Health behavior profiles in early pregnancy are associated with adverse pregnancy outcomes and maternal blood pressure 2–7 years after delivery

Background: The joint effects of individual health behaviors on pregnancy health are rarely considered. We examined associations between combinations of first trimester health behaviors with adverse pregnancy outcomes (APOs) and blood pressure (BP) 2-7 years after delivery, and estimated the proportion of associations with later BP mediated by APOs. Methods: Participants in the nuMoM2b Heart Health Study prospective cohort were included. Physical activity, diet, sleep duration, and smoking were scored using the Life's Essential 8 framework. APOs included hypertensive disorders of pregnancy, preterm birth, gestational diabetes, small-for-gestational-age birth, or stillbirth. We constructed latent profiles of health behaviors using the Life's Essential 8 scores. Risk of APOs and differences in continuous BP 2-7 years after delivery based on behavioral profiles were assessed with Poisson and linear regression. Mediation analysis examined the proportion of associations between behavioral profiles and BP mediated by APOs. Where appropriate, analyses were stratified by first trimester obesity status. Results: Among 8700 nulliparas, four behavioral profiles were identified: Healthiest Behaviors (36%), Healthy Activity/Sleep with Poor Diet/Smoking (21%), Healthy Sleep Only (32%), and Least Healthy Behaviors (11%). Adjusted risk of APOs was 9-18% higher across the less healthy behavioral profiles compared to the Healthiest Behaviors profile. Among women without first trimester obesity, adjusted systolic and diastolic BP were 0.93 and 0.85 mmHg higher, respectively, 2-7 years after delivery in those with less healthy behavioral patterns. Associations were not significant among women with first trimester obesity. APOs did not mediate a significant proportion of the association with later-life BP. Conclusions: Less healthy behavioral profiles in early pregnancy were associated with APOs and higher BP 2-7 years after delivery, and early pregnancy obesity was an important effect modifier for later-life BP. Associations with later BP were predominately direct, with no mediation through APOs.