Snoring, poor diet quality up risk for hypertensive disorders of pregnancy

Key takeaways:

• Women with poor diet quality scores and those who snored were more likely to develop a hypertensive disorder of pregnancy.
• The data suggest preconception counseling on sleep and diet could reduce risk.

Women who reported snoring or having poor diet quality during their first trimester were more likely to develop a hypertensive disorder of pregnancy, increasing their risk for cardiovascular events after delivery, researchers reported.

Hypertensive disorders of pregnancy are the second leading cause of maternal death behind maternal hemorrhage and are a significant cause of short- and long-term maternal and offspring morbidity worldwide. Despite this, specific lifestyle and wellness guidance to improve pregnancy health are limited, according to Katharine McCarthy, PhD, a perinatal epidemiologist and assistant professor of population health science and policy, and obstetrics, gynecology and reproductive science at the Icahn School of Medicine at Mount Sinai.

“Hypertensive disorders of pregnancy are common, affecting up to 15% of pregnancies, with the prevalence increasing over time,” McCarthy told Healio. “Many times when it manifests during pregnancy, it is too little, too late. We cannot go back in time and address the risk factors. There are therapeutic options and lifestyle changes that can be recommended during pregnancy, which can impact things like maternal weight gain; however, these types of changes have not been shown to move the needle when it comes to maternal morbidity and associated outcomes. We need to go further back in time.”

The researchers conducted a secondary analysis of 7,942 women from the prospective Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b) cohort. The women, all nulliparous with singleton pregnancies, did not have chronic hypertension or gestational diabetes. All participants completed the Alternative Healthy Eating Index (AHEI)-2010 to assess periconceptional diet, as well as questionnaires on sleep duration, snoring and physical activity at 6 to 13 weeks’ gestation. Researchers estimated odd ratios for developing a hypertensive disorder of pregnancy, adjusting for socioeconomic status, depression, perceived social support, maternal age, tobacco use and comorbidities.

“A lot of research has focused on these different lifestyle factors in isolation,” McCarthy told Healio. “But we have to look at them together in a multifactorial presentation.”

Researchers found that having an AHEI-2010 score in the lowest quartile was associated with 1.3 times higher odds of developing a hypertensive disorder of pregnancy compared with having a dietary score in the highest quartile (adjusted OR = 1.28; 95% CI, 1.04-1.58). Early pregnancy snoring was associated with 1.4 times greater odds of developing a hypertensive disorder of pregnancy (aOR = 1.39; 95% CI, 1.18-1.63).

“The snoring [association] surprised us,” McCarthy told Healio. “It is likely representing other things. It has been shown in other studies that snoring is associated with blood pressure. If you have severe snoring, it may be indicating that your body is not getting enough oxygen during the night, perhaps due to sleep apnea. This can increase your BP, but it is not something one typically thinks about as a screener when a patient comes in for early pregnancy or preconception.”

Women who developed a hypertensive disorder of pregnancy were also more likely to be older, Black, unmarried, smoke and have a higher BMI, McCarthy said.

Researchers next plan to study whether there are behavior “clusters” to determine who may need more support during pregnancy — women who may be physically inactive, have an unhealthy diet and also snore, McCarthy said.

“For women of reproductive age presenting at a routine visit, these data point to asking these questions to look for potentially early warning signs of CV dysfunction or behavior risks that have implications for CV dysfunction,” McCarthy told Healio. “People are not typically thinking about snoring in relation to pregnancy. These behaviors matter for heart health. This is an opportunity to educate women about these health behaviors, not only for the health of their pregnancy but their own CV health.”

As Healio previously reported, the American Heart Association incorporated sleep as a CV health metric for its updated Life’s Essential 8 risk calculator in 2022, as part of an effort to enhance CVD primordial and primary prevention efforts. Other metrics of the Life’s Essential 8 include health behaviors like diet, physical activity, nicotine exposure and health factors like body weight, lipids, blood glucose and BP.

For more information:

Katharine McCarthy, PhD, can be reached at katharine.mccarthy@mountsinai.org.