Date of Award

5-2009

Document Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Degree Program

Public Health

First Advisor

Lisa Chasan-Taber

Second Advisor

Penelope S. Pekow

Third Advisor

Lynnette L. Sievert

Subject Categories

Epidemiology | Medicine and Health Sciences | Public Health

Abstract

Hypertensive disorders of pregnancy affect approximately 8% of pregnancies, and can lead to serious complications for both mother and child. While Latinas are at two-fold increased risk of preeclampsia relative to non-Latina white women, little research on hypertension in pregnancy has been conducted in this population. Furthermore, there are few modifiable risk factors for hypertensive pregnancy. Therefore, we examined associations between psychosocial stress, physical activity, and pre-pregnancy BMI and gestational weight gain and hypertensive disorders of pregnancy using data from the Latina GDM Study, a prospective cohort study of 1,231 women. The first study evaluated the association between perceived stress in early pregnancy and hypertensive disorders of pregnancy. Prior studies suggest an increased risk of hypertensive pregnancy associated with high levels of work-related stress, however there is no previous research evaluating the impact of general psychosocial stress. Psychosocial stress was measured in early pregnancy through the Perceived Stress Scale and hypertensive disorders of pregnancy were confirmed through obstetrician review of medical records. Using multivariable logistic regression we found no statistically significant association between early pregnancy stress and hypertensive pregnancy. The second study focused on the association between pre- and early pregnancy physical activity and hypertensive pregnancy. While some prior literature suggests that pre- and early pregnancy physical activity may be inversely associated with hypertensive pregnancy, findings are not conclusive. Pre- and early pregnancy physical activity was quantified using the Kaiser Physical Activity Survey, administered early in pregnancy. In this study, there was no statistically significant association between pre-pregnancy physical activity and hypertensive pregnancy. However, early pregnancy physical activity (total and household/caregiving) was inversely associated with risk of gestational hypertension. Finally, we examined the associations between pre-pregnancy BMI and gestational weight gain and hypertensive pregnancy. Previous studies in this area have included few Latinas. We found an increase in risk of hypertensive disorders with increased pre-pregnancy BMI and gestational weight gain exceeding the current Institute of Medicine guidelines for weight gain in pregnancy. These findings extend prior research to a Latina population. In summary, this dissertation research adds to the limited research on modifiable risk factors for hypertensive disorders of pregnancy.

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Epidemiology Commons

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