Sedentary behavior during pregnancy and risk of pre-eclampsia and/or gestational hypertension: A systematic review

Abstract

Background: Despite improvements in perinatal care, pre-eclampsia remains a major cause of maternal and neonatal morbidity and mortality. Gestational hypertension and blood pressure are important intermediate endpoints for pre-eclampsia. Sedentary behavior has emerged as an independent risk factor for chronic disease, regardless of physical activity levels. Objectives: To systematically review the evidence on sedentary behavior during pregnancy and in the year before conception and its effect on risk of pre-eclampsia, gestational hypertension, combined hypertensive disorders of pregnancy, and blood pressure. Search Strategy: A systematic search of Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and EuropePMC preprints was performed up to May 25, 2023. Selection Criteria: Observational and experimental studies investigating the association between sedentary behavior and pre-eclampsia, gestational hypertension, combined hypertensive disorders of pregnancy, and blood pressure in pregnant individuals. Data Collection and Analysis: Effect estimates, a measure of uncertainty, and study and participant characteristics were extracted from study reports. A narrative synthesis is presented with forest plot visualizations. Quality assessment was conducted using the Newcastle-Ottawa Scale for cohort/case–control studies and the Appraisal Tool for Cross-Sectional Studies. Main Results: Of the 12 observational studies meeting eligibility criteria, two studies reported on the outcome of gestational hypertension; no significant association was found between amount of time spent sedentary and gestational hypertension risk. Four studies reported on pre-eclampsia risk and found no association between sedentary behavior and pre-eclampsia risk. Four studies assessed a combined outcome of total hypertensive disorders of pregnancy; of these, one study reported greater odds of hypertensive disorders among sedentary individuals compared with non-sedentary individuals, and one study found that cases spent more time on the computer relative to controls. Five studies investigated blood pressure in pregnancy; of these, one study reported a positive correlation between systolic blood pressure and sedentary behavior, and one study reported higher second-trimester diastolic blood pressure in groups with high versus low sedentary behavior. Conclusions: We found little evidence of an association between sedentary behavior and pre-eclampsia, gestational hypertension, or blood pressure. This is in contrast to the large body of evidence supporting the protective effect of physical activity on hypertensive disorders of pregnancy. Heterogeneity in the methods used to estimate sedentary behavior limited the ability to quantify this association. Additional high-quality observational studies or randomized trials are warranted to reach more definitive conclusions.