Abstract
Objectives
Healthy lifestyle, including healthy diet and physical activity, has been associated with lower blood pressure (BP). We hypothesized that overweight/obese women randomized to a lifestyle intervention beginning in early pregnancy would be less likely to have a higher BP trajectory.
Methods
The Health in Pregnancy and Postpartum study promoted a healthy lifestyle in pregnant and postpartum women with pre-pregnancy overweight or obesity. BP was measured at study visits at ≤ 16 and 32 weeks of pregnancy and 6 and 12 months postpartum. Latent class trajectories were constructed to identify groups of participants with similar BP patterns throughout the study period. Odds of being assigned to the higher BP trajectories between the intervention and control group were determined with logistic regression, adjusted for age, race, pre-pregnancy BMI, gestational weight gain, smoking during the study period, and household income.
Results
Of the 219 participants enrolled (44.3% Black participants, 55.7% White participants, mean age = 29.7 ± 0.3 years), 112 (51.1%) were randomized to the intervention. Two systolic and diastolic BP trajectory groups were identified (Low-Stable, Moderate-Increasing). Randomization to the lifestyle intervention was not associated with odds of Moderate-Increasing systolic (OR 0.83, 95%CI 0.4, 1.6) or diastolic (OR 0.67, 95%CI 0.3, 1.3) BP trajectory assignment. Those in the Moderate-Increasing BP groups had higher BMI and were more likely to have an adverse pregnancy outcome.
Conclusions
A lifestyle intervention initiated in early pregnancy to help prevent excessive gestational weight gain was not associated with odds of specific BP patterns through pregnancy and postpartum.
Significance
What is already known on the subject? In non-pregnant adults with overweight or obesity, improvements in physical activity and diet can improve blood pressure. Whether a lifestyle intervention initiated in early pregnancy and designed to combat excessive gestational weight gain is associated with blood pressure patterns through pregnancy and postpartum is not known.
What does this study add? The social-cognitive theory-based lifestyle intervention was not associated with blood pressure patterns during pregnancy and postpartum in participants with pre-pregnancy overweight and obesity.
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Data Availability
HIPP Study data are available to outside researchers. To complete a manuscript proposal form and request data, please contact Jihong Liu < jliu@mailbox.sc.edu > .
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Acknowledgements
We thank the participants for their time and willingness to be in the study.
Funding
The HIPP Study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (NIH) under award number R01HD078407 to SW and JL. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. ALC received funding from the American Heart Association: 18CDA34110038.
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AL conceived the study design, performed analyses, and drafted the manuscript. SW and JL earned funding for the HIPP Study and oversaw its completion. EW recruited participants, delivered the intervention, and collected and managed data. MKM helped to draft the manuscript. All authors critically revised drafts.
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The HIPP Study was approved by the Institutional Review Board at the University of South Carolina, Lexington Medical Center, Palmetto Health, and Medical University of South Carolina, and all participants gave written, informed consent.
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Lane, A., Wilcox, S., Wingard, E. et al. Association of a Lifestyle Intervention with Blood Pressure Trajectories During Pregnancy and Postpartum in Women with Pre-pregnancy Overweight and Obesity. Matern Child Health J 27, 1407–1415 (2023). https://doi.org/10.1007/s10995-023-03709-1
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DOI: https://doi.org/10.1007/s10995-023-03709-1