{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T06:05:55Z","timestamp":1773122755071,"version":"3.50.1"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T00:00:00Z","timestamp":1704844800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Key Research and Development Program of Shaanxi China","award":["2022SF-277"],"award-info":[{"award-number":["2022SF-277"]}]},{"name":"Scientific Research Project of Northwest Women\u2019s and Children\u2019s Hospital","award":["2018LQ03, 2022-YN10"],"award-info":[{"award-number":["2018LQ03, 2022-YN10"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Physical activity, a first-line approach for the treatment of non-gestational hypertension globally, has been shown to benefit most pregnant women in many respects. The benefits and risks of prenatal physical activity in complicated pregnancies, such as preeclampsia and chronic hypertension, require further investigation. It is worth conducting studies to address questions about physical activity during pregnancy in women with chronic hypertension, such as the benefits and risks, frequency, duration, and intensity. This prospective cohort study aims to investigate whether moderate-intensity daily physical activity reduces ambulatory blood pressure in pregnant women with chronic hypertension.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Pregnant women with chronic hypertension at 11<jats:sup>+0<\/jats:sup> to 13<jats:sup>+6<\/jats:sup> gestational weeks will be recruited from the outpatient clinic and divided into moderate- and light-intensity physical activity groups according to the intensity of the 7-day physical activity monitored using the model wGT3X-BT accelerometer. 24-h ambulatory blood pressure monitoring will be performed at enrollment as a baseline and will be repeated in the second and third trimesters. The primary outcome is the difference in the change in 24-h ambulatory systolic blood pressure from the first to the third trimester between the groups. Secondary outcomes include the difference of change in other ambulatory (24-h diastolic, daytime, and nighttime) and office blood pressure variables from the first to the second and third trimesters, the incidence of severe hypertension (\u2265160\/110 mmHg), and changes in the type and dosage of antihypertensive medication. The primary and secondary outcomes related to changes in blood pressure from baseline to the second and third trimesters between the groups will be analyzed using Student\u2019s independent t-test or the Mann\u2013Whitney U test.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Discussion<\/jats:title>\n<jats:p>This cohort study will provide a basis for randomized controlled trials and verify an easily achieved, economical, and non-fetotoxic approach for adjuvant blood pressure management in pregnant women with chronic hypertension.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Registry<\/jats:title>\n<jats:p>This study is registered with the Chinese Clinical Trials Registry (NO. ChiCTR2200062094). Date Registered: 21\/07\/2022.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0296023","type":"journal-article","created":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T18:25:47Z","timestamp":1704911147000},"page":"e0296023","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of daily physical activity on ambulatory blood pressure in pregnant women with chronic hypertension: A prospective cohort study protocol"],"prefix":"10.1371","volume":"19","author":[{"given":"Yanxiang","family":"Lv","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rui","family":"Hu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Liang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanan","family":"Lian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8040-8801","authenticated-orcid":true,"given":"Tongqiang","family":"He","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,1,10]]},"reference":[{"issue":"9","key":"pone.0296023.ref001","doi-asserted-by":"crossref","first-page":"e018494","DOI":"10.1161\/JAHA.120.018494","article-title":"Impact of Chronic Hypertension and Antihypertensive Treatment on Adverse Perinatal Outcomes: Systematic Review and Meta-Analysis","volume":"10","author":"SY Al Khalaf","year":"2021","journal-title":"J Am Heart Assoc"},{"issue":"4","key":"pone.0296023.ref002","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1080\/14737175.2022.2057224","article-title":"Status epilepticus in pregnancy: a literature review and a protocol proposal","volume":"22","author":"R Roberti","year":"2022","journal-title":"Expert Rev Neurother"},{"key":"pone.0296023.ref003","doi-asserted-by":"crossref","first-page":"g2301","DOI":"10.1136\/bmj.g2301","article-title":"Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis","volume":"348","author":"K Bramham","year":"2014","journal-title":"BMJ"},{"issue":"4","key":"pone.0296023.ref004","doi-asserted-by":"crossref","first-page":"515.e1","DOI":"10.1016\/j.ajog.2014.10.1090","article-title":"Expectant management of mild preeclampsia versus superimposed preeclampsia up to 37 weeks","volume":"212","author":"AM Valent","year":"2015","journal-title":"Am J Obstet Gynecol"},{"issue":"2","key":"pone.0296023.ref005","doi-asserted-by":"crossref","first-page":"137","DOI":"10.3109\/10641955.2014.982329","article-title":"Maternal and fetal outcome in de novo preeclampsia in comparison to superimposed preeclampsia: a two-year observational study","volume":"34","author":"M Rezk","year":"2015","journal-title":"Hypertens Pregnancy"},{"issue":"2","key":"pone.0296023.ref006","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1161\/HYPERTENSIONAHA.120.15146","article-title":"Prediction of Preeclampsia-Related Adverse Outcomes With the sFlt-1 (Soluble fms-Like Tyrosine Kinase 1)\/PlGF (Placental Growth Factor)-Ratio in the Clinical Routine: A Real-World Study","volume":"77","author":"LA Droge","year":"2021","journal-title":"Hypertension"},{"key":"pone.0296023.ref007","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.placenta.2022.02.021","article-title":"Second trimester uterine arteries pulsatility index is a function of placental pathology and provides insights on stillbirth aetiology: A multicenter matched case-control study","volume":"121","author":"S Amodeo","year":"2022","journal-title":"Placenta"},{"issue":"4","key":"pone.0296023.ref008","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1159\/000514201","article-title":"Placental Growth Factor and Adverse Obstetric Outcomes in a Mixed-Risk Cohort of Women Screened for Preeclampsia in the First Trimester of Pregnancy","volume":"48","author":"CK Ekelund","year":"2021","journal-title":"Fetal Diagn Ther"},{"issue":"4","key":"pone.0296023.ref009","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1007\/s00404-017-4296-x","article-title":"Decreased Endothelial Progenitor Cells (EPCs) and increased Natural Killer (NK) cells in peripheral blood as possible early markers of preeclampsia: a case-control analysis","volume":"295","author":"AS Lagana","year":"2017","journal-title":"Arch Gynecol Obstet"},{"issue":"5","key":"pone.0296023.ref010","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1056\/NEJMoa1404595","article-title":"Less-tight versus tight control of hypertension in pregnancy","volume":"372","author":"LA Magee","year":"2015","journal-title":"N Engl J Med"},{"issue":"19","key":"pone.0296023.ref011","doi-asserted-by":"crossref","first-page":"1781","DOI":"10.1056\/NEJMoa2201295","article-title":"Treatment for Mild Chronic Hypertension during Pregnancy","volume":"386","author":"AT Tita","year":"2022","journal-title":"N Engl J Med"},{"issue":"4","key":"pone.0296023.ref012","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/j.ajog.2020.03.016","article-title":"Comparative efficacy and safety of oral antihypertensive agents in pregnant women with chronic hypertension: a network metaanalysis","volume":"223","author":"I Bellos","year":"2020","journal-title":"Am J Obstet Gynecol"},{"key":"pone.0296023.ref013","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.preghy.2018.09.010","article-title":"Maternal and perinatal outcomes associated with the use of renin-angiotensin system (RAS) blockers for chronic hypertension in early pregnancy","volume":"14","author":"B Ahmed","year":"2018","journal-title":"Pregnancy Hypertens"},{"issue":"1","key":"pone.0296023.ref014","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1097\/AOG.0000000000001775","article-title":"Angiotensin-Converting Enzyme Inhibitors and the Risk of Congenital Malformations","volume":"129","author":"BT Bateman","year":"2017","journal-title":"Obstet Gynecol"},{"issue":"4","key":"pone.0296023.ref015","first-page":"227","article-title":"Diagnosis and treatment of hypertension and pre-eclampsia in pregnancy: a clinical practice guideline in China 2020","volume":"55","author":"Hypertensive Disorders in Pregnancy Subgroup CSoO, Gynecology CMA","year":"2020","journal-title":"Zhonghua Fu Chan Ke Za Zhi"},{"issue":"1","key":"pone.0296023.ref016","first-page":"1","article-title":"ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia","volume":"133","year":"2019","journal-title":"Obstet Gynecol"},{"issue":"6","key":"pone.0296023.ref017","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1161\/HYPERTENSIONAHA.120.15026","article-title":"2020 International Society of Hypertension Global Hypertension Practice Guidelines","volume":"75","author":"T Unger","year":"2020","journal-title":"Hypertension"},{"issue":"6","key":"pone.0296023.ref018","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.1249\/MSS.0000000000001943","article-title":"Physical Activity to Prevent and Treat Hypertension: A Systematic Review","volume":"51","author":"LS Pescatello","year":"2019","journal-title":"Med Sci Sports Exerc"},{"issue":"11","key":"pone.0296023.ref019","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1001\/jamacardio.2021.2735","article-title":"Effect of Exercise Training on Ambulatory Blood Pressure Among Patients With Resistant Hypertension: A Randomized Clinical Trial","volume":"6","author":"S Lopes","year":"2021","journal-title":"JAMA Cardiol"},{"issue":"7","key":"pone.0296023.ref020","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1001\/jamacardio.2017.1421","article-title":"Systolic Blood Pressure Reduction and Risk of Cardiovascular Disease and Mortality: A Systematic Review and Network Meta-analysis","volume":"2","author":"JD Bundy","year":"2017","journal-title":"JAMA Cardiol"},{"issue":"4","key":"pone.0296023.ref021","doi-asserted-by":"crossref","first-page":"437.e1","DOI":"10.1016\/j.ajog.2021.05.036","article-title":"The impact of physical activity during pregnancy on labor and delivery","volume":"225","author":"VY Watkins","year":"2021","journal-title":"Am J Obstet Gynecol"},{"issue":"10","key":"pone.0296023.ref022","doi-asserted-by":"crossref","DOI":"10.3390\/nu14102066","article-title":"Preventing Gestational Diabetes Mellitus by Improving Healthy Diet and\/or Physical Activity during Pregnancy: An Umbrella Review","volume":"14","author":"M Kouiti","year":"2022","journal-title":"Nutrients"},{"issue":"21","key":"pone.0296023.ref023","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1136\/bjsports-2018-099355","article-title":"Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis","volume":"52","author":"MH Davenport","year":"2018","journal-title":"Br J Sports Med"},{"issue":"2","key":"pone.0296023.ref024","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1001\/jamainternmed.2021.6373","article-title":"Association of Antenatal Diet and Physical Activity-Based Interventions With Gestational Weight Gain and Pregnancy Outcomes: A Systematic Review and Meta-analysis","volume":"182","author":"HJ Teede","year":"2022","journal-title":"JAMA Intern Med"},{"issue":"12","key":"pone.0296023.ref025","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1111\/1471-0528.14672","article-title":"Physical activity and the risk of preterm birth: a systematic review and meta-analysis of epidemiological studies","volume":"124","author":"D Aune","year":"2017","journal-title":"BJOG"},{"key":"pone.0296023.ref026","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/j.jad.2022.04.143","article-title":"Physical activity before and during pregnancy and maternal mental health: A systematic review and meta-analysis of observational studies","volume":"309","author":"C Cai","year":"2022","journal-title":"J Affect Disord"},{"issue":"21","key":"pone.0296023.ref027","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1136\/bjsports-2018-100056","article-title":"2019 Canadian guideline for physical activity throughout pregnancy","volume":"52","author":"MF Mottola","year":"2018","journal-title":"Br J Sports Med"},{"issue":"2","key":"pone.0296023.ref028","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1177\/1559827613498204","article-title":"Guidelines for Physical Activity during Pregnancy: Comparisons From Around the World","volume":"8","author":"KR Evenson","year":"2014","journal-title":"Am J Lifestyle Med"},{"issue":"4","key":"pone.0296023.ref029","doi-asserted-by":"crossref","first-page":"e178","DOI":"10.1097\/AOG.0000000000003772","article-title":"Physical Activity and Exercise During Pregnancy and the Postpartum Period: ACOG Committee Opinion, Number 804","volume":"135","year":"2020","journal-title":"Obstet Gynecol"},{"key":"pone.0296023.ref030","doi-asserted-by":"crossref","first-page":"j3024","DOI":"10.1136\/bmj.j3024","article-title":"Lifestyle in progression from hypertensive disorders of pregnancy to chronic hypertension in Nurses\u2019 Health Study II: observational cohort study","volume":"358","author":"S Timpka","year":"2017","journal-title":"BMJ"},{"key":"pone.0296023.ref031","doi-asserted-by":"crossref","first-page":"857047","DOI":"10.1155\/2013\/857047","article-title":"Maternal and Perinatal Outcomes of Exercise in Pregnant Women with Chronic Hypertension and\/or Previous Preeclampsia: A Randomized Controlled Trial","volume":"2013","author":"KT Kasawara","year":"2013","journal-title":"ISRN Obstet Gynecol"},{"issue":"3","key":"pone.0296023.ref032","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.preghy.2012.04.152","article-title":"PP041. The effect of exercise in pregnant women with chronic hypertension and\/or previous preeclampsia on blood pressure and heart rate variability","volume":"2","author":"CS Burgos","year":"2012","journal-title":"Pregnancy Hypertens"},{"issue":"5","key":"pone.0296023.ref033","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1097\/00005768-199805000-00021","article-title":"Calibration of the Computer Science and Applications, Inc. accelerometer","volume":"30","author":"PS Freedson","year":"1998","journal-title":"Med Sci Sports Exerc"},{"issue":"17","key":"pone.0296023.ref034","doi-asserted-by":"crossref","first-page":"2183","DOI":"10.1093\/eurjpc\/zwac179","article-title":"Epigenetics in the primary and secondary prevention of cardiovascular disease: influence of exercise and nutrition","volume":"29","author":"AB Gevaert","year":"2022","journal-title":"Eur J Prev Cardiol"},{"issue":"6","key":"pone.0296023.ref035","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1080\/14767058.2017.1296426","article-title":"miRNA expression for early diagnosis of preeclampsia onset: hope or hype?","volume":"31","author":"AS Lagana","year":"2018","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"5","key":"pone.0296023.ref036","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1002\/biof.1542","article-title":"The role of epigenetic changes in preeclampsia","volume":"45","author":"A Kamrani","year":"2019","journal-title":"Biofactors"},{"key":"pone.0296023.ref037","doi-asserted-by":"crossref","first-page":"6073167","DOI":"10.1155\/2017\/6073167","article-title":"Do miRNAs Play a Role in Fetal Growth Restriction? A Fresh Look to a Busy Corner","volume":"2017","author":"B Chiofalo","year":"2017","journal-title":"Biomed Res Int"},{"issue":"5","key":"pone.0296023.ref038","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1111\/1471-0528.16678","article-title":"Cardiac output and peripheral vascular resistance during normotensive and hypertensive pregnancy\u2014a systematic review and meta-analysis","volume":"129","author":"EG Mulder","year":"2022","journal-title":"BJOG"}],"updated-by":[{"DOI":"10.1371\/journal.pone.0344268","type":"expression_of_concern","label":"Expression of concern","source":"publisher","updated":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000}}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0296023","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T18:26:13Z","timestamp":1704911173000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0296023"}},"subtitle":[],"editor":[{"given":"Nur Aizati Athirah","family":"Daud","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2024,1,10]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0296023","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,10]]}}}