): 204-208.

Figures/Tables 2

Table 1.

Characteristics of the study participants by GH and PE

Characteristics	GH		P-value ^a	PE		P-value ^b
Characteristics	Case (n=126)	Control (n=6,694)	P-value ^a	Case (n=52)	Control (n=6,768)	P-value ^b
Age			0.520			0.779
<25 years	38 (30.2)	2,068 (30.9)		15 (28.8)	2,091 (30.9)
25-29 years	54 (42.8)	3,102 (46.3)		23 (44.2)	3,133 (46.3)
≥30 years	34 (27.0)	1,524 (22.8)		14 (26.9)	1,544 (22.8)
Occupations			0.342			0.845
No	57 (45.2)	3,314 (49.5)		25 (48.1)	3,346 (49.4)
Yes	69 (54.8)	3,380 (50.5)		27 (51.9)	3,422 (50.6)
Education level			0.176			0.843
Senior high school or below	66 (52.4)	3,908 (58.4)		31 (59.6)	3,943 (58.3)
Above senior high school	60 (47.6)	2,786 (41.6)		21 (40.4)	2,825 (41.7)
Annual household income			0.827			0.103
Less than 50,000 yuan	55 (43.7)	2,857 (42.7)		28 (53.8)	2,884 (42.6)
≥50,000 yuan	71 (56.3)	3,837 (57.3)		24 (46.2)	3,884 (57.4)
Family history of hypertension			0.001			0.013
No	94 (74.6)	5,723 (85.5)		38 (73.1)	5,779 (85.4)
Yes	32 (25.4)	971 (14.5)		14 (26.9)	989 (14.6)
Pre‐pregnancy BMI			<0.001			0.004
<18.5 kg/m²	11 (8.9)	1,174 (17.9)		3 (6.0)	1,182 (17.8)
18.5-24.0 kg/m²	71 (57.7)	4,494 (68.4)		34 (68.0)	4,531 (68.2)
24.0-28.0 kg/m²	28 (22.8)	716 (10.9)		8 (16.0)	736 (11.1)
≥28.0 kg/m²	13 (10.6)	189 (2.9)		5 (10.0)	197 (3.0)
History of HDP			<0.001			0.820
No	78 (97.5)	4,417 (99.9)		29 (100.0)	4,466 (99.8)
Yes	2 (2.5)	6 (0.1)		0 (0.0)	8 (0.2)
Parity			0.042			0.144
0	81 (64.3)	3,694 (55.2)		34 (65.4)	3,741 (55.3)
≥1	45 (35.7)	3,000 (44.8)		18 (34.6)	3,027 (44.7)
Diabetes mellitus			0.014			0.817
No	125 (99.2)	6,688 (99.9)		52 (100)	6,761 (99.9)
Yes	1 (0.8)	6 (0.1)		0 (0.0)	7 (0.1)
Tobacco use			0.409			0.560
Current	1 (0.8)	122 (1.8)		0 (0.0)	123 (1.8)
Former	9 (7.1)	339 (5.1)		2 (3.8)	346 (5.1)
Never	116 (92.1)	6,233 (93.1)		50 (96.2)	6,299 (93.1)
Alcohol use			0.175			0.601
Current	0 (0.0)	21 (0.3)		0 (0.0)	21 (0.3)
Former	18 (14.3)	1,379 (20.6)		8 (15.4)	1,389 (20.5)
Never	108 (85.7)	5,294 (79.1)		44 (84.6)	5,358 (79.2)
SBP, mmHg	117.5 (110.0-125.0)	108.0 (102.0-114.0)	<0.001	113.5 (109.5-123.9)	108.0 (102.0-114.5)	<0.001
DBP, mmHg	78.0 (72.5-83.6)	72.5 (67.0-77.5)	<0.001	76.8 (69.8-82.3)	72.5 (67.0-77.5)	0.001

Table 1.

Table 2.

References 23

[1]	Tsakiridis I, Giouleka S, Arvanitaki A, Giannakoulas G, Papazisis G, Mamopoulos A, et al. Gestational hypertension and preeclampsia: an overview of national and international guidelines. Obstet Gynecol Surv. 2021; 76(10):613-33. doi: 10.1097/OGX.0000000000000942 pmid: 34724074
[2]	Kattah AG, Garovic VD. The management of hypertension in pregnancy. Adv Chronic Kidney Dis. 2013; 20(3):229-39. doi: 10.1053/j.ackd.2013.01.014
[3]	Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, de Bonis M, et al. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018; 39(34):3165-241. doi: 10.1093/eurheartj/ehy340 pmid: 30165544
[4]	Zhao W, Di J, Huang A, Yang Q, Hu H. Incidence and risk factors of hypertensive disorders of pregnancy - 8 provinces, China, 2014-2018. China CDC Wkly. 2021; 3(22):476-82.
[5]	Webster K, Fishburn S, Maresh M, Findlay SC, Chappell LC, Guideline Committee. Diagnosis and management of hypertension in pregnancy: summary of updated NICE guidance. BMJ. 2019; 366:l5119.
[6]	Zhao P, Han X, You L, Zhao Y, Yang L, Liu Y. Maternal health services utilization and maternal mortality in China: a longitudinal study from 2009 to 2016. BMC Pregnancy Childbirth. 2020; 20(1):220. doi: 10.1186/s12884-020-02900-4
[7]	Chen L, Feng P, Shaver L, Wang Z. Maternal mortality ratio in China from 1990 to 2019: trends, causes and correlations. BMC Public Health. 2021; 21(1):1536. doi: 10.1186/s12889-021-11557-3 pmid: 34380436
[8]	Pan XF, Huang Y, Li X, Wang Y, Ye Y, Chen H, et al. Circulating fatty acids and risk of gestational diabetes mellitus: prospective analyses in China. Eur J Endocrinol. 2021; 185(1):87-97. doi: 10.1530/EJE-21-0118
[9]	Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR, Jr., Tudor-Locke C, et al. 2011 Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011; 43(8):1575-81. doi: 10.1249/MSS.0b013e31821ece12
[10]	Wu P, Wang Y, Ye Y, Yang X, Lu Q, Liu Y, et al. Serum retinol-binding protein 4 levels and risk of gestational diabetes mellitus: a nested case-control study in Chinese women and an updated meta-analysis. Diabetes Metab Res Rev. 2022; 38(2):e3496.
[11]	Xiang M, Konishi M, Hu H, Takahashi M, Fan W, Nishimaki M, et al. Reliability and validity of a chinese-translated version of a pregnancy physical activity questionnaire. Matern Child Health J. 2016; 20(9):1940-7. doi: 10.1007/s10995-016-2008-y
[12]	Magee LA, Smith GN, Bloch C, Côté AM, Jain V, Nerenberg K, et al. 426: hypertensive disorders of pregnancy: diagnosis, prediction, prevention, and management. J Obstet Gynaecol Can. 2022; 44(5):547-71.e1. doi: 10.1016/j.jogc.2022.03.002
[13]	Jeba Malar Abraham A, Bobby Z, Chaturvedula L, Vinayagam V. Association of umbilical cord serum oxidative stress markers, ADMA and adiponectin with adverse fetal outcomes in hypertensive disorders of pregnancy. Fetal Pediatr Pathol. 2023; 42(2):227-40. doi: 10.1080/15513815.2022.2112791
[14]	Agrawal A, Wenger NK. Hypertension during pregnancy. Curr Hypertens Rep. 2020; 22(9):64. doi: 10.1007/s11906-020-01070-0 pmid: 32852628
[15]	No authors listed. Gestational hypertension and preeclampsia: ACOG practice bulletin summary. Number 222. Obstet Gynecol. 2020; 135(6):1492-5.
[16]	Ford ND, Cox S, Ko JY, Ouyang L, Romero L, Colarusso T, et al. Hypertensive disorders in pregnancy and mortality at delivery hospitalization - United States, 2017-2019. MMWR Morb Mortal Wkly Rep. 2022; 71(17):585-91. doi: 10.15585/mmwr.mm7117a1
[17]	Panaitescu AM, Ciobanu AM, Popescu MR, Huluta I, Botezatu R, Peltecu G, et al. Incidence of hypertensive disorders of pregnancy in Romania. Hypertens Pregnancy. 2020; 39(4):423-8. doi: 10.1080/10641955.2020.1801718
[18]	Magro-Malosso ER, Saccone G, di Tommaso M, Roman A, Berghella V. Exercise during pregnancy and risk of gestational hypertensive disorders: a systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2017; 96(8):921-31. doi: 10.1111/aogs.2017.96.issue-8
[19]	Dipietro L, Evenson KR, Bloodgood B, Sprow K, Troiano RP, Piercy KL, et al. Benefits of physical activity during pregnancy and postpartum: an umbrella review. Med Sci Sports Exerc. 2019; 51(6):1292-302. doi: 10.1249/MSS.0000000000001941
[20]	Martínez-Vizcaíno V, Sanabria-Martínez G, Fernández-Rodríguez R, Cavero-Redondo I, Pascual-Morena C, Álvarez-Bueno C, et al. Exercise during pregnancy for preventing gestational diabetes mellitus and hypertensive disorders: an umbrella review of randomised controlled trials and an updated meta-analysis. BJOG. 2023; 130(3):264-75. doi: 10.1111/bjo.v130.3
[21]	Spracklen CN, Ryckman KK, Triche EW, Saftlas AF. Physical activity during pregnancy and subsequent risk of preeclampsia and gestational hypertension: a case control study. Matern Child Health J. 2016; 20(6):1193-202.
[22]	Mate A, Reyes-Goya C, Santana-Garrido Á, Vázquez CM. Lifestyle, maternal nutrition and healthy pregnancy. Curr Vasc Pharmacol. 2021; 19(2):132-40. doi: 10.2174/1570161118666200401112955
[23]	da Silva SG, Ricardo LI, Evenson KR, Hallal PC. Leisure-time physical activity in pregnancy and maternal-child health: a systematic review and meta-analysis of randomized controlled trials and cohort studies. Sports Med. 2017; 47(2):295-317. doi: 10.1007/s40279-016-0565-2 pmid: 27282925

PA	Total (n=6,820)	GH (n=126)	P-value ^a	PE (n=52)	P-value ^b
Total PA	120.6 (73.7-174.7)	118.0 (60.4-174.5)	0.378	123.5 (75.9-183.9)	0.503
By intensities
Sedentary	35.0 (17.5-80.2)	35.4 (20.1-79.9)	0.725	42.4 (21.3-85.8)	0.240
Light	39.2 (21.2-66.7)	38.3 (22.6-71.7)	0.944	40.5 (21.8-75.7)	0.738
MVPA	23.5 (10.1-46.8)	17.3 (9.0-41.2)	0.046	21.8 (7.5-49.5)	0.608
By types
Household/caregiving	27.8 (12.1-56.4)	29.1 (12.4-56.7)	0.914	27.2 (9.3-57.7)	0.711
Occupational	0.0 (0.0-71.1)	0.0 (0.0-72.5)	0.771	0.0 (0.0-72.1)	0.768
Sports/exercise	4.1 (0.8-9.6)	4.1 (1.6-9.6)	0.603	3.2 (0.8-9.6)	0.626
Transportation	14.0 (7.0-26.3)	14.0 (4.4-26.3)	0.359	15.8 (7.9-28.4)	0.543

The relationship between physical activity in early pregnancy and hypertensive disorders of pregnancy: a cohort study in Chinese women

RichHTML

PDF (PC)

Supplement

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 2

References 23

Related Articles 0

Recommended Articles

Comments