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 妇女是未来产妇心血管疾病(CVD)的主要危险因素。虽然温和到- 怀孕期间剧烈的体力活动(MVPA)可以降低这些风险，只有不到25%的孕妇 女性符合MVPA指南。确定其他可修改的行为可能会减少母体 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，人们对此知之甚少 关于久坐行为或睡眠在不良妊娠结局中的作用，这会增加未来的心血管疾病风险。这 是一个关键的研究差距，因为久坐行为和睡眠越来越被认为是心血管疾病的危险因素 在普通人群中，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(即，久坐)的新兴范式 行为、睡眠、光强度体力活动和MVPA)，缺乏重复测量，使用次优 评估方法，未能衡量临床相关的结果。阐明久坐的行为和 睡眠影响妊娠结局可为改善心血管疾病的干预目标和指南提供信息 怀孕期间和怀孕后的健康状况。这项拟议研究的总体目标是研究 久坐行为(目标1)和睡眠(目标2)合并妊娠期高血压疾病及其他不良反应 妊娠结局会增加未来的心血管疾病风险。将使用新的统计方法来确定最优 怀孕期间的24小时行为模式(目标3)对心血管健康的影响。为此，早期的500名女性 孕妇将被招募参加一项多地点(爱荷华大学和匹兹堡大学)队列研究。女人 将在怀孕的每三个月中佩戴三个最先进的设备七天来评估久坐状态 行为(Active PAL Micro 3)、睡眠(Actiwatch Spectrum Plus)和体力活动(Actigraph GT3X)。 妊娠高血压疾病和其他不良后果将通过医疗表获得 抽象。我们假设有高久坐行为模式、睡眠时间短的女性， 妊娠期间睡眠质量差的模式更容易患上妊娠期高血压疾病 (初级)、妊娠期糖尿病、早产、小于胎龄儿、高血压和贫穷 血糖控制(二级)。此外，我们假设，在统计上重新分配久坐的时间 体力活动(LPA或MVPA)的行为，但不是睡眠(在充足或持续时间较长的睡眠者中) 与这些不良后果的发生率较低有关。直接响应NHLBI研究优先事项 3.CC.04，该项目将使用先进的方法和模型来评估和表征24小时行为 在怀孕期间的周期，以更好地了解健康的差异。该项目将通知指导方针的最佳 怀孕期间的24小时行为模式，并为未来测试行为的研究奠定了基础 孕期干预以实现最佳结局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.