Sedentary behavior, physical activity, sleep, and cardiovascular risk in pregnancy: the Pregnancy 24/7 cohort study

摘要 不良妊娠结局，包括妊娠期高血压和先兆子痫，影响10-20%的孕妇 是未来母体心血管疾病（CVD）的主要危险因素。虽然温和， 怀孕期间剧烈强度的体力活动（MVPA）可以降低这些风险，不到25%的孕妇 妇女符合MVPA准则。确定可减少孕产妇死亡的其他可改变行为 怀孕期间的健康风险需要为临床干预和实践提供信息。值得注意的是， 关于久坐行为或睡眠在不良妊娠结局中的作用，这些不良妊娠结局会增加未来CVD风险。这 是一个关键的研究空白，因为久坐行为和睡眠越来越多地被认为是心血管疾病的危险因素 在一般人群中，独立于MVPA。不幸的是，现有的怀孕研究主要集中在 MVPA而不是考虑完整的24小时行为周期的新兴范式（即，久坐 行为、睡眠、轻强度体力活动和MVPA），缺乏重复测量，使用次优 评估方法，并未能衡量临床相关的结果。阐明久坐行为和 睡眠影响妊娠结局可以为改善心血管疾病干预目标和指南提供信息 怀孕期间和之后的健康。拟议研究的总体目标是检查 久坐行为（目标1）和睡眠（目标2）与妊娠期高血压疾病和其他不良 妊娠结局会增加未来CVD风险。新的统计方法将用于确定最佳的 24-小时行为模式（目标3）在怀孕期间心血管健康。为此，500名妇女在早期 将招募妊娠妇女参加多中心（爱荷华州和匹兹堡大学）队列研究。妇女 在怀孕的每个三个月里，她将佩戴三种最先进的设备七天， 行为（activPAL micro 3）、睡眠（ActiWatch Spectrum Plus）和体力活动（ActiGraph GT 3X）。 妊娠期高血压疾病及其他不良结局将通过病历获得 抽象我们假设久坐不动的女性，睡眠时间短的女性， 在妊娠期睡眠质量差的模式将更有可能有高血压疾病的怀孕 （原发性）、妊娠期糖尿病、早产、小于胎龄儿、高血压和贫困 血糖控制（次要）。此外，我们假设在统计上重新分配久坐不动的时间 身体活动行为（LPA或MVPA），但不是睡眠（在充足或高持续时间睡眠者中），将 与这些不良结果的发生率较低相关。在直接响应NHLBI研究优先 3.CC.04，本项目将使用先进的方法和模型来评估和表征24小时行为 怀孕期间的周期，以更好地了解健康的差异。该项目将为最佳的 24-小时的行为模式，以及奠定了基础，为未来的研究测试行为 在怀孕期间采取干预措施，以实现最佳结果并改善妇女的长期心血管健康。

ABSTRACT Adverse pregnancy outcomes, including gestational hypertension and preeclampsia, affect 10-20% of pregnant women and are major risk factors for future maternal cardiovascular disease (CVD). Though moderate-to- vigorous intensity physical activity (MVPA) during pregnancy can reduce these risks, less than 25% of pregnant women meet MVPA guidelines. Identification of additional modifiable behaviors that could reduce maternal health risks during pregnancy is needed to inform clinical interventions and practice. Remarkably, little is known about the role of sedentary behavior or sleep in adverse pregnancy outcomes that increase future CVD risk. This is a critical research gap because sedentary behavior and sleep are increasingly recognized as CVD risk factors in the general population, independent of MVPA. Unfortunately, existing studies in pregnancy largely focus on MVPA rather than the emerging paradigm that considers the full 24-hour behavioral cycle (i.e., sedentary behavior, sleep, light-intensity physical activity, and MVPA), lack repeated measures, use suboptimal assessment methods, and fail to measure clinically relevant outcomes. Clarifying how sedentary behavior and sleep influence pregnancy outcomes could inform intervention targets and guidelines to improve cardiovascular health during and after pregnancy. The overall goal of the proposed study is to examine the associations of sedentary behavior (Aim 1) and sleep (Aim 2) with hypertensive disorders of pregnancy and other adverse pregnancy outcomes that increase future CVD risk. Novel statistical methods will be used to determine optimal 24-hour behavioral patterns (Aim 3) during pregnancy for cardiovascular health. For this, 500 women in early pregnancy will be recruited to take part in a multi-site (Universities of Iowa and Pittsburgh) cohort study. Women will wear three state-of-the-art devices for seven days in each trimester of pregnancy to assess sedentary behavior (activPAL micro 3), sleep (ActiWatch Spectrum Plus), and physical activity (ActiGraph GT3X). Hypertensive disorders of pregnancy and other adverse outcomes will be obtained through medical chart abstraction. We hypothesize that women with a high sedentary behavior pattern, short sleep duration pattern, and poor sleep quality pattern across trimesters will be more likely to have hypertensive disorders of pregnancy (primary), gestational diabetes, preterm birth, small-for-gestational age infants, high blood pressure, and poor glycemic control (secondary). Further, we hypothesize that statistically reallocating time spent in sedentary behavior for physical activity (LPA or MVPA), but not sleep (among adequate or high duration sleepers), will be associated with lower incidence of these adverse outcomes. In direct response to the NHLBI Research Priority 3.CC.04, this project will use advanced methods and models to assess and characterize the 24-hour behavioral cycle during pregnancy to better understand differences in health. This project will inform guidelines on optimal 24-hour behavioral patterns in pregnancy, as well as lay the foundation for future studies testing behavioral interventions in pregnancy to achieve optimal outcomes and improve women’s long-term cardiovascular health.