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Early Pregnancy Health Behavior Profiles Are Associated With Adverse Pregnancy Outcomes: 1000
Abstract   Peer reviewed

Early Pregnancy Health Behavior Profiles Are Associated With Adverse Pregnancy Outcomes: 1000

Andrea C. Kozai, Bethany Barone Gibbs, Lisa D. Levine, Abbi Lane, William Grobman, Philip Greenland, Phyllis C. Zee, Natalie A. Cameron, Matthew K. Hoffman, C. Noel Bairey Merz, …
Medicine and science in sports and exercise, Vol.57(10S), pp.293-294
10/2025
DOI: 10.1249/01.mss.0001157132.18123.9a

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Abstract

PURPOSE Adverse pregnancy outcomes (APO; e.g. preterm birth, preeclampsia) impact 1 in 3 pregnancies and are a major source of maternal and neonatal morbidity. Prevention strategies are limited, but evidence shows healthy behaviors reduce the risk of APO. Behaviors associated with pregnancy health include physical activity, diet, smoking, and sleep. Whether pregnant people engage in distinct combinations of these behaviors, and how combinations of health behaviors relate to risk of APO, are unknown. We aimed to examine the association between latent classes of behavior combinations and APO. METHODS Participants (N = 8700, 26.9 ± 5.6 years, 40% underrepresented race and/or ethnicity) in the nuMoM2b Study were included. Physical activity, diet, smoking, and sleep duration were self-reported in the first trimester and scored 0-100 (higher is healthier) using the Life’s Essential 8 metric. APO were adjudicated by experts and defined as any occurrence of preterm birth (<37 weeks gestation), hypertensive disorders of pregnancy (gestational hypertension, preeclampsia, or eclampsia), gestational diabetes, small-for-gestational age (birthweight ≤10th percentile), or stillbirth. Latent classes of health behaviors were constructed with structural equation modelling and Poisson regression computed relative risk (RR) of APO among classes. RESULTS Four classes of health behaviors were found, 32% were diagnosed with ≥1 APO, and RR was significantly different among classes (Table). Associations were robust to adjustment for demographics and when excluding those with chronic hypertension or diabetes. CONCLUSION: Risk of APO was highest among those with low adherence to all four health behaviors in the first trimester, and those in classes characterized by smoking or poor diet were also at increased risk. These results may inform future research into whether combined behavioral interventions influence pregnancy outcomes and long-term maternal health factors.

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