Sleep patterns and sleep disturbances across pregnancy

Pathways to depressive symptoms in Chinese pregnant women and their influence on delivery approach: a qualitative comparative analysis

The aim of this study was to apply complexity theory to explain and understand how risk factors combined in complex ways, eventually leading to a high prevalence of depressive symptoms among pregnant women. We also aimed to evaluate whether depressive symptoms affected delivery approach. The study had a longitudinal design and was conducted between May and September 2017. A total of 481 pregnant women were recruited to participate and completed closed-end surveys at two distinct times: during prenatal care at the hospital after 26 weeks of pregnancy and 1 to 4 weeks after delivery. This study identified eleven different pathways that led to an increase in depressive symptoms. Each pathway differentiated the effects of different influencing factors. Among the 481 pregnant women, 128 (26.6%) had cesarean deliveries without medical indications. Although depressive symptoms could affect delivery approach, it was not the most important factor. Surprisingly, the first production emerged as the key factor determining delivery mode. This study was innovative in that it examined which factors and which combinations of factors were necessary for the development of depressive symptoms. Additionally, this study provided a better understanding of the mechanisms underlying the choice of cesarean section without medical indications.

Association between sleep quality and duration during pregnancy and risk of gestational diabetes: A systematic review and meta-analysis

OBJECTIVE

Gestational diabetes mellitus (GDM) is associated with several adverse maternal and neonatal outcomes. Previous studies reported a link between altered sleep and risk of GDM. This systematic review aims to collate evidence on the association between impaired sleep quality and duration, and the risk of GDM.

METHODS

PubMed, Embase, Web of Science, and Scopus databases were searched up to January 20, 2024. Studies reporting the association between impaired sleep quality and duration and risk of GDM were included. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Random-effects meta-analysis was performed, and the results were reported as hazard ratio (HR) with 95% confidence interval (CI).

RESULTS

19 studies were included. Meta-analysis revealed a significant increase in the risk of GDM in pregnant women with poor sleep quality (i.e. <5 PSQI) (HR: 1.50, 95% CI: 1.26 - 1.78, p < .001). Sleep duration of <7 h (HR: 1.56, 95% CI.: 1.20 - 2.01, p < .001), and >8 h (HR: 2.32, 95% CI.: 1.19 - 4.50, p = .01) were also associated with a significantly higher incidence of GDM.

CONCLUSION

Sleep quality and duration emerge as critical risk factors of GDM. Healthcare practitioners should consider targeted interventions to improve sleep hygiene as a potential measure for GDM prevention.

Trends in sensor-based health metrics during and after pregnancy: descriptive data from the apple women's health study

Background

While it is known that vital signs and behaviors change during pregnancy, there is limited data on timing and scale of changes for sensor-derived health metrics across pregnancy and postpartum. Wearable technology provides an opportunity to understand physiologic and behavioral changes across pregnancy with greater detail, more frequent measurements, and improved accuracy. The aim of this study is to describe changes in physiologic and behavioral sensor-based health metrics during pregnancy and postpartum in the Apple Women's Health Study (AWHS) and their relationship to demographic factors.

Methods

The Apple Women's Health Study is a digital, longitudinal, observational study that includes U.S. residents with an iPhone and Apple Watch. We evaluated changes from pre-pregnancy through delivery and postpartum for sensor-derived health metrics. Minimum required data samples per day, week and overall were data element specific, and included 12 weeks prior to pregnancy start, and 12 weeks postpartum for pregnancies lasting between 24 and 43 weeks.

Findings

A total of 757 pregnancies from 733 participants were included. Resting heart rate (RHR) increased across pregnancy, peaking in the third trimester (pre-pregnancy median RHR 65.0 beats per minute [BPM], interquartile range [IQR] 60.0-70.2 B.M. third trimester median RHR 75.5 B.M. IQR 69.0-82.0 B.M., with a decrease prior to delivery and nadir postpartum (postpartum median RHR 62.0 B.M. IQR 57.0-66.0 B.M.. Heart rate variability (HRV) decreased from pre-pregnancy (39.9 milliseconds, IQR 32.6-48.3 milliseconds), reaching a nadir in the third trimester (29.9 milliseconds, IQR 25.2-36.4 milliseconds), before rebounding in the last weeks of pregnancy. Measures of activity, such as exercise minutes, stand minutes, step count and Cardio Fitness were all decreased in each trimester compared to pre-pregnancy, with their nadirs postpartum. Total sleep duration increased slightly in early pregnancy (pre-pregnancy 7.2 hours, IQR 6.7-7.7 hours; 1st trimester 7.4 hours, IQR 6.8-7.9 hours), with the lowest sleep duration postpartum (6.2 hours, IQR 5.4-6.8 hours).

Interpretation

Resting heart rate increased during pregnancy, with a decrease prior to delivery, while heart rate variability decreased across pregnancy, with an upward trend before delivery. Behavioral metrics, such as exercise and sleep, showed decreasing trends during and after pregnancy. These data provide a foundation for understanding normal pregnancy physiology and can facilitate hypothesis generation related to physiology, behavior, pregnancy outcomes and disease.

Sleep disturbances in late pregnancy: associations with induction of labor

PURPOSE

Sleep disturbances, which are common during pregnancy, may compromise labor. Nevertheless, little is known about associations between sleep disturbances and the likelihood of ending up induction of labor (IOL). Accordingly, we aimed to evaluate the connections between sleep disturbances during pregnancy and IOL.

METHODS

Altogether 1778 women from the FinnBrain Birth Cohort Study with gestation weeks over 37 + 6 were enrolled in the study. The women were divided into IOL (n = 331) and spontaneous onset of labor (SOL, n = 1447) groups. Sleep disturbances in late pregnancy were evaluated using the Basic Nordic Sleep Questionnaire. Logistic regression analyses were conducted with adjustments for age, body mass index, parity, smoking, and depressive symptoms.

RESULTS

Sleep disturbances were frequent in both IOL and SOL groups. In the IOL group 43.0% and in the SOL group 39.0% had poor general sleep quality (P = 0.186). Nocturnal awakenings occurred most commonly, in 94.0% and 93.9%, respectively (P = 0.653). In the IOL group, more women (22.7%) were habitual snorers than in the SOL group (17.0%, P = 0.017), however, the difference lost the statistical significance in adjusted analysis (P = 0.848). Women in the IOL group were more likely to be short sleepers (< 7 h) compared to those in the SOL group (20.2% and 15.4%, respectively, P = 0.034) with no difference after adjustment (P = 0.133). The two groups showed no differences in sleep loss (P = 0.252).

CONCLUSIONS

Deterioration in sleep quality was noticeable in pregnant women, but it was unconnected with IOL. As the frequency of IOL is increasing, more research for related risk factors is needed.

Association of Maternal Short Sleep Duration With Neurodevelopmental Delay in Offspring: A Prospective Cohort Study

CONTEXT

To investigate how short sleep duration (SSD) during pregnancy is related to neurodevelopmental delays in offspring, we aimed to inform pregnancy sleep guidelines and promote maternal health and child development.

OBJECTIVE

To identify the associations between SSD during pregnancy and offspring neurodevelopmental delay and to determine whether fetal glucose metabolism plays a role in SSD and neurodevelopmental delays.

METHODS

This cohort study followed 7059 mother-child pairs from the Maternal & Infants Health in Hefei cohort, and collected sleep data during pregnancy via the Pittsburgh Sleep Quality Index at weeks 24 to 28 and 32 to 36. Neurodevelopmental outcomes from 6 to 36 months postpartum were assessed via the Denver Developmental Screening Test-II and the Gesell Development Diagnosis Scale. Cox proportional hazard regression was used to analyze the link between maternal SSD and neurodevelopmental delay risk. Mediation analysis was used to evaluate the role of cord blood serum C-peptide levels. Three hospitals and children's health centers in Hefei were involved.

RESULTS

The stratified analysis revealed a significant association between mothers with SSD during midpregnancy and neurodevelopmental delay in boys (adjusted HR 2.05, 95% CI 1.29, 3.25). Cord blood marker analysis revealed a positive relationship between cord blood serum C-peptide levels and neurodevelopmental delay in offspring (RR 0.04, 95% CI 0.00, 0.08). The proportion of the association between SSD and neurodevelopmental delay mediated by cord blood C-peptide was 11.05%.

CONCLUSION

Maternal SSD during pregnancy was continuously associated with an increased incidence of neurodevelopmental delay with sex differences among offspring. This association may be mediated in part by increased higher levels of cord C-peptide.

Sleep duration and sleep loss during pregnancy: a longitudinal FinnBrain birth cohort study

PURPOSE

To investigate sleep duration and sleep loss during antenatal period and assess associative factors, including maternal characteristic and mood symptoms.

METHODS

A cohort of 3038 women was enrolled. Self-reported sleep duration and sleep loss, the latter being calculated from preferred sleep need and actual sleep duration, were measured in early, mid- and late pregnancy, and at delivery. The associations with age, BMI, parity, education, smoking, napping, and depressive and anxiety symptoms were evaluated.

RESULTS

Sleep duration was longest in early pregnancy and shortest at delivery (7.93 h-7.76 h, p < 0.001). The proportion of short sleepers (< 6 h) increased from 1.4% to 5.9% throughout the studied period (p < 0.001). Mean sleep loss remained stable in early- and mid-pregnancy, lowering in late pregnancy (p < 0.001) and increasing again until delivery (p = 0.003). The number of women with notable sleep loss (> 2 h) was similar during the first three measurement points (9.4%, 8.9% and 9.5%), but increased until delivery (14.1%, p < 0.001). Older, multiparous, and more-depressive women slept less (p < 0.001, p < 0.001, p = 0.017). Women with higher BMI were more likely to sleep < 6 h in late pregnancy (p = 0.012). Multiparous, more-depressive, and higher-BMI women reported more sleep loss (p < 0.001, p < 0.001, p = 0.049).

CONCLUSION

We confirmed earlier reported decrease in sleep duration at the end of pregnancy. As a novel finding, we showed a notable increase in sleep loss during the last month of pregnancy. Various factors were associated with both short sleep and sleep loss, especially multiparity, napping and depressive symptoms.

Maternal Sleep Health, Social Support, and Distress: A Mixed-Methods Analysis of Mothers of Infants and Young Children in Rural US

OBJECTIVES

The purpose of this study was to explore sleep health in rural maternal populations through a social-ecological framework and identify risk and protective factors for this population.

METHODS

39 individuals who are mothers of infants or children under the age of 5 years completed an online survey, 35 of which completed a subsequent semi-structured interview. Recruitment was limited to one rural community and was in partnership with community healthcare providers. Results were integrated using a convergent, parallel mixed-methods design.

RESULTS

Poor sleep health and high prevalence of insomnia symptoms in rural mothers were evident and associated with social support and maternal distress. Qualitative content from interviews indicated that well-established precipitating and perpetuating factors for insomnia may contribute to poor maternal sleep health. Results also revealed a gap in knowledge and language surrounding sleep health among rural mothers.

CONCLUSIONS

Sleep health is challenged during the transition to motherhood and rural mothers have less access to specialized perinatal and behavioral health care than their urban counterparts. In this sample, poor sleep was attributable to distress in addition to nocturnal infant and child sleep patterns which has implications for psychoeducation and promotion of sleep health in mothers. Sleep is a modifiable health indicator that is associated with several other maternal health outcomes and should be considered an element of a comprehensive maternal health for prevention and intervention across individual, interpersonal, and societal domains of the social-ecological model of sleep health.

Objective and self-reported assessment of sleep quality during each trimester of pregnancy: A prospective observational study

OBJECTIVES

Studies on actual circumstances of sleep in pregnant women are limited to surveys of self-reported symptoms, and objective assessments are missing. Sleep disturbances due to hormonal imbalances are common during pregnancy. This study aimed to assess sleep quality by objective assessment using an actigraph and by self-reported assessment using a questionnaire for sleep during each trimester of pregnancy and to elucidate how sleep quality changed from the first to the third trimester of pregnancy.

STUDY DESIGN

A longitudinal questionnaire survey was administered and sleep measurements using an actigraph were recorded at three time points during the first, second, and third trimesters in primiparous women who had conceived naturally.

RESULTS

During the first trimester, "feeling of being refreshed when waking up in the morning" was not noted, and a decline was observed in mental function. During the second trimester, a positive correlation was observed between morning sickness and sleep quality.

CONCLUSIONS

Sleep quality was the worst during the third trimester, with the shortest total sleep time and poor sleep efficiency, along with poor physical function scores. Back pain and leg cramps significantly correlated with sleep efficiency in the third trimester. Poor sleep during pregnancy begins in the first trimester. If minor problems, such as morning sickness, continue in the second trimester, sleep quality is greatly affected. Furthermore, during the third trimester of pregnancy, low back pain and leg cramps are more likely to occur due to an increase in the abdominal area and may interfere with sleep.

Feasibility and Acceptability of Mindfulness-based Stress Reduction and Prenatal Sleep Classes for Poor Prenatal Sleep Quality: Pilot Randomized Controlled Trial

OBJECTIVES

The main objectives of the current paper were to examine the feasibility, acceptability, and adherence of a remotely delivered intervention consisting of mindfulness-based stress reduction plus prenatal sleep classes (MBSR+PS) compared with treatment as usual (TAU).

METHOD

In this pilot randomized controlled trial, 52 pregnant women with poor sleep quality were randomized to MBSR+PS or TAU. MBSR was delivered through eight weekly 2.5-hour sessions, and PS was delivered through eight weekly 30-minute sessions. PS content drew material from cognitive behavioral therapy for insomnia tailored for the perinatal period and from a mindfulness- and acceptance-based lens. Participants completed endpoint measures 10-12 weeks after randomization.

RESULTS

We surpassed all acceptability targets, including the percentage of eligible participants willing to be randomized (96%), percentage of participants who initiated treatment (88%), and satisfaction scores (Client Satisfaction Questionnaire-8 score M = 28.04, SD = 3.6). We surpassed all feasibility targets, including our enrollment target, retention rate (92%), and measure completion (96%). Finally, we surpassed adherence targets, including MBSR and PS session attendance (≥80%). Though sleep outcomes were exploratory, increases in sleep efficiency were greater in the MBSR+PS group relative to TAU (SMD=.68).

CONCLUSIONS

Patient-reported poor sleep quality during pregnancy has high public health significance because it is common, consequential, and under-treated. The current feasibility and acceptability data for using remotely delivered MBSR and PS to improve prenatal sleep quality are encouraging and warranting future research that is sufficiently powered and designed to provide efficacy data. In addition, exploratory sleep outcomes offer preliminary evidence that this sleep program may improve sleep efficiency during pregnancy.

The association between maternal sleep and circadian rhythms during pregnancy and infant sleep and socioemotional outcomes

Studies have established that maternal sleep and circadian rhythm disturbances during pregnancy are associated with poor prenatal and perinatal outcomes for mothers and offspring. However, little work has explored its effects on infant sleep or socioemotional outcomes. The current study examined the relationship between maternal sleep and circadian rhythm disturbances during pregnancy and infant sleep and socioemotional outcomes in a diverse sample of N = 193 mothers and their infants (51% White; 52% Female; Mage = 11.95 months). Maternal sleep and circadian rhythms during pregnancy were assessed using self-reports and actigraphy. Mothers reported on infants' sleep and socioemotional outcomes when infants were one year old. When controlling for infant sex, age, gestational age at birth, family income-to-needs ratios, and maternal depression, mothers who reported more sleep problems during pregnancy had infants with more sleep disturbances when they were one year old. Moreover, mothers who had later sleep timing (i.e., went to bed and woke up later, measured via actigraphy) during pregnancy had infants with more dysregulation (e.g., increased feeding difficulties, sensory sensitivities) and externalizing problems, and mothers with increased intra-daily variability in rest-activity rhythms (as measured via actigraphy) had infants with more externalizing problems. Findings suggest that maternal sleep and circadian rhythm disturbances during pregnancy may be a risk factor for infant sleep problems and socioemotional difficulties.

Evaluating the global prevalence of insomnia during pregnancy through standardized questionnaires and diagnostic criteria: a systematic review and meta-analysis

Introduction

Insomnia during pregnancy presents significant medical care challenges and heightens the risk of adverse outcomes for both pregnant women and fetuses. This study undertook a meta-analysis to assess the global prevalence of insomnia during pregnancy, examining both the overall prevalence and regional variations.

Method

The aim of this study was to perform a meta-analysis of articles indexed in PubMed, Embase, and Web of Science from the inception of these databases up to February 29, 2024. The study systematically reviewed the global prevalence of gestational insomnia and explored potential moderating factors, encompassing research type, publication date, regional influences, maternal age, pregnancy status, depressive symptoms, and anxiety symptoms.

Result

Forty-four studies, encompassing a total of 47,399,513 participants, were included in the analysis. The overall prevalence of insomnia symptoms during pregnancy was 43.9%. Regional factors and depression emerged as the main factors affecting insomnia, with Europe (53.6%) surpassing North America (41.0%), followed by South America (50.6%) and Asia (40.7%). High depression rates (56.2%) correlated with increased insomnia prevalence compared to low depression rates (39.8%). The type of research and publication date showed no significant impact on the prevalence of insomnia symptoms.

Conclusion

The meta-analysis results indicated that the prevalence of insomnia symptoms was higher during pregnancy, especially among pregnant women who were in a highly depressed state or located in the European region.

Systematic review registration

PROSPERO, identifier CRD42018104460.

Prevalence and Predictors of Leg Cramps in the Third Trimester of Pregnancy: A Cross-Sectional Study

Objective

This study aimed to estimate the prevalence and determine predictors of leg cramps among pregnant women in their third trimester.

Methods

A sample of pregnant women in their third trimester who routinely visited local clinics in Jordan was recruited. Participants completed a socio-demographic and clinical characteristics questionnaire, the numeric pain rating scale (NPRS) for leg cramp pain intensity, the Arabic version of the Pregnant Physical Activity Questionnaire (PPAQ), the Nordic Musculoskeletal Questionnaire (NMQ), Short Form Health Survey (SF-12), Pittsburgh Sleep Quality Index (PSQI), and Hospital Anxiety and Depression Scale (HADS). In addition, magnesium (Mg) and calcium (Ca) serum levels were examined. Logistic regression analyses were used to identify predictors of leg cramps occurrence. A linear regression model was used to investigate predictors of leg cramps pain intensity among pregnant women who reported leg cramps.

Results

Two hundred and five (n=205) pregnant women completed the study. The estimated prevalence of leg cramps was 58%. Logistic regression results showed that not receiving assistance with housework (OR 0.46, p=0.025), progress in the number of gestational weeks (OR 1.10, p=0.021), the number of previous pregnancies (OR 1.21, p=0.049), having leg swelling (OR 2.28, p=0.019), and having gastrointestinal (GIT) problems (OR 2.12, P=0.046) were associated with a higher odds of leg cramps occurrence. In the subsample with pregnant women with leg cramps, linear regression results showed that pregnant women with high school education versus elementary school (β=0.70, p=0.012), number of working hours (β=0.11, p=0.010), using vitamins supplements (β=-1.70, p=0.043), having diabetes after pregnancy (β=1.05, p=0.036), having sciatica (β=0.58, p=0.028), having hip pain (β =-.33, p=0.029), and higher PSQI total score (β=0.09, p=0.020) were the significant predictors of leg cramp pain intensity.

Conclusion

Many health-related conditions, as well as work and home-related work characteristics, may be considered risk factors for the occurrence of leg cramps and increased leg cramps pain intensity in pregnancy.

Effects of paternal involvement in nighttime childcare on child and maternal sleep: exploring the roles of relationship satisfaction and maternal competence about child sleep

STUDY OBJECTIVES

Supportive coparenting between couples has been shown to have positive effects on the dyadic relationship, child development, and parental and child sleep. This study aimed to investigate the association between paternal involvement in nighttime childcare and child and maternal sleep, while exploring relationship satisfaction and maternal competence about child sleep as mediators.

METHODS

The sample consisted of 290 mothers (mean age ± standard deviation = 34.8 ± 4.1) with children (50.7% male) aged 6-36 (mean ± standard deviation = 22.7 ± 8.6) months. Participants reported their paternal involvement in nighttime childcare and completed the following questionnaires: Brief Infant Sleep Questionnaire-Revised, Dyadic Adjustment Scale-4 items, and the Insomnia Severity Index. Path analysis was conducted to examine the impact of paternal involvement on child and maternal sleep through relationship satisfaction and maternal competence.

RESULTS

Among the sample, 74.8% responded that paternal participation in nighttime childcare was less than 25%. Path analysis showed that paternal involvement had a significant direct effect on maternal insomnia (β = -.15, P < .05) but not on child sleep. Direct pathways from paternal involvement to relationship satisfaction (β = .17), from relationship satisfaction to maternal competence (β = .19), from maternal competence to child's sleep (β = -.57), and from child sleep to maternal insomnia (β = .48) were significant (P < .01). Relationship satisfaction mediated the associations between paternal involvement and child (β = -.08, P < .05) and maternal (β = -.04, P < .05) sleep.

CONCLUSIONS

Paternal nighttime childcare involvement was low in South Korea. The results highlight the importance of considering paternal supportive participation and relationship satisfaction in future research on child and maternal sleep.

CITATION

Song J, Jang E, Astbury L, Bei B, Suh S. Effects of paternal involvement in nighttime childcare on child and maternal sleep: exploring the roles of relationship satisfaction and maternal competence about child sleep. J Clin Sleep Med. 2024;20(8):1241-1250.

Establishing causal relationships between insomnia and gestational diabetes mellitus using Mendelian randomization

Background

Gestational diabetes mellitus (GDM) is a common condition observed globally, and previous studies have suggested a link between GDM and insomnia. The objective of this study was to elucidate the causative relationship between insomnia and GDM, and to investigate the influence of factors related to insomnia on GDM.

Methods

We performed bidirectional Mendelian randomization (MR) analyses using single nucleotide polymorphisms (SNPs) as genetic instruments for exposure and mediators, thereby minimizing bias due to confounding and reverse causation. The Cochran Q test was utilized for heterogeneity analysis, MR-Egger regression for pleiotropy assessment, and the leave-one-out method for evaluating the robustness of the results. Additionally, we determined the causal relationships between GDM and other factors such as coffee consumption, alcohol intake, and household income.

Results

Insomnia was positively associated with GDM, as indicated by 39 SNPs (OR = 1.27, 95 % CI 1.12-1.439, P-value = 0.008). Conversely, the MR analysis did not reveal any causal relationship between GDM and insomnia (OR = 1.032, 95 % CI 0.994-1.071, P-value = 0.99). Additionally, no causal relationship was observed between coffee consumption, alcohol intake, household income, and GDM (all P-values >0.05).

Conclusion

Our study indicates that insomnia elevates the risk of GDM, thereby establishing a causal link with GDM, independent of coffee consumption, alcohol intake, and household income.

Evaluation of Prenatal Comfort, Sleep, and Quality of Life in Pregnant Women with Cholestasis: A Cross-Sectional Study

BACKGROUND

Associated with adverse pregnancy outcomes, intrahepatic cholestasis of pregnancy is the most prevalent liver disease that women typically experience during pregnancy. This study aimed to evaluate prenatal comfort, sleep, and quality of life in pregnant women with cholestasis.

METHODS

This cross-sectional study was implemented between November 2022 and June 2023 at Mardin Training and Research Hospital with 150 pregnant women who received a diagnosis of pregnancy-induced intrahepatic cholestasis and agreed to participate. The following tools were utilized to collect data: A personal information form exploring socio-demographic and obstetric characteristics of participants, the Prenatal Comfort Scale (PCS), the Pittsburgh Sleep Quality Index (PSQI), and the World Health Organization Quality of Life-Brief Form (WHOQOL-BREF).

RESULTS

The mean age of participants was 27.79 ± 6.33 years. The mean PCS and PSQI scores were 61.20 ± 5.84 and 9.52 ± 3.02, respectively. The mean scores of "physical health, psychological health, social relationships, and environmental health" sub-dimensions in WHOQOL-BREF were 10.63 ± 2.18, 10.48 ± 2.10, 11.31 ± 3.28, and 11.27 ± 2.10, respectively. A significant difference was found for PSQI regarding hospitalization status and change in sleep quality variables (p = 0.025 and p = 0.035, respectively).

CONCLUSIONS

Cholestasis of pregnancy creates problems such as pruritus, body image changes, hospitalization, and poor sleep quality in women. This study showed that pregnant women with cholestasis had low levels of sleep quality and quality of life, implying that cholestasis affects their sleep quality, prenatal comfort levels, and quality of life in general. In addition, it is seen that women with this problem do not want to fall pregnant again.

Dietary Intake of Nutrients Involved in Serotonin and Melatonin Synthesis and Prenatal Maternal Sleep Quality and Affective Symptoms

Poor sleep quality and psychological distress in pregnancy are important health concerns. Serotonin and melatonin levels may underlie variation in these adverse outcomes. In this study, we examined dietary nutrients involved in serotonin and melatonin synthesis in relation to maternal sleep quality and affective symptoms during pregnancy. Pregnant women at no greater than normal medical risk at enrollment completed 24-hour dietary recalls in mid-late pregnancy. Usual intakes of vitamin B6, vitamin D, eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA), and tryptophan were estimated from dietary intake of foods and supplements using the National Cancer Institute (NCI) method. Sleep quality, depression, and anxiety were measured using validated questionnaires. Associations between nutrient intakes, sleep quality, and affective symptoms were estimated using generalized estimating equation models adjusting for potential confounding factors. In minimally adjusted models, EPA + DHA and tryptophan intakes were associated with a lower score indicating better sleep quality (b: -1.07, 95% CI: -2.09, -0.05) and (b: -12.40, 95% CI: -24.60, -0.21), respectively. EPA + DHA and tryptophan intakes were also associated with a lower odds of shorter sleep duration and sleep disturbances. In addition, tryptophan was associated with a lower odds of higher sleep latency. However, associations were attenuated and nonsignificant after adjustment for demographic and lifestyle factors. In conclusion, intakes of EPA + DHA and tryptophan were associated with improved sleep quality, but these associations were confounded by maternal demographic and lifestyle characteristics. This study highlights the need to consider dietary intake and pregnancy health in the context of demographic characteristics and lifestyle behaviors.

Improvements in Maternal Cardiovascular Health Over the Perinatal Period Longitudinally Predict Lower Postpartum Psychological Distress Among Individuals Who Began Their Pregnancies With Overweight or Obesity

BACKGROUND

Adverse cardiovascular events during pregnancy (eg, preeclampsia) occur at higher rates among individuals with overweight or obesity (body mass index ≥25 kg/m2) and have been associated with postpartum depression. The present study examined whether changes in cardiovascular health (CVH) during the perinatal period, as defined by the American Heart Association's Life's Essential 8 framework, predicted postpartum psychological functioning among individuals with prepregnancy body mass index ≥25 kg/m2.

METHODS AND RESULTS

Pregnant individuals (N = 226; mean ± SD age = 28.43 ± 5.4 years; mean body mass index = 34.17 ± 7.15 kg/m2) were recruited at 12 to 20 weeks of gestation (mean, 15.64 ± 2.45 weeks) for a longitudinal study of health and well-being. Participants completed ratings of depression and perceived stress and reported on CVH behaviors (dietary intake, physical activity, nicotine exposure, and sleep) at baseline and at 6 months postpartum. Body mass index and CVH behaviors were used to calculate a composite CVH score at both time points. Linear regression analyses were performed to examine whether change in CVH related to postpartum symptom scores. Because sleep was measured in only a subset of participants (n = 114), analyses were conducted with and without sleep. Improved CVH was associated with lower postpartum depression (β = -0.18, P<0.01) and perceived stress (β = -0.13, P=0.02) scores. However, when including sleep, these relationships were no longer significant (all P>0.4).

CONCLUSIONS

Improvements in CVH from early pregnancy to 6 months postpartum were associated with lower postpartum depressive symptoms and perceived stress but not when including sleep in the CVH metric, potentially due to the large reduction in sample size. These data suggest that intervening during pregnancy to promote CVH may improve postpartum psychological functioning among high-risk individuals.

The Importance of Sleep in Overcoming Childhood Obesity and Reshaping Epigenetics

The development of childhood obesity is a complex process influenced by a combination of genetic predisposition and environmental factors, such as sleep, diet, physical activity, and socioeconomic status. Long-term solutions for decreasing the risk of childhood obesity remain elusive, despite significant advancements in promoting health and well-being in school and at home. Challenges persist in areas such as adherence to interventions, addressing underlying social determinants, and individual differences in response to treatment. Over the last decade, there has been significant progress in epigenetics, along with increased curiosity in gaining insights into how sleep and lifestyle decisions impact an individual's health. Epigenetic modifications affect the expression of genes without causing changes to the fundamental DNA sequence. In recent years, numerous research studies have explored the correlation between sleep and the epigenome, giving a better understanding of DNA methylation, histone modification, and non-coding RNAs. Although significant findings have been made about the influence of sleep on epigenetics, a notable gap exists in the literature concerning sleep-related genes specifically associated with childhood obesity. Consequently, it is crucial to delve deeper into this area to enhance our understanding. Therefore, this review primarily focuses on the connection between sleep patterns and epigenetic modifications in genes related to childhood obesity. Exploring the interplay between sleep, epigenetics, and childhood obesity can potentially contribute to improved overall health outcomes. This comprehensive review encompasses studies focusing on sleep-related genes linked to obesity.

Promoting sleep health during pregnancy for enhancing women's health: a longitudinal randomized controlled trial combining biological, physiological and psychological measures, Maternal Outcome after THERapy for Sleep (MOTHERS)

BACKGROUND

Sleep is vital for maintaining individuals' physical and mental health and is particularly challenged during pregnancy. More than 70% of women during the gestational period report insomnia symptoms. Sleep dysfunction in the peripartum increases the risk for a cascade of negative health outcomes during late pregnancy, birth, and postpartum. While psychological interventions are considered the first line treatment for sleep difficulties, they are still scarcely offered during pregnancy and there is a lack of longitudinal research combining psychological and physiological indices.

METHODS

The present protocol outlines a randomized controlled trial aimed at testing the long-term effectiveness of an automatized digitalized psychoeducational intervention for insomnia for expectant mothers complaining insomnia symptoms without comorbidity. Outcomes include physiological, hormonal, and subjective indices of maternal psychopathology, stress, and emotional processes, and sleep and wellbeing of the family system. The trial is part of a longitudinal study evaluating expectant mothers from early pregnancy (within the 15th gestational week) to 6-months postpartum through 6 observational phases: baseline (BSL), 6- and 12-weeks from BSL (FU1-FU2), 2-to-4 weeks after delivery (FU3), and 3- and 6-months after delivery (FU4-5). We plan to recruit 38 women without sleep difficulties (Group A) and 76 women with sleep difficulties (Group B). Group B will be randomly assigned to digital psychological control intervention (B1) or experimental psychoeducational intervention targeting insomnia (B2). At 3 time points, an ecological-momentary-assessment (EMA) design will be used to collect data on sleep and emotions (diaries), sleep-wake parameters (actigraphy) and stress reactivity (salivary cortisol). We will also test the DNA methylation of genes involved in the stress response as biomarkers of prenatal poor sleep. Information on partner's insomnia symptoms and new-borns' sleep will be collected at each stage.

DISCUSSION

The proposed protocol aims at testing an easily accessible evidence-based psychoeducational intervention for expectant mothers to help them improving sleep, health, and wellbeing in the peripartum. The results could improve the understanding and management of sleep difficulties and peripartum depression.

TRIAL REGISTRATION

The study protocol has been registered on 22 April 2024 with ClinicalTrials.gov Protocol Registration and Results System (PRS), ID: NCT06379074.

PROTOCOL VERSION

April 23, 2024.

Effects of sleep quality in early pregnancy on pregnancy outcomes and mood state

PURPOSE

To clarify the relationship between quality of sleep and pregnancy outcomes and to explore how sleep quality affects mood state in the first trimester of pregnancy.

METHODS

This prospective cohort study enrolled pregnant women from June 2020 to June 2021. Maternal sleep conditions, daytime sleepiness, and mood state in the first trimester were assessed using four Chinese self-rating scales, namely, the Pittsburgh Sleep Quality Index (PSQI), the Sleep Hygiene Practice Scale (SHPS), Epworth Sleepiness Scale (ESS), and the abbreviated version of the Profile of Mood States (a-POMS). Participants were divided into an exposed group (PSQI score > 5, poor sleep quality group) and a non-exposed group (PSQI score ≤ 5, good sleep quality group). Maternal characteristics, pregnancy outcomes, and the relationship among sleep quality, sleepiness, and mood state were analyzed. Comparisons of sleep hygiene behavior variables between the two subgroups were also analyzed.

RESULTS

A total of 2703 pregnant women were enrolled in the study. Poor sleep quality increased the probability of gestational diabetes mellitus (GDM) (1.573, 1.315-1.863), liver function damage (1.467, 1.021-2.107), preterm delivery (1.468, 1.077-2.002), mild sleepiness (1.612, 1.357-1.915), and excessive sleepiness (2.134, 1.686-2.701). Poor maternal sleep quality was significantly associated with the occurrence of preterm premature rupture of membranes (1.947, 1.168-3.243) and perinatal death (1.003, 1.000-1.006). Additionally, a significant positive correlation between the PSQI score and the total mood disturbance (TMD) score was revealed by Spearman's correlation analysis (r = 0.378, P < 0.01). Enter Regression analysis demonstrated that sleep quality (R2 = 0.390, P < 0.01) and sleepiness (R2 = 0.234, P < 0.01) exerted significant direct effects on mood state during pregnancy. Furthermore, Spearman's correlation analysis indicated a positive association between the PSQI score and the SHPS total score (r = 0.227, P < 0.01).

CONCLUSIONS

Poor sleep quality is significantly associated with elevated rates of maternal mood disturbances, obstetric complications, and adverse outcomes in infants. The findings suggest that it may be useful to provide comprehensive sleep assessment and education on sleep hygiene during the early stages of pregnancy.

Application of portable sleep monitoring devices in pregnancy: a comprehensive review

Objective.The physiological, hormonal and biomechanical changes during pregnancy may trigger sleep disordered breathing (SDB) in pregnant women. Pregnancy-related sleep disorders may associate with adverse fetal and maternal outcomes including gestational diabetes, preeclampsia, preterm birth and gestational hypertension. Most of the screening and diagnostic studies that explore SDB during pregnancy were based on questionnaires which are inherently limited in providing definitive conclusions. The current gold standard in diagnostics is overnight polysomnography (PSG) involving the comprehensive measurements of physiological changes during sleep. However, applying the overnight laboratory PSG on pregnant women is not practical due to a number of challenges such as patient inconvenience, unnatural sleep dynamics, and expenses due to highly trained personnel and technology. Parallel to the progress in wearable sensors and portable electronics, home sleep monitoring devices became indispensable tools to record the sleep signals of pregnant women at her own sleep environment. This article reviews the application of portable sleep monitoring devices in pregnancy with particular emphasis on estimating the perinatal outcomes.Approach.The advantages and disadvantages of home based sleep monitoring systems compared to subjective sleep questionnaires and overnight PSG for pregnant women were evaluated.Main Results.An overview on the efficiency of the application of home sleep monitoring in terms of accuracy and specificity were presented for particular fetal and maternal outcomes.Significance.Based on our review, more homogenous and comparable research is needed to produce conclusive results with home based sleep monitoring systems to study the epidemiology of SDB in pregnancy and its impact on maternal and neonatal health.

Associations between anxiety, sleep, and blood pressure parameters in pregnancy: a prospective pilot cohort study

BACKGROUND

The potential effect modification of sleep on the relationship between anxiety and elevated blood pressure (BP) in pregnancy is understudied. We evaluated the relationship between anxiety, insomnia, and short sleep duration, as well as any interaction effects between these variables, on BP during pregnancy.

METHODS

This was a prospective pilot cohort of pregnant people between 23 to 36 weeks' gestation at a single institution between 2021 and 2022. Standardized questionnaires were used to measure clinical insomnia and anxiety. Objective sleep duration was measured using a wrist-worn actigraphy device. Primary outcomes were systolic (SBP), diastolic (DBP), and mean (MAP) non-invasive BP measurements. Separate sequential multivariable linear regression models fit with generalized estimating equations (GEE) were used to separately assess associations between anxiety (independent variable) and each BP parameter (dependent variables), after adjusting for potential confounders (Model 1). Additional analyses were conducted adding insomnia and the interaction between anxiety and insomnia as independent variables (Model 2), and adding short sleep duration and the interaction between anxiety and short sleep duration as independent variables (Model 3), to evaluate any moderating effects on BP parameters.

RESULTS

Among the 60 participants who completed the study, 15 (25%) screened positive for anxiety, 11 (18%) had subjective insomnia, and 34 (59%) had objective short sleep duration. In Model 1, increased anxiety was not associated with increases in any BP parameters. When subjective insomnia was included in Model 2, increased DBP and MAP was significantly associated with anxiety (DBP: β 6.1, p = 0.01, MAP: β 6.2 p < 0.01). When short sleep was included in Model 3, all BP parameters were significantly associated with anxiety (SBP: β 9.6, p = 0.01, DBP: β 8.1, p < 0.001, and MAP: β 8.8, p < 0.001). No moderating effects were detected between insomnia and anxiety (p interactions: SBP 0.80, DBP 0.60, MAP 0.32) or between short sleep duration and anxiety (p interactions: SBP 0.12, DBP 0.24, MAP 0.13) on BP.

CONCLUSIONS

When including either subjective insomnia or objective short sleep duration, pregnant people with anxiety had 5.1-9.6 mmHg higher SBP, 6.1-8.1 mmHg higher DBP, and 6.2-8.8 mmHg higher MAP than people without anxiety.

Sleep-wake timing and chronotype in perinatal periods: longitudinal changes and associations with insomnia symptoms, sleep-related impairment, and mood from pregnancy to 2 years postpartum

Across the perinatal transition, existing research focuses mainly on significant changes in sleep duration and quality, neglecting sleep timing. This study investigated change trajectories of sleep timing and chronotype from late pregnancy to 2 years postpartum and examined longitudinal associations of chronotype with symptoms of insomnia, daytime sleep-related impairment, and mood. Data were from a two-arm randomised controlled trial testing parent-focused wellbeing interventions. Participants were a community sample of nullipara without severe sleep/mental health conditions. Participants self-reported bedtime, rise-time, chronotype, insomnia symptoms, sleep-related impairment, depression, and anxiety at seven time points: gestation Weeks 30 and 35, and postpartum Months 1.5, 3, 6, 12 and 24. Trajectories were estimated using mixed-effects models with continuous time, quadratic splines, and a knot at childbirth, controlling for age and group allocation. A total of 163 participants (mean [SD] age 33.35 [3.42] years) took part. Bedtime and rise-times delayed during late pregnancy (~8 and ~20 min, respectively) but became progressively earlier (~20 and ~60 min, respectively) over the 2 postpartum years. Chronotype became more eveningness in late pregnancy, and more morningness after childbirth, however changes were small. Controlling for sleep duration and efficiency, greater morningness was associated with significantly less symptoms of insomnia and sleep-related impairment over time (all p < 0.001); longitudinal associations between chronotype and symptoms of depression and anxiety were non-significant (all p > 0.65). Sleep-wake timing and chronotype became progressively earlier from pregnancy to 2 years postpartum. Morningness chronotype may be sleep-protective during the transition from pregnancy to parenthood. Mechanisms underlying these associations require further research.

Associations of maternal sleep trajectories during pregnancy and adverse perinatal outcomes: a prospective cohort study

OBJECTIVE

Sleep problems are common in pregnant women and sleep is altered during pregnancy. However, the associations between sleep trajectory patterns and adverse maternal and neonatal outcomes are unclear. The current study aims to identify sleep trajectory patterns and explore their associations with adverse perinatal outcomes in a prospective cohort study.

METHODS

Pregnant women (N = 232) completed the Pittsburgh Sleep Quality Index each trimester during pregnancy in Tianjin, China. Perinatal outcomes were extracted from the hospital delivery records. Latent class growth analysis (LCGA) described the trajectories of sleep timing, duration, and efficiency. Multivariable linear regression and multivariable logistic regression were employed to evaluate associations between sleep trajectory patterns and perinatal outcomes.

RESULTS

Trajectories were identified for bedtime (early, 49.1%; delaying, 50.9%), wake-up time (early, 82.8% of the sample; late, 17.2%), duration (short, 5.2%; adequate 78.0%; excessive, 16.8%), and efficiency (high, 88.4%; decreasing, 11.6%). Compared with women in more optimal sleep groups, those in the late wake-up, excessive duration, and decreasing efficiency groups had babies with shorter birth lengths (β range, -0.50 to -0.28, p < 0.05). Moreover, women in the decreasing efficiency group had babies with lower birth weight (β, -0.44; p < 0.05). Women in the delaying bedtime group had greater odds of preterm delivery (OR, 4.57; p < 0.05), while those in the decreasing efficiency group had greater odds of cesarean section (OR, 3.12; p < 0.05).

CONCLUSIONS

Less optimal sleep trajectory patterns during pregnancy are associated with perinatal outcomes. Therefore, early assessment of maternal sleep during pregnancy is significant for identifying at-risk women and initiating interventions to reduce perinatal outcomes.

Association between sleep duration and quality with food intake, chrononutrition patterns, and weight gain during pregnancy

To analyse the association between sleep duration and quality with food intake, chrononutrition patterns, and weight gain during pregnancy. A prospective cohort study was conducted with 100 pregnant women. Data collection occurred once during each gestational trimester. The assessment of sleep quality and duration was performed using the Pittsburgh Sleep Quality Index. Food intake was assessed using three 24-h recalls in each trimester. Body weight was measured during the three trimesters, and height was measured only once to calculate the BMI. Linear regression analyses were performed to associate sleep duration and quality with food consumption and weight gain variables. Longer sleep duration was associated with a later dinner in the first trimester (β = 0·228, P = 0·025) and earlier in the third trimester (β = -0·223, P = 0·026), in addition to a later morning snack in the second trimester (β = 0·315, P = 0·026). Worse sleep quality was associated with higher total energy intake (β = 0·243, P = 0·044), total fat (β = 0·291, P = 0·015) and the chrononutrition variables such as a higher number of meals (β = 0·252, P = 0·037), higher energetic midpoint (β = 0·243, P = 0·044) and shorter fasting time (β = -0·255, P = 0·034) in the third trimester. Sleep quality was also associated with a higher BMI in the first trimester of pregnancy (β = 0·420, P = < 0·001). Most of the associations found in the present study show that poor sleep is associated with higher energy and fat intake and higher BMI. Longer sleep duration was associated with a later dinner in early pregnancy and an earlier dinner in late pregnancy, as well as with a later morning snack in the second trimester of pregnancy.

Sleep pattern and disorders among pregnant women in Ibadan, Southwest Nigeria

BACKGROUND

Sleep is essential for pregnant women's and the offspring's health and wellbeing. Poor sleep and disorders have been linked with adverse fetal outcomes and delivery conditions. However, pregnant women often experience several forms of sleep disruption, which has been scarcely reported in low and middle-income countries (LMIC), including Nigeria where the influence of lifestyle factors has also been lacking. We investigated sleep patterns and disorders and the associated factors among pregnant women in Southwest, Nigeria.

METHOD

A cross-sectional study was conducted among five hundred (500) pregnant women attending Adeoyo Maternity Teaching Hospital. A semi-structured questionnaire was used to examine different domains of sleep and associated disorders, namely sleep quality (Pittsburgh Sleep Quality Index (> 5 and ≤ 5)), insomnia (Insomnia Severity Index (> 8 and ≤ 8)), restless leg syndrome (Restless Leg Syndrome Rating Scale (> 10 and ≤ 10). Significant covariates such as physical activity, minimum dietary diversity, smoking and alcohol intake were also assessed. We conducted bivariate and multivariate analysis at p < 0.05 significance level.

RESULTS

The mean age of participants was 30.4 ± 4.8 years. The pattern of sleep disorder in pregnant were poor sleep quality (50%), restless leg syndrome (58.2%) and insomnia (33.4%). Being currently married (AOR = 6.13; 95% CI: (1.65-22.23)), increasing gestational age: second trimester (AOR = 8.25;95% CI: (1.78-38.17)) to third trimester (AOR = 10.98; 95% CI: (2.44-49.48)) increased the odds of poor sleep quality. Factors associated with restless leg syndrome were marital status [AOR = 3.60; 95% CI; (1.25-10.35)], religion, rigorous physical activities [AOR = 1.52; 95% CI: (1.05-2.21)] and alcohol consumption [AOR = 3.51; 95% CI: (1.00-12.27)]. Factors associated with insomnia were maternal age [AOR = 1.83; 95% CI: (1.11-3.01)], income [AOR = 2.99 (1.26-7.16)] and rigorous physical activity [AOR = 2.55 (1.61-4.02)].

CONCLUSION

Poor sleep quality, restless leg syndrome and insomnia were typical among pregnant women in Ibadan, Southwest Nigeria. Thus, awareness and education on the importance of sleep and its risk and protective factors, such as alcohol consumption, smoking, rigorous activity and spousal and family support, should be increased to reduce poor sleep quality and sleep disorders (restless leg syndrome and insomnia) during the pregnancy period.

Exploring relationship of poor sleeping habits with prenatal stress among pregnant women in Pakistan: a cross-sectional study

OBJECTIVE

Pregnancy is a complex phenomenon accompanied by biological, physiological and psychosocial changes for a mother. It is also regarded as a stressful life event where a woman's role, identity and interpersonal relationships are restructured. The present study from Pakistan explores the association of sleep quality and poor sleeping habits with prenatal stress using Pittsburgh Sleep quality Index.

RESULTS

There were a total of 516 women (mean age = 29.82 years), with more than half reporting poor sleep quality. Ethnically, a majority (395, 76.6%) were natives of the Punjab province while rest were non-natives. A high percentage of respondents reported poor subjective sleep quality (22.1%), sleep latency (44.1%), habitual sleep efficiency (27.5%), sleep disturbance (30.1%), use of medications (7.1%) and daytime dysfunction (29.5%). According to logistic regression analysis, respondents with poor sleep quality were 2.24 (95% CI = 1.55-3.22, P < 0.001) times more likely to have high stress levels (P < 0.001).

Association between sleep quality with maternal and neonatal outcomes during the covid-19 pandemic

AIM

Sleep disorders during pregnancy can impact maternal and neonatal outcomes. The objective of this study is to examine the relationship between sleep quality and maternal and neonatal outcomes during the COVID-19 pandemic.

METHOD

This prospective cohort study was conducted at the Educational-Therapeutic Center of Shohadaye Yaftabad Referral Hospital in Tehran, Iran, from December 2020 to September 2022. A total of 198 eligible participants were randomly assigned to either the sleep disorders group or the no sleep disorders group. Data were collected through demographic questionnaires, the Corona Disease Anxiety Scale (CDAS) questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the checklist for maternal and neonatal outcomes.

RESULTS

At baseline, the sleep disorders and no sleep disorders groups were similar in terms of age, body mass index (before pregnancy), education level, employment status, gravida, parity, abortion, and history of COVID-19. Within the sleep disorders group, there was a statistically significant, direct linear correlation between sleep disorders and FBS 34-36 weeks (r = 0.33, P < 0.001) as well as Corona Disease Anxiety (CDA) (r = 0.35, P < 0.001). The linear regression results indicated that for every unit increase in sleep disorders, the risk of FBS 34-36 weeks increased by 1.09 times (β = 1.09, P < 0.001). Additionally, sleep disorders increased the risk of CDA by 1.36 times (β = 1.36, P < 0.001). The results showed no statistically significant differences in terms of birth weight, type of delivery (vaginal or cesarean section), gestational age (preterm or full term), length of labor stages (first and second stage), Apgar score at minutes 1 and 5, and NICU admission between the two groups.

CONCLUSION

Based on the results, a certain degree of correlation exists between sleep quality and FBS at 34-36 weeks and CDA. These findings underscore the need for future public health guidelines to formulate detailed strategies to improve sleep quality during the COVID-19 pandemic.

Sleep Quality in High-Risk Pregnancies: Mixed Methods Results from a Randomized Controlled Trial of a Mindfulness Training Intervention

Objectives: Sleep difficulties in pregnancy are common and increase the risk for obstetric complications. Past research shows that mindfulness training (MT) is helpful for improving sleep in non-pregnant adults and may improve sleep during pregnancy. However, it is unknown if MT improves sleep among pregnant people at risk for obstetric complications. We examined the effects of MT on sleep quality in individuals at risk of developing hypertensive disorders of pregnancy. Methods: Twenty-nine participants (mean age, 32 ± 4 years; mean gestational age, 16 ± 3weeks) at risk for hypertensive disorders in pregnancy (HDP) were randomized to an 8-week phone-delivered MT intervention (n = 15) or treatment as usual (TAU; n = 14), designed to test MT feasibility and acceptability. As part of the study, participants completed the Pittsburgh Sleep Quality Index and participated in a semi-structured individual qualitative interview which queried for sleep changes over pregnancy. Results: Participants randomized to MT reported less daytime sleep dysfunction compared to TAU (F = 5.79, p = 0.03, ηp2 = 0.28). Qualitative data illustrated the common experiences of sleep disturbance across both study groups; however, MT participants reported an improved ability to initiate sleep and return to sleep using mindfulness skills. About half of the participants in the MT condition reported an improvement in overall sleep quality due to less interference related to anxiety and restlessness, while other MT participants reported no change in sleep quality. Conclusions: Results from this study confirm that pregnant individuals frequently encounter sleep challenges. Findings also suggest that MT may be a helpful tool in improving sleep quality among pregnant people at risk for obstetric complications.

The effect of maternal sleep quality in late pregnancy on prenatal, birth and early postnatal outcomes

This cross-sectional study investigated the effect of maternal sleep quality in late pregnancy on prenatal, birth and early postnatal outcomes. The research was conducted in three parts with women at 28 or more weeks of gestation. In the first part, pregnant women admitted for delivery were evaluated in terms of eligibility criteria. Pregnant women in the latent phase of labour completed the Prenatal Questionnaire. In the second part, labour follow-up was performed. The researchers completed the Birth Follow-up Questionnaire based on observations and hospital birth records. In the third part, mothers were interviewed between the 12th and 24th hour of postnatal. Participants filled out the Postnatal Questionnaire, the Childbirth Experience Questionnaire, and the Pittsburgh Sleep Quality Index (n = 385). The data were analysed using the chi-square independence test, Fisher test, independent samples t-test, effect sizes, and binary logistic regression analysis. Participants had a mean maternal sleep quality score of 4.00 ± 1.38. They slept for 7.53 ± 0.92 hr on average. One-third of the participants were poor sleepers (32.2%). Employed participants were 71.6% less likely to have poor maternal sleep quality than their non-employed counterparts (odds ratio = 0.29, 95% confidence interval: 0.13-0.62; p = 0.002). The odds of poor maternal sleep quality increased by 13.7% when maternal weight gain during pregnancy increased by 1 kg (odds ratio = 1.14, 95% confidence interval: 1.03-1.26; p = 0.014). Increased maternal sleep quality positively affected the birth process (p < 0.05). Healthcare professionals should routinely screen the maternal sleep quality of pregnant women and increase their sleep hygiene.

Navigating Perinatal Challenges: A Comprehensive Review of Cholestasis of Pregnancy and Its Impact on Maternal and Fetal Health

Cholestasis of pregnancy (CP), or intrahepatic CP (ICP), represents a condition peculiar to pregnancy, marked by impaired bile acid flow and consequent accumulation in the maternal bloodstream. Primarily emerging in the third trimester, CP is linked with considerable risks to both the mother and fetus, including heightened incidences of preterm birth, fetal distress, and stillbirth, alongside maternal complications such as intense pruritus and liver dysfunction. Despite its clinical significance, the etiology of CP, which involves genetic, hormonal, and environmental factors, remains partially understood. This comprehensive review delves into the physiology and pathophysiology of CP, outlines its clinical manifestations and diagnostic criteria, and discusses the associated maternal and fetal complications. Furthermore, it evaluates current management strategies, prognostic implications, and potential long-term effects on maternal and child health. It also explores future research directions, emphasizing the need for advancements in understanding the pathophysiology of CP, developing novel therapeutic interventions, and improving risk stratification models. By offering a thorough overview of CP, this review aims to enhance clinical awareness, guide management practices, and identify areas requiring further investigation, ultimately contributing to better health outcomes for affected women and their babies.

The Concurrent and Longitudinal Relationship between Perinatal Sleep Difficulties and Depression in a Large Sample of High-Risk Women in South Africa

INTRODUCTION

Perinatal depression and sleep difficulties are common among studies conducted in high income countries (HIC). This study examines the relationship between sleep difficulties and depression during the perinatal period and over an eight-year follow-up period in South Africa, a middle income country.

METHOD

A population cohort of 1238 pregnant women (mean age = 26.33) in 24 township neighborhoods in South Africa were recruited and reassessed six times over the next 8 years post birth with follow-up rates of 96-83%. The relationship between maternal depressed mood and sleep difficulties was examined over time, as well as the relationship of sleep with other socioeconomic, environmental, and psychiatric risk factors.

RESULTS

Thirty-five percent of the women reported sleep difficulties during the perinatal period; whereas only 8% reported sleep difficulties at 8-year follow-up. Perinatal sleep difficulties were associated with lower income, lower educational attainment, less access to electricity, more food insecurity, higher rates of interpersonal violence and HIV, alcohol consumption, and depressed mood at 8 years. However, the severity of depressed mood was the strongest predictor of sleep problems longitudinally and cross-sectionally, after accounting for all other risk factors.

CONCLUSIONS

We found that the severity of depressed mood is highly associated with sleep difficulties from pregnancy to 8 years post-birth and in a linear relationship, so that higher depressed mood is associated with more sleep problems.

TRIAL REGISTRATION

ClinicalTrials.gov registration: # NCT00996528.

Sleep Quality and Associated Factors among Pregnant Women Attending Antenatal Care Unit at the Referral Hospitals in Oromia National Regional State, Ethiopia, 2021: A Multicenter Cross-Sectional Study

INTRODUCTION

Poor sleep quality during pregnancy leads to adverse neonatal outcomes such as low birth weight, intrauterine growth retardation, preterm birth, and operative birth. Though it has many consequences, a limited study was conducted on the prevalence and associated factors of poor sleep quality among pregnant women in Ethiopia.

OBJECTIVE

This study is aimed to determine poor sleep quality and associated factors among pregnant women attending antenatal care units at the selected referral hospitals.

METHODS

Institution-based cross-sectional study was used from April 20 to June 10, 2021. A The data were collected through systematic random sampling. The Pittsburgh Sleep Quality Index (PSQI) was used to assess the outcome variable based on interview.

RESULTS

Out of 423, almost 414 participated in the study with a response rate of 97.9%. The prevalence of poor sleep quality was 54.6% (95% CI: 49.7%, 59%). Based on the trimester; about 44.8%, 36.8%, and 64.2% were observed poor sleep quality in the first, second, and third trimesters, respectively. Third trimester [AOR (Adjusted Odd Ratio) = 4.33; 95% CI (Confidence Interval) (1.43, 13.7)], primigravida [AOR = 4.03; 95% CI (2.59, 7.97)], para ≥2 [AOR = 1.95: 95% CI (1.09, 3.48)], depression [AOR = 4.59: 95% CI (2.31, 9.15)], and perceived stress [AOR = 1.15: 95% CI (1.1, 1.22)] were factors significantly associated.

CONCLUSION

One in every two pregnant women has poor sleep quality. Depression, perceived stress, gestational age, gravida, and parity were identified as associated factors with poor sleep quality. Therefore, healthcare providers should work on screening and counseling for sleep problems during prenatal checkups.

Maternal Sleeping Problems Before and After Childbirth - A Systematic Review

The perinatal and postpartum period is of great significance for women due to physiological changes, shifts in circadian rhythms, social setting, and psychological well-being, all of which affect the quality and quantity of their sleep. A mixed-studies systematic review was undertaken to enhance our understanding of sleep disturbances and mood disorders in women in late pregnancy and the postpartum period, their connection with breastfeeding, and the assessment of interventions for sleep disturbance. Three electronic databases (PUBMED, EMBASE and Google Scholar) were searched for qualitative, observational, and mixed-method studies from the year 2016 to June 2023. Twenty-nine articles were included in the analysis. The results were synthesized into four overarching themes: (і) the sleep quality of women in the perinatal period; (ii) the relationship between sleep and breastfeeding; (iii) the relationship between sleep quality and emotional disturbance in the perinatal period; (iv) sleep interventions in the researched group. The subjective nature of the perception of sleep disturbances, along with the absence of an objective measurement tool is clearly an inconvenience. It is advisable to include the assessment of maternal sleep hygiene and family sleep patterns during postpartum healthcare provider appointments to develop strategies not only for women's sleep quality but also for their mental well-being.

Sleep health predicted glucose metabolism among pregnant women: A prospective cohort study

AIMS

To examine whether sleep health in the first trimester could predict glucose metabolism in the second trimester.

METHODS

Pregnant women (N = 127) during the first trimester were recruited (August 2022 to March 2023). Overall sleep health was assessed by the Sleep Health Index. Various dimensions of sleep health were measured using a 7-day sleep diary and questionnaires. The outcomes, including diagnosis of gestational diabetes mellitus (GDM) and HbA1c, were obtained from the medical records in the second trimester. Poisson regression analysis and multiple linear regression were used for data analysis.

RESULTS

The average age of the participants was 32.6 years. The incidence of GDM was 28.3 % and the mean HbA1c was 5.2 % (33 mmol/mol). Sleep duration regularity (RR = 1.808; 95 %CI 1.023, 3.196) was associated with GDM after controlling for confounders. SHI total score (β = -0.278; 95 %CI -0.022, -0.005) and sleep duration regularity (β = 0.243; 95 %CI 0.057, 0.372) were associated with HbA1c.

CONCLUSIONS

Worse sleep health, particularly lower sleep regularity, predicted worse glucose metabolism among pregnant women. Healthcare professional may consider adding sleep-related assessment to prenatal care. Maintaining regular sleep should be encouraged. Studies examining the impact of sleep intervention on glucose metabolism among pregnant women are warranted.

The relationship between sleep problems and sexual dysfunction among pregnant women in Turkey

OBJECTIVE

Sexual dysfunction and sleep problems are common in women. Nevertheless, the relationship between sleep problems and sexual dysfunction during pregnancy has yet to be fully clarified. The aim of this study was to evaluate the relationship between sleep problems and sexual dysfunction in pregnant women.

METHODS

The study had a cross-sectional design and the sample was determined by employing the G*Power program on the basis of the findings of a related study. Taking the correlation value between the Female Sexual Function Index (FSFI) and the Insomnia Severity Index (ISI) into account, it was found that the minimum sample size was 219 pregnant women. Healthy pregnant women who were literate, did not have a diagnosed psychiatric disease, did not have a mental disability or communication problems, were in the gestation period, were not restricted by their doctors in terms of engaging in sexual activity, and who were willing to participate were included. The study included those pregnant women who consecutively attended the NST polyclinic in a maternity hospital in a province in the Black Sea region of Turkey between January 2022 and August 2022. The Sociodemographic Information Form, the Pittsburgh Sleep Quality Index (PSQI), the ISI, and the FSFI were used to collect data.

RESULTS

A total of 220 pregnant women took part. The women had a mean age of 27.4 ± 6.3. Of the pregnant women, all had poor sleep quality: 61% had insomnia problems; 30% had sexual dysfunction. When the relationships between the PSQI, ISI and FSFI were examined, there was a statistically significant positive correlation between the mean PSQI and ISI scores (p = 0.000). A statistically significant negative correlation was determined between the mean ISI and FSFI scores (p = 0.044). According to the multiple regression analysis, age did not significantly predict sexual function (β = -0.112; t = -1.639; p = 0.103); insomnia severity predicted sexual function negatively (β = -0.146; t = -2.136; p = 0.034). The explained variance was 2.6%.

CONCLUSION

The findings suggest that sleep quality as measured by the PSQI does not correlate with female sexual dysfunction in pregnant women. However, severity of insomnia does correlate with sexual dysfunction.

The effect of classical foot massage on insomnia and anxiety in preeclamptic pregnant women: a randomized controlled study

OBJECTIVE

Preeclampsia is one of the most common complaints during pregnancy. Preeclamptic pregnant women may experience insomnia and anxiety.

METHODS

This study was a randomized controlled trial with 71 preeclamptic women. In the experimental group, a foot massage was done for 3 days in a week. In the control group, any applications were not done. These groups were assessed for insomnia and anxiety levels.

RESULTS

In this study, it was found that classical foot massage significantly reduced (12.45±5.74 vs. 33.4±6.41) insomnia and anxiety compared with the control group (18.8±6.44 vs. 39.19±8.31, respectively, p<0.05).

CONCLUSION

The classical foot massage can effectively decrease insomnia and anxiety symptoms.

Study Design and Protocol of the Multisite Pregnancy 24/7 Cohort Study

Hypertensive disorders of pregnancy and other adverse pregnancy outcomes (APOs) are associated with an increased risk of future maternal cardiovascular disease. Physical activity during pregnancy reduces the risk of these APOs, yet few meet physical activity guidelines during pregnancy. Little is known about the role of sedentary behavior or sleep in APOs, a critical gap in knowledge given these behaviors comprise the majority of a 24-hour day. To address this knowledge gap, the Pregnancy 24/7 cohort study (2020-2025) uses 2 devices for 24-hour activity assessment in each trimester of pregnancy to examine associations of sedentary behavior, sleep, and the 24-hour activity cycle (composition of sedentary behavior, physical activity, and sleep) with hypertensive disorders and other APOs. Participants (n = 500) are recruited from the University of Iowa, University of Pittsburgh, and West Virginia University in early pregnancy and followed through delivery. The activPAL3 micro and Actiwatch Spectrum Plus are worn in each trimester for 7 days of 24-hour wear to assess the 24-hour activity cycle. APOs are abstracted from medical charts. This study will provide critical data to fuel future research examining how modifying the 24-hour activity cycle in pregnancy can improve maternal health.

Maternal exposure to zolpidem and risk of specific birth defects

Zolpidem is a non-benzodiazepine agent indicated for treatment of insomnia. While zolpidem crosses the placenta, little is known about its safety in pregnancy. We assessed associations between self-reported zolpidem use 1 month before pregnancy through to the end of the third month ("early pregnancy") and specific birth defects using data from two multi-site case-control studies: National Birth Defects Prevention Study and Slone Epidemiology Center Birth Defects Study. Analysis included 39,711 birth defect cases and 23,035 controls without a birth defect. For defects with ≥ 5 exposed cases, we used logistic regression with Firth's penalised likelihood to estimate adjusted odds ratios and 95% confidence intervals, considering age at delivery, race/ethnicity, education, body mass index, parity, early-pregnancy antipsychotic, anxiolytic, antidepressant use, early-pregnancy opioid use, early-pregnancy smoking, and study as potential covariates. For defects with three-four exposed cases, we estimated crude odds ratios and 95% confidence intervals. Additionally, we explored differences in odds ratios using propensity score-adjustment and conducted a probabilistic bias analysis of exposure misclassification. Overall, 84 (0.2%) cases and 46 (0.2%) controls reported early-pregnancy zolpidem use. Seven defects had sufficient sample size to calculate adjusted odds ratios, which ranged from 0.76 for cleft lip to 2.18 for gastroschisis. Four defects had odds ratios > 1.8. All confidence intervals included the null. Zolpidem use was rare. We could not calculate adjusted odds ratios for most defects and estimates are imprecise. Results do not support a large increase in risk, but smaller increases in risk for certain defects cannot be ruled out.

Circadian rhythm and sleep disruptions in relation to prenatal stress and depression symptoms

Circadian rhythm and sleep are related to health, but there is little data on the relationship between the sleep/wake rhythm and mood at different stages of pregnancy. The aim of this prospective, longitudinal study was to investigate the associations of circadian rhythm and sleep disruptions with stress and depression among women in early and late pregnancy. The participants were 26 pregnant women. Objective and subjective estimations of circadian rhythm and sleep were administered, namely actigraphy and the Biological Rhythms Interview of Assessment in Neuropsychiatry in the form of a questionnaire. The Perceived Stress Scale and the Edinburgh Postnatal Depression Scale were also used. Subjectively perceived circadian rhythm disruptions were positively related to stress. Tendency to maintain a regular rhythm of sleep and activity in early pregnancy and subjectively perceived disruptions of circadian rhythms in late pregnancy were positively associated with prenatal depression in late pregnancy. Sleep fragmentation and long time spent in bed at night in early pregnancy were positively associated with stress and depression in late pregnancy. The results suggest the importance of flexibility and the ability to adapt one's circadian activities to the demands of the situation of pregnancy-related changes in lifestyle. They also indicate the significance of good-quality uninterrupted night sleep in early pregnancy.

The predictive effect of mid-pregnancy sleep disorders on perinatal depression within women with or without depression in early pregnancy: A prospective cohort study

BACKGROUND

To investigate the relationship between depression in early pregnancy and sleep quality in mid-pregnancy, and explore whether sleep disorders independently predicts depression across the perinatal period within women with or without depression in early pregnancy.

METHODS

Data were collected at 7 time points from 12 weeks of pregnancy to 6 weeks postpartum. Multiple logistic regression and survival analysis were used to explore the relationship between sleep quality in mid-pregnancy and perinatal depression within women with or without depression in early pregnancy.

RESULTS

390 women were included. Women with depression in early pregnancy were more likely to have sleep disorders and perinatal depression. Women with sleep disorders had a higher risk of perinatal depression compared to women without sleep disorders in mid-pregnancy. Stratified analysis based on whether depressed at 12 weeks of pregnancy found that among women without depression, those with sleep disorders in mid-pregnancy were more likely to have subsequent perinatal depression and appeared earlier; whereas, among women with depression, mid-pregnancy sleep disorders was not a predictor of subsequent perinatal depression.

LIMITATION

High rates of missed visits may lead to sample bias, with depression and sleep quality being assessed by self-report.

CONCLUSIONS

Women with depression in early pregnancy are more likely to have sleep disorders in mid-pregnancy. There is a strong correlation between sleep quality in mid-pregnancy and perinatal depression among women without depression in early pregnancy. Routine screening and intervention for sleep disorders should be a priority in perinatal care to reduce the incidence of perinatal depression.

Sleep and sleep disorders during pregnancy and postpartum: The Life-ON study

OBJECTIVE

to prospectively assess sleep and sleep disorders during pregnancy and postpartum in a large cohort of women.

METHODS

multicenter prospective Life-ON study, recruiting consecutive pregnant women at a gestational age between 10 and 15 weeks, from the local gynecological departments. The study included home polysomnography performed between the 23rd and 25th week of pregnancy and sleep-related questionnaires at 9 points in time during pregnancy and 6 months postpartum.

RESULTS

439 pregnant women (mean age 33.7 ± 4.2 yrs) were enrolled. Poor quality of sleep was reported by 34% of women in the first trimester of pregnancy, by 46% of women in the third trimester, and by as many as 71% of women in the first month after delivery. A similar trend was seen for insomnia. Excessive daytime sleepiness peaked in the first trimester (30% of women), and decreased in the third trimester, to 22% of women. Prevalence of restless legs syndrome was 25%, with a peak in the third trimester of pregnancy. Polysomnographic data, available for 353 women, revealed that 24% of women slept less than 6 h, and 30.6% of women had a sleep efficiency below 80%. Sleep-disordered breathing (RDI≥5) had a prevalence of 4.2% and correlated positively with BMI.

CONCLUSIONS

The Life-ON study provides the largest polysomnographic dataset coupled with longitudinal subjective assessments of sleep quality in pregnant women to date. Sleep disorders are highly frequent and distributed differently during pregnancy and postpartum. Routine assessment of sleep disturbances in the perinatal period is necessary to improve early detection and clinical management.

Sleep disorders during pregnancy: an underestimated risk factor for gestational diabetes mellitus

Sleep disorders are highly prevalent during pregnancy and significantly affect women's health and quality of life. Gestational diabetes mellitus (GDM) is one of the most common metabolic complications during pregnancy and constitutes a significant risk factor for both mother and fetus in the short and the long term. While the association between sleep disorders and type 2 diabetes mellitus (T2DM) is indisputable, it is not clear whether there is a link between sleep disorders and GDM. The aim of this article was to investigate the association between sleep disorders and GDM and whether the treatment of sleep disorders may prevent GDM development. Insomnia, obstructive sleep apnea (OSA), restless legs syndrome (RLS), and narcolepsy were the most common sleep disorders identified during pregnancy and were related to poor sleep quality and short or prolonged sleep duration. They were all associated with an increased risk of GDM. The ideal sleep duration for pregnant women was determined at 8-9 h daily. In conclusion, sleep disorders constitute a risk factor for GDM. It is imperative that prospective studies be conducted to evaluate the effect of the early management of sleep disorders on GDM manifestation and control. Healthcare providers should highlight the importance of sufficient sleep to reinforce pregnancy outcomes.

Improvements in cardiovascular health over the perinatal period predicts lower postpartum psychological distress

Background

Adverse cardiovascular events during pregnancy (e.g., pre-eclampsia) occur at higher rates among individuals with pre-pregnancy overweight or obesity (body mass index [BMI]≥25kg/m2) and have been associated with postpartum depression. However, it is unclear whether cardiovascular health (CVH), defined more holistically than the absence of cardiovascular conditions in pregnancy, relates to postpartum psychological functioning. The present study examined whether changes in CVH during the perinatal period predicted postpartum psychological functioning among individuals with pre-pregnancy BMI≥25kg/m2.

Methods

Individuals (N=226; Mage=28.43±5.4 years; MBMI=34.17±7.15kg/m2) were recruited when their pregnancies were 12-20 weeks gestation (M=15.64±2.45 weeks) for a longitudinal study of health and well-being. Participants completed the Center for Epidemiological Studies Depression Scale (CES-D) and Perceived Stress Scale (PSS) and reported on CVH behaviors (dietary intake, physical activity, nicotine exposure, and sleep) at baseline and at 6-months postpartum. BMI and CVH behaviors were coded according to the American Heart Association's Life's Essential 8 to create a CVH score at both timepoints. Linear regression analyses were performed to examine whether change in CVH related to postpartum CES-D and PSS scores. Because sleep was only measured in a subset of participants (n=114), analyses were conducted with and without sleep included. Baseline CVH, CES-D and PSS scores, and demographic factors were included as covariates in all models.

Results

Improved CVH was associated with lower postpartum CES-D (β=-0.18, p<0.01) and PSS (β=-0.13, p=0.02) scores when excluding sleep. Compared to those whose CVH improved by >1SD from pregnancy to 6-months postpartum, individuals whose CVH worsened by >1SD scored 6.42 points higher on the CESD (MCESD=15.25±10.92 vs. 8.52±6.90) and 6.12 points higher on the PSS (MPSS=24.45±8.29 vs. 17.83±8.70). However, when including sleep, these relationships were no longer significant (ps>0.4).

Conclusions

Improvements in CVH from early pregnancy to 6-months postpartum were associated with lower postpartum depressive symptoms and perceived stress. However, these relationships were no longer significant when including sleep in the CVH metric, potentially due to the large reduction in sample size. These data suggest that intervening during pregnancy to promote CVH may improve postpartum psychological functioning among high-risk individuals.

Decoding distress among pandemic pregnancies: Examining pregnancy distress and COVID-19 stress as concurrent predictors of current and anticipated postpartum sleep during the COVID-19 pandemic

OBJECTIVES

The goal of the present study was to examine pregnancy distress, COVID-19 stress, COVID-19 compliance, and life satisfaction as concurrent predictors of perceived current and anticipated postpartum sleep duration (SD) and quality among a U.S. sample of pregnant individuals.

METHODS

The sample comprised 544 pregnant individuals (62.3% non-Hispanic White; mean age = 28.0 and SD = 6.2), most of whom were in their third trimester (42.3%). Participants were recruited through an online panel (Qualtrics) between October and November 2020.

RESULTS

The primary analysis was based on a concurrent path model, which examined pregnancy distress, COVID-19 stress, COVID-19 compliance, and life satisfaction as predictors of current and anticipated postpartum SD and sleep quality, controlling for several demographic (eg, age and income), familial (eg, number of children and adults in the home), sleep-related (eg, chronotype and use of sleeping medication), and psychosocial functioning (eg, COVID-19 impact) variables. Results indicated that higher COVID-19 compliance was significantly associated with poorer current sleep quality. Furthermore, both pregnancy distress and COVID-19 stress predicted worse anticipated postpartum sleep quality (but not duration). Life satisfaction, however, was consistently significantly associated with current and anticipated postpartum SD and quality.

CONCLUSIONS

Findings are critical for understanding how various forms of stress correlate with sleep health behaviors during pregnancy, as well as expectations for postpartum sleep among a vulnerable population at risk for both psychological and sleep challenges during a period of unprecedented global stress.

Prevalence and predictors for postpartum sleep disorders: a nationwide analysis

OBJECTIVE

To describe the prevalence and predictors of postpartum sleep disorders.

DESIGN

A retrospective cohort study.

SETTING

Postpartum.

POPULATION

Commercially insured women delivering in California (USA) between 2011 and 2014.

METHODS

Using the Optum Clinformatics Datamart Database.

MAIN OUTCOME MEASURES

Prevalence of a postpartum sleep disorder diagnosis with and without a depression diagnosis up to 12 months following hospital discharge for inpatient delivery. We also identified predictors of a postpartum sleep disorder diagnosis using multivariable logistic regression.

RESULTS

We identified 3535 (1.9%) women with a postpartum sleep disorder diagnosis. The prevalence of sleep disorder diagnoses was insomnia (1.3%), sleep apnea (0.25%), and other sleep disorder (0.25%). The odds of a postpartum sleep disorder were highest among women with a history of drug abuse (adjusted odds ratio (aOR): 2.70, 95% confidence interval (CI): 1.79-4.09); a stillbirth delivery (aOR: 2.15, 95% CI: 1.53-3.01); and chronic hypertension (aOR: 1.82; 95% CI: 1.57-2.11). A comorbid diagnosis of a postpartum sleep disorder and depression occurred in 1182 women (0.6%). These women accounted for 33.4% of all women with a postpartum sleep disorder. The strongest predictors of a comorbid diagnosis were a history of drug abuse (aOR: 4.13; 95% CI: 2.37-7.21) and a stillbirth delivery (aOR: 2.93; 95% CI: 1.74-4.92).

CONCLUSIONS

Postpartum sleep disorders are underdiagnosed conditions, with only 2% of postpartum women in this cohort receiving a sleep diagnosis using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Insomnia was the most common disorder and one-third of women diagnosed with a postpartum sleep disorder had a co-morbid diagnosis of depression. Future studies are needed to improve the screening and diagnostic accuracy of postpartum sleep disorders.

Sleep deprivation during pregnancy leads to poor fetal outcomes in Sprague-Dawley rats

Sleep deprivation is a common problem during pregnancy, but its impact on the fetus remains unclear. We aimed to investigate the effect of sleep deprivation during pregnancy on fetal outcomes and its mechanism in Sprague-Dawley rats. Sleep deprivation was performed from gestational day(GD) 1-19 using a multiplatform method for 18 h/day. Rats were sacrificed on GD20, and their blood and placentas were collected. Fetal and placental parameters were ascertained. Melatonin, adrenocorticotropic hormone (ACTH) and corticosterone were also measured in serum. The levels of arylalkylamine N-acetyltransferase (AANAT) and two melatonin receptors MT1 and MT2, in placental tissues were detected by western blotting. The inflammatory status and oxidative stress in serum and placentas were investigated. Miscarriage and intrauterine growth restriction were observed in the sleep deprivation group. Sleep deprivation resulted in an increased fetal absorption rate, while fetal weight, crown-rump length and placental weight were reduced. Placental histopathology showed that the labyrinth ratio in the sleep deprivation group was significantly reduced, with hypoplastic villi and obviously decreased blood vessels. Sleep deprivation decreased melatonin in serum and the expression of AANAT, MT1 and MT2 in placental tissues, elevated the oxidative stress products 8-hydroxy-deoxyguanosine (8-OHdG) and malondialdehyde(MDA) in serum and 4-hydroxynonenal (4HNE) in the placenta, and decreased the antioxidants superoxide dismutase (SOD) and total antioxidant capacity (T-AOC) in serum. Serum proinflammatory cytokines including interleukin-1-beta (IL-1β), interleukin-6 (IL-6), necrotizing factor-alpha (TNF-α), and interleukin-8(IL-8), were all elevated by sleep deprivation, and the inflammatory regulatory factor nuclear factor-κB p65 (NF-κB p65) in the placenta was enhanced when examined by immunohistochemistry. Corticosterone levels were comparable between the two groups, although ACTH levels were elevated significantly in the sleep deprivation group. Our study revealed that sleep deprivation during pregnancy can adversely impact fetal outcomes. Melatonin may play an important role in this pathology through the oxido-inflammatory process.

Sleep Deficiency in Pregnancy

Sleep is a critical aspect of one's daily life for overall health, with a recommended 7 to 9 hours in adulthood (ages 26-64). Up to a third of women do not sleep sufficiently, and pregnant women are at an increased risk for sleep deficiency. Throughout pregnancy, sleep is affected in differing ways. For example, in the first trimester, hormones affect sleep cycles, but by the third trimester, physical complaints such as increasing frequent urination and fetal movement create frequent awakenings. Associations between sleep deficiency and gestational diabetes, hypertensive disorders, depression, and some evidence regarding preterm birth exist. A woman's labor course and perception of delivery are also negatively affected by short sleep duration.

The relationship between body mass index and sleep in women with risk factors for gestational diabetes mellitus

Background

Both obesity and sleep disorders are common among women during pregnancy. Although prior research has identified a relationship between obesity and sleep disorders, those findings are from women later in pregnancy.

Objective

To explore the relationships between self-reported sleep duration, insufficient sleep and snoring with body mass index (BMI) among multiethnic women at risk of gestational diabetes mellitus (GDM)in early pregnancy.

Methods

Cross-sectional study of baseline data from women at risk of GDM enrolled in the Treatment of BOoking Gestational diabetes Mellitus (TOBOGM) multicentre trial across 12 Australian/Austrian sites. Participants completed a questionnaire before 20 weeks' gestation to evaluate sleep. BMI <25 kg/m2 served as the reference group in multivariable logistic regression.

Results

Among the 2865 women included, the prevalence of overweight and obesity classes I-III was 28%, 19%, 11% and 12%, respectively. There was no relationship between sleep duration and BMI. The risk of insufficient sleep >5 days/month was higher in class II and class III obesity (1.38 (1.03-1.85) and 1.34 (1.01-1.80), respectively), and the risk of snoring increased as BMI increased (1.59 (1.25-2.02), 2.68 (2.07-3.48), 4.35 (3.21-5.88) to 4.96 (3.65-6.74), respectively)).

Conclusions

Obesity is associated with insufficient sleep among pregnant women at risk of GDM. Snoring is more prevalent with increasing BMI.

Prevalence and associated factors of insomnia symptoms among pregnant women in the third trimester in a moderately developing region of China

BACKGROUND

Insomnia is the most common sleep disorder in the general population, especially among pregnant women, and it is considered a major public health issue. Not only can it cause mental and physical problems in pregnant women, but it may also affect the growth of the fetus. However, there are few reports on the prevalence and influencing factors of insomnia symptoms in third-trimester women in China. The objective of this study was to assess the prevalence of insomnia symptoms among pregnant women in the third trimester in a moderately developing region of China and to further explore the associated factors of insomnia symptoms from various aspects.

METHODS

A cross-sectional survey was conducted among eligible pregnant women in the third trimester from December 2022 to February 2023. Data on socio-demographic characteristics, clinical characteristics, and behavioral and psychological characteristics of pregnant women were collected through a structured questionnaire. The Chi-square test and multivariate logistics regression were applied to explore the associated factors of insomnia symptoms.

RESULTS

A total of 535 pregnant women in the third trimester were included in this study, and the prevalence of insomnia symptoms was 59.8%. Multivariate logistic regression analysis revealed that pregnant women who lived together with elders (OR: 0.58, 95% CI: 0.40-0.86), had low perceived stress (OR: 0.58, 95% CI: 0.35-0.97), had no threatened abortion (OR: 0.55, 95% CI: 0.32-0.93) and had good doctor-patient communication (OR: 0.66, 95% CI: 0.45-0.98) were more likely to stay away from insomnia symptoms. However, pregnant women with anxiety symptoms (OR: 2.27, 95% CI: 1.28-4.03), fear of childbirth (OR: 1.63, 95% CI: 1.11-2.40) and a high experience of COVID-19 fear (OR: 1.61, 95% CI: 1.03-2.54) tended to have insomnia symptoms.

CONCLUSIONS

The prevalence of insomnia symptoms in pregnant women is high in Lianyungang city in eastern China in the third trimester. Insomnia symptoms is influenced by multiple factors. There is an urgent need to develop interventions to reduce the prevalence of insomnia symptoms in the third trimester and to focus on pregnant women with risk factors for insomnia symptoms.