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Cardiorespiratory fitness, exercise haemodynamics and birth outcomes: the Coronary Artery Risk Development in Young
A D Lane-Cordova1,2, M R Carnethon1, J M Catov3,4
1Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Insights
Cardiorespiratory fitness and exercise responses years before pregnancy do not predict preterm birth (PTB) or small for gestational age (SGA) delivery. However, exercise testing closer to pregnancy, particularly heart rate recovery (HRR) and systolic blood pressure (SBP), may offer predictive value.
Area of Science:
- Cardiovascular Health
- Reproductive Epidemiology
- Exercise Physiology
Background:
- Cardiorespiratory fitness and hemodynamic responses during exercise are indicators of cardiovascular health.
- Preterm birth (PTB) and small for gestational age (SGA) are significant adverse pregnancy outcomes.
- The predictive value of pre-pregnancy exercise test parameters for adverse pregnancy outcomes is not well-established.
Purpose of the Study:
- To investigate the association between cardiorespiratory fitness, exercise systolic blood pressure (SBP), and heart rate recovery (HRR) measured years before pregnancy and the risk of PTB and SGA.
- To determine if exercise test variables obtained preceding pregnancy can identify women at higher risk for PTB and SGA.
Main Methods:
- A prospective, longitudinal, multi-site observational cohort study followed 2787 women for 25 years.
- Data from 768 nulliparous women who had at least one live birth by the 25-year follow-up were analyzed.
- Poisson regression was used to assess the association between baseline exercise test variables (fitness, SBP, HRR) and PTB/SGA outcomes.
Main Results:
- Women experiencing PTB and/or SGA were younger, had less education, and were more likely to be Black compared to controls.
- Women with PTB/SGA exhibited lower cardiorespiratory fitness and higher submaximal SBP at baseline.
- After adjustment, no exercise test variables were significantly associated with PTB/SGA. However, HRR and submaximal SBP showed a trend towards significance when exercise tests were performed within 5 years of delivery.
Conclusions:
- Cardiorespiratory fitness and hemodynamic responses to maximal exercise tests performed a median of 5 years before pregnancy are not associated with PTB or SGA.
- These findings suggest that low fitness or abnormal exercise responses several years prior to conception may not be reliable indicators for predicting PTB/SGA.
- Exercise testing, particularly HRR and submaximal SBP, may be more valuable for predicting PTB/SGA when conducted closer to the time of pregnancy.
Objective:
Determine associations of cardiorespiratory fitness, exercise systolic blood pressure (SBP) and heart rate recovery (HRR) following a maximal exercise test performed years preceding pregnancy with odds of preterm birth (PTB; <37 weeks' gestation) and small for gestational age (SGA; birthweight <10th percentile) delivery.
Design:
Prospective, longitudinal.
Setting:
Multi-site, observational cohort study initially consisting of 2787 black and white women aged 18-30 at baseline (1985-86) and followed for 25 years (Y25; 2010-2011).
Population:
768 nulliparous women at baseline who reported ≥1 live birth by the Y25 exam.
Methods:
We used Poisson regression to determine associations of exposures with PTB/SGA.
Main Outcome Measures:
PTB and/or SGA births.
Results:
Women with PTB (n = 143) and/or SGA (n = 88) were younger, had completed fewer years of education and were more likely to be black versus women without PTB/SGA (n = 546). Women with PTB/SGA had lower fitness (501 ± 9 versus 535 ± 6 seconds, P < 0.002) and higher submaximal SBP than women without PTB/SGA (144 ± 1 versus 142 ± 1 mmHg, P < 0.04). After adjustment, no exercise test variables were associated with PTB/SGA, though the association with HRR and submaximal SBP approached significance in the subset of women who completed the exercise test <5 years before the index birth.
Conclusions:
Neither fitness nor haemodynamic responses to exercise a median of 5 years preceding pregnancy, were associated with PTB/SGA. These findings indicate excess likelihood of PTB/SGA is not detectable by low fitness or exercise haemodynamic responses 5 years preceding pregnancy, but exercise testing, especially HRR and submaximal SBP, may be more useful when conducted closer to the onset of pregnancy.
Tweetable Abstract:
Exercise testing conducted >5 years before pregnancy may not detect women likely to have PTB/SGA.
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