Am J Obstet Gynecol MFM. 2022 Mar;4(2):100556. doi: 10.1016/j.ajogmf.2021.100556. Epub 2021 Dec 18.
It is unclear whether prepregnancy physical activity influences the risk of hypertensive disorders of pregnancy and whether any impact is similar for preeclampsia and gestational hypertension.
To evaluate the relation of prepregnancy physical activity with hypertensive disorders of pregnancy and its alignment with the current recommendations for physical activity for the general population.
We studied 28,147 singleton pregnancies from 18,283 women without chronic hypertension, cardiovascular disease, or cancer, participating in the Nurses' Health Study-II between 1989 and 2010. The women self-reported their physical activity before pregnancy and pregnancy complications, including preeclampsia and gestational hypertension. Logistic regression models using generalized estimating equations to account for within-woman correlations across pregnancies were used to estimate the relative risk (95% confidence interval) of preeclampsia and gestational hypertension across quartiles of prepregnancy physical activity, adjusting for age at pregnancy, parity, smoking, multivitamin use, infertility history, marital status, race, year of pregnancy, and history of preeclampsia.
We identified 842 (3.0%) pregnancies with preeclampsia and 905 (3.2%) pregnancies with gestational hypertension. Physical activity before pregnancy was related to a lower risk of hypertensive disorders of pregnancy (relative risk, 0.75 [95% confidence interval, 0.65-0.87] for women in the highest quartile compared with the lowest quartile). This relation was driven by a 39% lower risk of gestational hypertension (relative risk, 0.61; 95% confidence interval, 0.50-0.76) comparing women in the highest quartile of physical activity (≥30.6 metabolic equivalents of task-hours/week) vs women in the lowest quartile (<6.0 metabolic equivalents of task-hours/week). Women whose moderate physical activity levels exceeded those recommended in the Physical Activity Guidelines for Americans (>5 hours/week) had a 50% lower (relative risk, 0.50; 95% confidence interval, 0.36-0.69) risk of gestational hypertension than women who did not meet this recommendation (<2.5 hours/week). For vigorous physical activity, the risk of gestational hypertension was lower among the women who met (1.25-2.5 hours/week; relative risk, 0.77; 95% confidence interval, 0.64-0.93) or exceeded (>2.5 hours/week; relative risk, 0.76; 95% confidence interval, 0.62-0.92) the recommendations than women whose activity levels were below those recommended. Physical activity was not related to the risk of preeclampsia (relative risk, 0.93; 95% confidence interval, 0.76-1.14).
Physical activity before pregnancy may lower the risk of developing gestational hypertension but not preeclampsia.
目前尚不清楚孕前体力活动是否会增加妊娠高血压疾病的风险，以及这种影响是否与子痫前期和妊娠期高血压相同。
评估孕前体力活动与妊娠高血压疾病的关系，并与目前针对普通人群体力活动的建议保持一致。
我们研究了 18283 名无慢性高血压、心血管疾病或癌症的女性在 1989 年至 2010 年期间参加的护士健康研究 II 中的 28147 例单胎妊娠。女性在怀孕前自我报告体力活动情况以及妊娠并发症，包括子痫前期和妊娠期高血压。使用广义估计方程的 logistic 回归模型来考虑妊娠之间的个体内相关性，以估计妊娠前体力活动四分位数与子痫前期和妊娠期高血压的相对风险（95%置信区间），并调整妊娠年龄、产次、吸烟、多种维生素使用、不孕史、婚姻状况、种族、妊娠年份和子痫前期史。
我们发现 842 例（3.0%）妊娠发生子痫前期，905 例（3.2%）妊娠发生妊娠期高血压。孕前体力活动与较低的妊娠高血压疾病风险相关（最高四分位组与最低四分位组相比，相对风险为 0.75 [95%置信区间，0.65-0.87]）。这种关系主要归因于妊娠期高血压风险降低 39%（相对风险，0.61；95%置信区间，0.50-0.76），与体力活动最高四分位组（≥30.6 代谢当量任务小时/周）相比，体力活动最低四分位组（<6.0 代谢当量任务小时/周）。体力活动水平超过美国体力活动指南推荐水平（>5 小时/周）的女性患妊娠期高血压的风险降低 50%（相对风险，0.50；95%置信区间，0.36-0.69），而未达到该推荐水平的女性（<2.5 小时/周）则无此风险。对于剧烈体力活动，符合（1.25-2.5 小时/周；相对风险，0.77；95%置信区间，0.64-0.93）或超过（>2.5 小时/周；相对风险，0.76；95%置信区间，0.62-0.92）推荐水平的女性患妊娠期高血压的风险低于活动水平低于推荐水平的女性。体力活动与子痫前期风险无关（相对风险，0.93；95%置信区间，0.76-1.14）。
孕前体力活动可能降低妊娠期高血压的风险，但不会降低子痫前期的风险。
