Muscle strength in early pregnancy linked to risk of hypertensive disorders of pregnancy

Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal mortality worldwide. In addition, HDP can lead to fetal growth restriction, preterm birth, and various long-term adverse health outcomes. Therefore, identifying women at high risk and implementing early interventions targeting modifiable risk factors are crucial. Grip strength is a representative indicator of muscle strength and overall health status. Several prospective studies in the general population have shown that lower grip strength is associated with increased risks of cardiovascular disease and related mortality. However, the association between grip strength and HDP remains unclear in pregnant women. Moreover, previous studies have reported inconsistent findings regarding absolute grip strength and relative grip strength (i.e., absolute grip strength standardized by body weight or BMI) in relation to health outcomes. Both absolute and relative measures should be considered when understanding the relationship between grip strength and outcomes.

To address this gap, Professor An Pan and Dr. Yuxiang Wang examined the associations between absolute and relative grip strength in early pregnancy with the subsequent risk of HDP. The study included 6,802 pregnant women from the Tongji–Huaxi–Shuangliu Birth Cohort, with a mean age of 26.6 years. During the follow-up, 180 participants were diagnosed with HDP. Grip strength was measured early in pregnancy and assessed in three ways: absolute grip strength and two relative indices (absolute grip strength normalized to body mass index or to body weight). This study was published online on April 01, 2026, in the Chinese Medical Journal.

The results showed an inverse association between grip strength and HDP risk. When participants were categorized into quartiles according to absolute grip strength, the odds ratios (95% confidence intervals) for HDP in the second to fourth quartiles, relative to the lowest quartile, were 0.93 (0.63–1.35), 0.67 (0.44–1.00), and 0.35 (0.21–0.56), respectively. Similar trends were observed for relative grip strength. Restricted cubic spline analysis showed a nonlinear association between absolute grip strength and HDP risk. The risk remained stable at lower absolute grip strength levels but decreased linearly after reaching a certain threshold. In contrast, both relative grip strength measures showed linear associations with HDP risk. Subgroup analyses by age, parity, and physical activity level revealed similar patterns and no significant interactions.

According to Prof. Pan, these differences may be partly explained by the correlation between absolute grip strength and body weight. “Absolute grip strength tends to be higher in individuals with greater body mass, but higher body weight itself is a risk factor for HDP,” he noted. “Small increases in muscle strength may not offset the harmful effects of excess fat mass, which partly explains the nonlinear association we observed.”

Prof. Pan added that several biological mechanisms may link muscle strength to HDP. “Handgrip training has been shown to reduce oxidative stress and inflammation—two key pathways in the development of HDP. Myokines released from contracting muscles, such as irisin, may also exert antihypertensive effects. Animal studies suggest that elevated irisin levels can improve preeclampsia by enhancing vascular remodeling and embryo implantation. Further cohort studies and clinical trials are needed to clarify whether improving grip strength can help reduce HDP risk.”

In conclusion, this cohort study comprehensively investigated the associations of absolute and relative grip strength with HDP. Notably, the robust and linear association between relative grip strength and HDP across subgroups suggests its potential as a simple tool for risk stratification of HDP.

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Reference
DOI: 10.1097/CM9.0000000000004024

About Xiong-Fei Pan from Sichuan University
Xiong-Fei Pan is a research fellow at Sichuan University and is responsible for the Epidemiology and Population Health Laboratory at West China Second University Hospital. Using large longitudinal cohorts, his research focuses on identifying risk factors, elucidating etiological mechanisms, and assessing the adverse health effects of cardiometabolic diseases. He has published more than 150 articles, including over 40 first- or corresponding-author papers published over the past three years in journals, such as The Lancet Diabetes & Endocrinology, Gut, Advanced Science, and Cell Genomics.

Funding information
This study was funded by the National Key R&D Program of China (grant numbers: 2022YFC2702905 and 2024YFC2707602), the National Natural Science Foundation of China (grant numbers: 82325043 and 82473646), the Sichuan Provincial Natural Science Foundation (grant number: 2024NSFSC0578), and the Fundamental Research Funds for the Central Universities (grant number: YJ202346).