Diet Quality and Physical Activity at 3-4 Years Following a Hypertensive Pregnancy: A Blood Pressure Postpartum Cross-Sectional Sub-Study

INTRODUCTION: Hypertensive disorders of pregnancy (HDP), as well as being a leading global cause of maternal mortality, confer lifelong increased maternal cardiovascular disease (CVD) risk. Although lifestyle interventions may mitigate these risks, robust evidence remains scarce. MATERIAL AND METHODS: This cross-sectional sub-study of the three-armed, multicenter BP² randomised controlled trial primarily assessed diet quality, physical activity, and their association with CVD risk markers in women 3-4 years after HDP, following different BP² postpartum care/lifestyle intervention strategies implemented between six and 12 months post-HDP. Diet quality was evaluated using the Australian Recommended Food Score (ARFS) derived from the Australian Eating Survey. Duration of moderate-vigorous physical activity (MVPA) was estimated using the International Physical activity Questionnaire. Associations between key lifestyle outcomes and clinical cardiovascular markers were examined using linear regression models. Secondary lifestyle outcomes include estimated daily energy intake, food consumption, nutrients, estimated duration and engagement of specific physical activity types, and sedentary behaviour. RESULTS: In 180 participants, the mean ARFS was 33.8 ± 10.5 (SD), with 61% scoring < 38 indicating suboptimal diet quality. Median MVPA was 515 (IQR 690) minutes/week with 87% meeting physical activity recommendations of at least 150 min/week. No significant differences were observed across BP² lifestyle intervention strategies, HDP subtypes (chronic hypertension, gestational hypertension, preeclampsia, and superimposed preeclampsia), or baseline body mass index (BMI) categories (< 30 vs. ≥ 30 kg/m²). Neither ARFS nor MVPA showed significant associations with blood pressure, BMI, or waist circumference. CONCLUSIONS: Suboptimal diet was observed 3-4 years after HDP despite prior lifestyle interventions, highlighting the need for postpartum support and long-term lifestyle interventions to reduce CVD risks post-HDP.