Hypertensive disorders of pregnancy (HDP) continue to pose one of the most severe threats to maternal and fetal health worldwide. Characterized by elevated blood pressure during pregnancy, HDP carries significant risks not only for expectant mothers but also for their developing offspring. It is well established that HDP contributes to increased maternal mortality and morbidity, and is strongly linked with adverse neonatal outcomes, including fetal growth retardation and preterm birth. Extensive research into early identification and intervention strategies remains a critical priority in obstetrical medicine, paving the way for better maternal-fetal outcomes through timely and targeted care.
In a landmark prospective cohort study recently published in the Chinese Medical Journal, researchers have turned their attention to an intriguing biomarker: grip strength. Often used as a simple proxy for overall muscle strength and health status, grip strength is gaining attention as an accessible, non-invasive measure with broad clinical applications. While prior investigations have linked diminished grip strength in the general population to higher cardiovascular risks and mortality rates, its relationship with hypertensive disorders specific to pregnancy had remained poorly defined. This study, drawing from the extensive Tongji–Huaxi–Shuangliu Birth Cohort, offers compelling evidence that grip strength measured early in pregnancy may serve as a predictive marker for HDP risk.
The cohort comprised 6,802 pregnant women, with grip strength assessments conducted at the early stages of gestation. Researchers meticulously evaluated grip strength via two distinct metrics: absolute grip strength, measured as the raw force exerted, and relative grip strength, quantified by normalizing absolute grip strength to either body mass index (BMI) or body weight. This dual-parameter approach allowed for a nuanced analysis, addressing the confounding influence of maternal body size and composition—a critical factor since both obesity and impaired muscle function independently impact HDP risk.
Results from this robust cohort revealed a clear inverse association between grip strength levels and the subsequent development of hypertensive disorders during pregnancy. Studying women stratified into quartiles based on absolute grip strength, those in the highest quartile exhibited drastically reduced odds of HDP, with the strongest group showing an odds ratio of approximately 0.35 compared to those in the lowest quartile. This dramatic decline signals a substantial protective effect correlated with increased muscular strength. Importantly, relative grip strength demonstrated a consistent linear association with HDP risk reduction, underscoring its potential clinical utility as a straightforward, scalable screening tool.
Additionally, the application of restricted cubic spline modeling illuminated a critical nonlinear relationship between absolute grip strength and HDP. At lower grip strength values, HDP risk plateaued, suggesting minimal protective effects. However, beyond a certain threshold of muscular strength, the risk markedly declined, revealing a tipping point where muscle capacity exerts significant influence on hypertensive pathophysiology. Contrastingly, relative grip strength maintained a steady, linear inverse relationship, reinforcing the idea that normalizing for body size refines predictive accuracy by accounting for confounding adiposity.
The investigators proposed a biologically plausible rationale for these differential patterns. Absolute grip strength correlates directly with body mass, meaning higher values may reflect increased muscle mass but also accompany elevated fat mass—known to increase HDP risk. Consequently, modest improvements in absolute grip strength within heavier individuals might insufficiently counterbalance the deleterious effects of excess adiposity. Relative grip strength, however, minimizes this bias by contextualizing muscle strength according to the individual’s size, providing a clearer indication of functional fitness relevant to pregnancy-associated cardiovascular health.
Emerging mechanistic insights offer further support for the protective role of muscular strength against HDP. Muscle contractions during handgrip training are known to attenuate oxidative stress and inflammatory pathways—both instrumental in the etiology of preeclampsia and gestational hypertension. Myokines such as irisin, secreted by active skeletal muscle, have demonstrated vasoprotective and antihypertensive properties in experimental models. Preclinical studies indicate that elevated irisin levels improve placental vascular remodeling and enhance embryo implantation, critical components compromised in HDP. These findings suggest a promising avenue where interventions to enhance maternal muscle strength may directly mitigate hypertensive risks.
Subgroup analyses stratified by maternal age, parity, and physical activity levels yielded consistent trends, with no statistically significant interactions detected. This uniformity underscores the broad applicability of grip strength as an HDP risk marker across diverse demographic and behavioral cohorts. Whether a first-time mother or with prior pregnancies, engaging in regular physical activity or relatively sedentary, grip strength remained a robust predictor. Such universal applicability heightens the appeal of grip strength measurement as a cost-effective clinical assessment during routine prenatal visits.
This study’s implications extend beyond predictive diagnostics. If causal links between muscle strength enhancement and reduced HDP risk are substantiated by future clinical trials, prenatal exercise regimens targeting grip strength could become standardized components of antenatal care. This hypothesis aligns with growing data advocating for structured physical activity in pregnancy to improve both maternal cardiovascular health and pregnancy outcomes, positioning muscular conditioning as a modifiable, non-pharmacological intervention to combat one of obstetrics’ most daunting complications.
Professor An Pan, a leading epidemiologist and one of the study’s principal investigators, emphasizes the need for continued research to parse out causality and delineate optimal intervention strategies. “Understanding the interplay between muscle fitness and hypertensive disorders provides exciting prospects for low-cost, accessible prevention strategies in maternal health,” he commented. Enhanced grip strength, indicating improved muscle function, may emerge as a sentinel biomarker, forecasting pregnancy risks and guiding preemptive clinical actions.
In conclusion, this pioneering cohort investigation elucidates the nuanced relationship between grip strength and hypertensive disorders of pregnancy, highlighting relative grip strength’s linear inverse association as a compelling target for clinical risk stratification. Grip strength measurement is a simple, non-invasive, and inexpensive tool with the potential to revolutionize early pregnancy assessments. Its integration into routine prenatal screening protocols could facilitate earlier identification of women at elevated HDP risk, enabling timely lifestyle interventions and optimized monitoring to improve both maternal and neonatal outcomes.
As hypertensive disorders during pregnancy persist as a global health challenge, innovative strategies leveraging biomarkers like grip strength can augment existing efforts to reduce morbidity and mortality. These findings invite a paradigm shift towards incorporating functional muscle metrics into obstetrical care and underscore the broader importance of maternal physical fitness in safeguarding pregnancy health. Further research is warranted to validate these associations in diverse populations and refine intervention programs, but the current evidence firmly establishes grip strength as a promising frontier in maternal cardiovascular medicine.
Subject of Research: People
Article Title: Association between grip strength and hypertensive disorders of pregnancy: prospective analyses in the Tongji–Huaxi–Shuangliu Birth Cohort
News Publication Date: 1-Apr-2026
References: DOI: 10.1097/CM9.0000000000004024
Image Credits: Xiong-Fei Pan from Sichuan University, China
Keywords: Hypertensive disorders of pregnancy, grip strength, relative grip strength, absolute grip strength, maternal health, cardiovascular risk, preeclampsia, muscle function, pregnancy complications, oxidative stress, myokines, irisin
Tags: cardiovascular health in pregnancyearly pregnancy muscle strengthfetal growth retardation and HDPgrip strength as pregnancy biomarkerhypertensive disorders of pregnancy riskmaternal health and hypertensionmaternal mortality and hypertensive disordersmaternal-fetal health outcomesnon-invasive pregnancy risk assessmentobstetrical intervention strategiespreterm birth risk factorsprospective cohort studies in pregnancy
