植物性饮食（Plant-based diets, PBD）与非孕期成年人心血管疾病风险较低有关，但关于其对妊娠期高血压疾病（HDP）风险的特定证据很少。为评估怀孕前对植物性饮食的契合度与HDP风险之间的潜在关联。我们假设更加契合植物性饮食的女性患有HDP的风险会降低。本研究追踪了11,459名分娩的妇女（16,780例单胎妊娠），排除了慢性疾病、先兆子痫和癌症病史的人群，他们参与了护士健康研究第二期（1991-2009），这是一项前瞻性队列研究。每4年使用经过验证的食物频率问卷调查饮食情况，通过计算植物性饮食指数（PDI，得分越高表示契合度越高）评估参与者的健康相关性，同时考虑植物性食物的质量。参与者自报HDP，包括先兆子痫和妊娠期高血压（GHTN）。我们使用广义估计方程对PDI契合度在五分位数中与HDP的相关风险进行对数二项回归分析，调整潜在混杂因素并考虑同一妇女多次妊娠的影响。首次入组妊娠时的平均（标准差）年龄为35（4）岁。共报告了1,033例HDP病例，包括482例（2.9%）子痫前症和551例（3.3%）GHTN病例。PDI最高五分位数的女性与最低五分位数的女性相比，与HDP的风险显著相关（相对风险[95%置信区间] = 0.76 [0.62-0.93]）。PDI与HDP风险呈反向剂量-反应关系。调整多个变量后，PDI逐渐增高五分位数的女性HDP的相对风险（95%置信区间）分别为1（参考）、0.93（0.78，1.12）、0.86（0.72，1.03）、0.84（0.69，1.03）和0.76（0.62，0.93），在五分位数间存在显著的线性趋势（p，趋势=0.005）。对于GHTN的相关性（相对风险[95%置信区间] = 0.77 [0.60-0.99]）明显强于子痫前症的相关性（相对风险[95%置信区间] = 0.80 [0.61-1.04]）。中介分析表明，PDI与HDP之间关系的39%（95%置信区间：15-70%）和PDI与GHTN之间关系的48%（95%置信区间：12-86%）可以解释为饮食评估与怀孕之间体重控制的改善。更高的植物性饮食契合度与HDP风险降低有关，其中的许多益处似乎与改善体重控制有关。保留所有权利，©2023 Elsevier Inc.

Plant-based diets (PBD) have been associated to a lower risk of cardiovascular disease in non-pregnant adults, but specific evidence for their effects on risk of hypertensive disorders of pregnancy (HDP) is scarce.To evaluate the prospective association between adherence to PBD before pregnancy and risk of HDP. We hypothesized that women with higher adherence to PBD would have a lower risk of HDP.We followed 11,459 parous women (16,780 singleton pregnancies) without chronic diseases, history of preeclampsia, and cancers who participated in the Nurses' Health Study II (1991-2009), a prospective cohort study. Diet was assessed every 4 years using a validated food frequency questionnaire, from which we calculated plant-based diet index (PDI, higher score indicates higher adherence) to evaluate the health associations of PBD among participants while accounting for the quality of plant-based foods. Participants self-reported HDP, including preeclampsia and gestational hypertension (GHTN). We estimated the relative risk (RR) of HDP in relation to PDI adherence in quintiles using generalized estimating equations log-binomial regression while adjusting for potential confounders and accounting for repeated pregnancies within the same woman.The mean (SD) age at first in-study pregnancy was 35 (4) years. A total of 1,033 cases of HDP, including 482 cases of preeclampsia (2.9%) and 551 cases of GHTN (3.3%) were reported. Women in the highest quintile of PDI were significantly associated with lower risk of HDP compared to women in the lowest quintile (RR [95%CI=0.76 [0.62-0.93]). There was an inverse dose-response relationship between PDI and risk of HDP. The multivariable-adjusted RR (95%CI) of HDP for women in increasing quintiles of PDI were 1 (ref), 0.93 (0.78, 1.12), 0.86 (0.72, 1.03), 0.84 (0.69, 1.03), and 0.76 (0.62, 0.93), with a significant linear trend across quintiles (p, trend=0.005). This association was slightly stronger for GHTN (RR [95%CI=0.77 [0.60-0.99]) than for preeclampsia (RR [95%CI=0.80 [0.61-1.04]). Mediation analysis suggested that BMI assessed between dietary assessment and pregnancy explained 39% (95% CI: 15-70%]) of the relation between PDI and HDP, and 48% (95%CI: 12-86%]) of the relation between PDI and GHTN.Higher adherence to PBD was associated with a lower risk of developing HDP. Much of the benefit appears to be related to improved weight control.Copyright © 2023 Elsevier Inc. All rights reserved.