妊娠早期的健康行为特征与分娩后2-7年的不良妊娠结局和孕产妇血压有关

IF 5.4 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology Pub Date : 2026-10-01 Epub Date: 2026-02-15 DOI:10.1016/j.ajpc.2026.101489

Andrea C Kozai, Bethany Barone Gibbs, Lisa D Levine, Abbi D Lane, Mitali Ray, William Grobman, Philip Greenland, Matthew K Hoffman, C Noel Bairey Merz, Phyllis C Zee, Lisa Mims, Natalie A Cameron, George Saade, Robert M Silver, Natalie A Bello, Eliza C Miller, Uma M Reddy, Judith H Chung, Kara M Whitaker, Janet M Catov

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引用次数: 0

摘要

个体健康行为对妊娠健康的共同影响很少被考虑。我们研究了妊娠早期健康行为组合与不良妊娠结局（APOs）和分娩后2-7年血压（BP）之间的关联，并估计了APOs介导的后期BP的关联比例。方法纳入nuMoM2b心脏健康研究前瞻性队列的参与者。体育活动、饮食、睡眠时间和吸烟都是根据“生活必需品”8个框架进行评分的。apo包括妊娠期高血压疾病、早产、妊娠期糖尿病、小胎龄分娩或死产。我们利用生活基本8分构建了健康行为的潜在概况。采用泊松法和线性回归法评估产后2-7年apo风险和连续血压差异。中介分析考察了apo介导的行为特征与血压之间的关联比例。在适当的情况下，根据妊娠早期肥胖状况对分析进行分层。结果在8700名无行为者中，确定了四种行为特征：最健康的行为（36%），健康活动/睡眠伴不良饮食/吸烟（21%），仅健康睡眠（32%）和最不健康的行为（11%）。与最健康行为组相比，不健康行为组的APOs调整风险高9-18%。在没有妊娠早期肥胖的妇女中，在分娩后2-7年，行为模式较不健康的妇女的调整收缩压和舒张压分别高出0.93和0.85 mmHg。在妊娠早期肥胖的妇女中，相关性不显著。apoo在与晚年BP的关联中没有显著的中介作用。结论妊娠早期不良行为与apo及产后2 ~ 7年血压升高有关，妊娠早期肥胖是影响后期血压的重要因素。与后期血压的关系主要是直接的，没有通过apo介导。

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Health behavior profiles in early pregnancy are associated with adverse pregnancy outcomes and maternal blood pressure 2–7 years after delivery

Background

The joint effects of individual health behaviors on pregnancy health are rarely considered. We examined associations between combinations of first trimester health behaviors with adverse pregnancy outcomes (APOs) and blood pressure (BP) 2–7 years after delivery, and estimated the proportion of associations with later BP mediated by APOs.

Methods

Participants in the nuMoM2b Heart Health Study prospective cohort were included. Physical activity, diet, sleep duration, and smoking were scored using the Life’s Essential 8 framework. APOs included hypertensive disorders of pregnancy, preterm birth, gestational diabetes, small-for-gestational-age birth, or stillbirth. We constructed latent profiles of health behaviors using the Life’s Essential 8 scores. Risk of APOs and differences in continuous BP 2–7 years after delivery based on behavioral profiles were assessed with Poisson and linear regression. Mediation analysis examined the proportion of associations between behavioral profiles and BP mediated by APOs. Where appropriate, analyses were stratified by first trimester obesity status.

Results

Among 8700 nulliparas, four behavioral profiles were identified: Healthiest Behaviors (36%), Healthy Activity/Sleep with Poor Diet/Smoking (21%), Healthy Sleep Only (32%), and Least Healthy Behaviors (11%). Adjusted risk of APOs was 9–18% higher across the less healthy behavioral profiles compared to the Healthiest Behaviors profile. Among women without first trimester obesity, adjusted systolic and diastolic BP were 0.93 and 0.85 mmHg higher, respectively, 2–7 years after delivery in those with less healthy behavioral patterns. Associations were not significant among women with first trimester obesity. APOs did not mediate a significant proportion of the association with later-life BP.

Conclusions

Less healthy behavioral profiles in early pregnancy were associated with APOs and higher BP 2–7 years after delivery, and early pregnancy obesity was an important effect modifier for later-life BP. Associations with later BP were predominately direct, with no mediation through APOs.

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