Background: High fitness is related to inflammation, blood pressure (BP), and endothelial dysfunction, the pathways believed to be involved in the development of hypertension in pregnancy. High fitness may also protect against preterm birth (PTB) and small for gestational age (SGA) deliveries, birth outcomes frequently associated with maternal vascular dysfunction. Hypothesis: Higher cardiorespiratory fitness in the years preceding pregnancy and childbirth is inversely associated with incident SGA and PTB. Methods: The CARDIA study is a prospective cohort study that encompasses child-bearing years. We studied 840 women who were nulliparous at baseline, reported ≥1 live birth(s) between the baseline and year 25 exam, and underwent a maximal treadmill exercise test at baseline. Number of births, gestational age for each birth, and birth weight were obtained by self-report at each exam. SGA was defined as birth weight <10 th percentile for gestational age, and PTB was any birth that occurred before week 37 of pregnancy. We used Cox regression to determine hazard ratios for incident SGA and/or PTB. We adjusted for demographic and clinical co-variates at the exam immediately preceding the incident SGA/PTB or the 1 st birth for women who did not report SGA or PTB (Model 2). Results: Women who reported SGA (n=118) or PTB (n=185) were younger at baseline, completed fewer years of education, and were more likely to be black compared to women who did not report SGA/PTB (n=537). There was no difference in baseline BP or BMI between groups. Women without SGA/PTB had higher fitness than women with SGA/PTB; treadmill test duration was 541 s (95% CI: 529, 553 s) vs 500 s (95% CI: 483, 518 s). Treadmill test duration was inversely associated with time to SGA/PTB following adjustment (Table). Findings were similar by race. Conclusions: Higher cardiorespiratory fitness in the years preceding pregnancy and childbirth was associated with decreased risk of SGA/PTB. Achieving a higher fitness level in young adulthood may help protect against SGA and PTB.
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