Prepregnancy Body Mass Index, Pregnancy Physical Activity Trajectories, and Postpartum Blood Pressure

Jaclyn D Borrowman; Alex H Crisp; Melissa A Jones; Janet M Catov; Bethany Barone Gibbs; Kara M Whitaker

doi:10.1161/JAHA.126.051063

Back

Prepregnancy Body Mass Index, Pregnancy Physical Activity Trajectories, and Postpartum Blood Pressure

Journal article

Open access

Peer reviewed

Prepregnancy Body Mass Index, Pregnancy Physical Activity Trajectories, and Postpartum Blood Pressure

Jaclyn D Borrowman, Alex H Crisp, Melissa A Jones, Janet M Catov, Bethany Barone Gibbs and Kara M Whitaker

Journal of the American Heart Association, Vol.15(18), e051063

09/09/2026

DOI: 10.1161/JAHA.126.051063

PMID: 42714460

Files and links (1)

url

https://doi.org/10.1161/JAHA.126.051063View

Published (Version of record) Open Access

Abstract

How prepregnancy body mass index (BMI) and pregnancy physical activity (PA) jointly shape postpartum cardiovascular risk remains unclear. This study evaluated whether joint trajectories of PA and sedentary behavior during pregnancy mediate the association between prepregnancy BMI and postpartum blood pressure (BP). Pregnancy 24/7 is a multisite observational cohort enrolling individuals <13 weeks' gestation, aged 18 to 45 years, without chronic hypertension, diabetes, sleep disorders, or severe mobility limitation (n=500). Participants with valid PA/sedentary behavior data for ≥1 trimester and a clinic BP reading 4 to 8 weeks postpartum were analyzed. Prepregnancy BMI was chart-abstracted; PA/sedentary behavior were measured each trimester via the activPAL3 micro. Hypertensive postpartum BP was defined as systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg. Parallel-process latent growth modeling and K-means clustering identified PA trajectory groups; mediation analysis tested whether these groups explained the BMI-BP association. Among 388 participants (aged 30.9±4.5 years), 109 (28.4%) had hypertensive postpartum BP. Each 1-unit increase in prepregnancy BMI was associated with 6.0% greater risk of hypertensive postpartum BP (risk ratio, 1.06 [95% CI, 1.04-1.09]), adjusting for demographic and pregnancy characteristics. Three trajectory groups emerged: active-declining (n=142), active-improving (n=103), and consistently sedentary (n=143). The active-declining group had 37% lower risk than the consistently sedentary group, but this attenuated after BMI adjustment. Physical activity trajectories did not mediate the BMI-BP relationship, which was largely explained by prepregnancy BMI alone. Prepregnancy BMI predicted hypertensive postpartum BP independent of activity patterns, underscoring the clinical value of prepregnancy weight optimization and vigilant postpartum monitoring for those entering pregnancy with elevated BMI. URL: https://www.clinicaltrials.gov; Unique identifier: NCT04749849.

Pregnancy

blood pressure

body mass index

physical activity

Details

Title: Subtitle: Prepregnancy Body Mass Index, Pregnancy Physical Activity Trajectories, and Postpartum Blood Pressure
Creators: Jaclyn D Borrowman - Northwestern University
Alex H Crisp - University of Iowa
Melissa A Jones - Oakland University
Janet M Catov - University of Pittsburgh
Bethany Barone Gibbs - West Virginia University
Kara M Whitaker - University of Iowa
Resource Type: Journal article
Publication Details: Journal of the American Heart Association, Vol.15(18), e051063
DOI: 10.1161/JAHA.126.051063
PMID: 42714460
NLM abbreviation: J Am Heart Assoc
ISSN: 2047-9980
eISSN: 2047-9980
Publisher: American Heart Association
Grant note: National Institutes of Health R01: R01 HL153095 T32 training grant: T32 HL069771
The Pregnancy 24/7 Cohort Study was funded by a National Institutes of Health R01 grant (R01 HL153095). Dr Borrowman (first and corresponding author) is supported by a T32 training grant (T32 HL069771).
Language: English
Electronic publication date: 09/09/2026
Academic Unit: Epidemiology; Health, Sport, and Human Physiology
Record Identifier: 9985224437702771

Metrics

3 Record Views