Daily sleep and fatigue characteristics in nulliparous women during the third trimester of pregnancy

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.

Dreaming for two: A systematic review of mental sleep activity during pregnancy

Changes in sleep and dreams are often observed during pregnancy. Dreaming may represent privileged access to the inner world of individuals, providing relevant information about their well-being. For this reason, a growing but heterogeneous literature has investigated dream experiences of pregnant women. The present paper aimed to systematically review the available evidence on the relationship between pregnancy and oneric activity, focusing on dream and nightmare frequency, dream contents, and emotional features. Moreover, dream changes between pre-partum and post-partum periods and the impact of previous pregnancy-related adverse events on dreaming have been summarized. Overall, 17 studies have been examined. The reviewed evidence suggests that women tend to have an abundant production of dreams and nightmares during pregnancy, and some results support the view that a high rate of dream recall is associated with poor sleep quality. Most studies have shown a high presence of pregnancy-related dream content, likely reflecting waking experiences and concerns. Additionally, dreaming may promote psychological preparation and activation of functional coping strategies to face life changes after childbirth.

Diagnosis and management of common sleep disorders during the perinatal period

The perinatal period is a critical phase in a woman's life characterized by significant physical, emotional, and societal changes. Sleep disorders such as insomnia, restless legs syndrome, obstructive sleep apnea, and poor sleep quality have been observed to increase in prevalence during the perinatal period. Given the harmful impact of sleep disturbances on the health of both mother and newborn, it is crucial to diagnose and treat them promptly. There is a paucity of literature on sleep problems during the perinatal period. This narrative review aimed to summarize the existing evidence and provide suggestions for promptly identifying and managing these disorders.

A Descriptive Comparative Pilot Study: Association Between Use of a Self-monitoring Device and Sleep and Stress Outcomes in Pregnancy

Pregnancy is a challenging time for maintaining quality sleep and managing stress. Digital self-monitoring technologies are popular because of assumed increased patient engagement leading to an impact on health outcomes. However, the actual association between wear time of such devices and improved sleep/stress outcomes remains untested. Here, a descriptive comparative pilot study of 20 pregnant women was conducted to examine associations between wear time (behavioral engagement) of self-monitoring devices and sleep/stress pregnancy outcomes. Women used a ring fitted to their finger to monitor sleep/stress data, with access to a self-monitoring program for an average of 9½ weeks. Based on wear time, participants were split into two engagement groups. Using a linear mixed-effects model, the high engagement group showed higher levels of stress and a negative trend in sleep duration and quality. The low engagement group showed positive changes in sleep duration, and quality and experienced below-normal sleep onset latency at the start of the pilot but trended toward normal levels. Engagement according to device wear time was not associated with improved outcomes. Further research should aim to understand how engagement with self-monitoring technologies impacts sleep/stress outcomes in pregnancy.

Daytime napping and nighttime sleep in pregnant individuals with insomnia disorder

STUDY OBJECTIVES

Examine bidirectional associations between daytime napping and nighttime sleep among pregnant individuals with insomnia disorder.

METHODS

We used baseline data from a randomized controlled trial of insomnia treatment during pregnancy (n = 116). Participants in their second or third trimester of pregnancy self-reported daytime napping and nighttime sleep parameters using a sleep diary and wore an Actiwatch-2 during the same 7-day period. Linear regression models, accounting for intraindividual correlation, were used to estimate associations between daytime napping and nighttime sleep parameters (duration, efficiency, quality, awakenings). Models were also stratified by trimester of pregnancy.

RESULTS

Sixty-three percent of participants reported napping on at least 1 day. Among participants in the second trimester (65%), napping 15-59 minutes was associated with 6.3% greater self-reported sleep efficiency (95% confidence interval: 2.3, 10.2) and 0.5 units greater self-reported sleep quality (95% confidence interval: 0.0, 0.9) that night; napping 60+ minutes was associated with 0.6 hours shorter actigraphy-measured sleep duration (95% confidence interval: -1.0, -0.2). Napping was not associated with nighttime sleep overall or during the third trimester. Nighttime sleep parameters were not associated with napping duration the following day.

CONCLUSIONS

Among pregnant individuals with insomnia in the second trimester, short napping duration was associated with higher self-reported sleep efficiency and quality; long napping duration was associated with shorter actigraphy-measured sleep duration. Additional research is needed to examine the interaction between nap duration and nap timing. In the future, these results may lead to more nuanced recommendations for daytime napping among pregnant individuals with insomnia disorder.

CLINICAL TRIAL REGISTRATION

Registry: ClinicalTrials.gov; Name: Treatment for Insomnia during Pregnancy; URL: https://clinicaltrials.gov/ct2/show/NCT01846585; Identifier: NCT01846585.

CITATION

Badon SE, Dietch R, Simpson N, Lyell DJ, Manber R. Daytime napping and nighttime sleep in pregnant individuals with insomnia disorder. J Clin Sleep Med. 2023;19(2):371-377.

Longitudinal changes in objective sleep parameters during pregnancy

BACKGROUND

Sleep disturbances are associated with adverse perinatal outcomes. Thus, it is necessary to understand the continuous patterns of sleep during pregnancy and how moderators such as maternal age and pre-pregnancy body mass index impact sleep.

OBJECTIVE

This study aimed to examine the continuous changes in sleep parameters objectively (i.e. sleep stages, total sleep time, and awake time) in pregnant women and to describe the impact of maternal age and/or pre-pregnancy body mass index as moderators of these objective sleep parameters.

DESIGN

This was a longitudinal observational design.

METHODS

Seventeen women with a singleton pregnancy participated in this study. Mixed model repeated measures were used to describe weekly patterns, while aggregated changes describe these three pregnancy periods (10-19, 20-29, and 30-39 gestational weeks).

RESULTS

For the weekly patterns, we found significantly decreased deep (1.26 ± 0.18 min/week, p < 0.001), light (0.72 ± 0.37 min/week, p = 0.05), and total sleep time (1.56 ± 0.47 min/week, p < 0.001) as well as increased awake time (1.32 ± 0.34 min/week, p < 0.001). For the aggregated changes, we found similar patterns to weekly changes. Women (⩾30 years) had an even greater decrease in deep sleep (1.50 ± 0.22 min/week, p < 0.001) than those younger (0.84 ± 0.29 min/week, p = 0.04). Women who were both overweight/obese and ⩾30 years experienced an increase in rapid eye movement sleep (0.84 ± 0.31 min/week, p = 0.008), but those of normal weight (<30 years) did not.

CONCLUSION

This study appears to be the first to describe continuous changes in sleep parameters during pregnancy at home. Our study provides preliminary evidence that sleep parameters could be potential non-invasive physiological markers predicting perinatal outcomes.

[Analysis of causes or reasons that fragment sleep and sleep disorder in pregnant and non-pregnant women]

Introduction

During pregnancy, sleep undergoes important changes. The objective was to assess the causes or reasons that fragment sleep and sleep disorders in different women and trimesters of pregnancy, comparing them with those of non-pregnant women (NPW).

Methods

Cross-sectional study. Anonymous surveys were used to evaluate reasons that fragment sleep and specific questionnaires to evaluate sleep disorders. Results: Pregnant Women (PW)= 320. 1st Trimester of pregnancy (T): n = 106, 2nd. T: n = 104, 3rd T: n = 110. MNE: n = 304. Most frequent reasons that fragmented sleep, statistically significant in PW and were: need to urinate, uncomfortable position, not being able to rotate in bed. As sleep disorders we find: nightmares 44 vs 4.9%; snoring with pauses: 31 vs 3%.

Conclusion

We found that in the PW studied, most of the causes or reasons analyzed fragmented sleep; they had more sleep disorders such as nightmares, respiratory disorders and periodic leg movements, in that order, compared to the NPW who in turn, presented insomnia, excessive sleepiness and bruxism.

[Fatigue relief by aromatherapy use in prenatal and postnatal women: a systematic review and meta-analysis]

Purpose

The purpose of this systematic review was to examine aromatherapy interventions for prenatal and postnatal women, and to determine the effectiveness of these interventions on fatigue.

Methods

Six national and international databases were reviewed to retrieve and collect studies published up to September 7, 2021, describing randomized controlled trials and controlled clinical trials of aromatherapy interventions for prenatal and postnatal women's fatigue. Of the 323 articles initially identified, 64 duplicates were excluded and 259 were screened. After further excluding 216 articles not related to PICO framework, 10 were selected for review. Two reviewers independently selected studies and conducted data extraction and quality appraisal using Cochran's Risk of Bias and Risk of Bias Assessment Tool for Non-randomized Studies.

Results

The quality of the 10 selected studies was overall satisfactory. A meta-analysis of three studies showed that aromatherapy with lavender oil? produced a 0.75-point reduction in postnatal mothers' fatigue when compared to control groups. Sleep quality was also analyzed as a secondary outcome of fatigue. A meta-analysis of four studies using lavender and/or orange peel oil found that aromatherapy produced a 0.98-point improvement in postnatal mothers' quality of sleep. Although a meta-analysis could not be conducted to synthesize the findings for fatigue in pregnant women, inhalation and massage therapy using lavender oil showed positive effects on prenatal fatigue and sleep quality.

Conclusion

Aromatherapy using lavender oil and orange peel oil is effective in improving prenatal and postnatal fatigue and sleep quality.

A randomized controlled trial on the effects of blue-blocking glasses compared to partial blue-blockers on sleep outcomes in the third trimester of pregnancy

OBJECTIVE

Sleep disturbances are common in pregnancy. Blocking blue light has been shown to improve sleep and may be a suitable intervention for sleep problems during pregnancy. The present study investigated the effects of blue light blocking in the evening and during nocturnal awakenings among pregnant women on primary sleep outcomes in terms of total sleep time, sleep efficiency and mid-point of sleep.

METHODS

In a double-blind randomized controlled trial, 60 healthy nulliparous pregnant women in the beginning of the third trimester were included. They were randomized, using a random number generator, either to a blue-blocking glass intervention (n = 30) or to a control glass condition constituting partial blue-blocking effect (n = 30). Baseline data were recorded for one week and outcomes were recorded in the last of two intervention/control weeks. Sleep was measured by actigraphy, sleep diaries, the Bergen Insomnia Scale, the Karolinska Sleepiness Scale and the Pre-Sleep Arousal Scale.

RESULTS

The results on the primary outcomes showed no significant mean difference between the groups at posttreatment, neither when assessed with sleep diary; total sleep time (difference = .78[min], 95%CI = -19.7, 21.3), midpoint of sleep (difference = -8.9[min], 95%CI = -23.7, 5.9), sleep efficiency (difference = -.06[%], 95%CI = -1.9, 1.8) and daytime functioning (difference = -.05[score points], 95%CI = -.33, .22), nor by actigraphy; total sleep time (difference = 13.0[min], 95%CI = -9.5, 35.5), midpoint of sleep (difference = 2.1[min], 95%CI = -11.6, 15.8) and sleep efficiency (difference = 1.7[%], 95%CI = -.4, 3.7). On the secondary outcomes, the Bergen Insomnia Scale, the Karolinska Sleepiness Scale and the Pre-Sleep Arousal Scale the blue-blocking glasses no statistically significant difference between the groups were found. Transient side-effects were reported in both groups (n = 3).

CONCLUSIONS

The use of blue-blocking glasses compared to partially blue-blocking glasses in a group of healthy pregnant participants did not show statistically significant effects on sleep outcomes. Research on the effects of blue-blocking glasses for pregnant women with sleep-problems or circadian disturbances is warranted.

TRIAL REGISTRATION

The trial is registered at ClinicalTrials.gov (NCT03114072).

Associations between Pregnancy-Related Symptoms, Serum 25(OH)D, and Physical Quality of Life in Pregnant Women

Vitamin D deficiency has been associated with pregnancy-related symptoms including fatigue, poor sleep quality, and musculoskeletal pain. Pregnant Black and Hispanic women are more likely to have vitamin D deficiency compared with pregnant non-Hispanic White women. Data are limited on the association of vitamin D deficiency with quality of life (QOL) among pregnant women. This study examined the association of serum 25(OH)D and pregnancy-related symptoms with QOL among pregnant predominantly minority women. Using a cross-sectional design, 119 pregnant Black and Hispanic women completed surveys and had blood drawn for serum 25(OH)D levels between 24–32 weeks gestation. Hierarchical regression analysis indicated that total pregnancy-related symptoms and serum 25(OH)D level were significant predictors of QOL, while controlling for covariates. Higher total pregnancy-related symptoms and lower serum 25(OH)D predicted poorer physical QOL. Screening for pregnancy-related symptoms and vitamin D levels among childbearing women might be important nursing interventions to improve physical QOL.

Association of Fatigue With Sleep Duration and Bedtime During the Third Trimester

PURPOSE

To investigate the association between fatigue and sleep habits of pregnant women to further explore the effect of sleep duration and bedtime on fatigue during the third trimester.

MATERIALS AND METHODS

A total of 465 Chinese Han pregnant women in the third trimester (after 28 weeks) with a singleton gestation were recruited. Sleep habits (such as bedtime, sleep onset latency, and night sleep duration) and the 14-item Fatigue Scale scores (FS-14, used to assess fatigue) were collected.

RESULTS

The effects of sleep duration and bedtime on FS-14 physical and total scores were significant. FS-14 physical scores and total scores of the participants in the group of sleep before 23 o'clock (SBC) of short sleep duration (<7 h) were significantly higher as compared to the participants in the group of SBC of normal sleep duration, and those of the participants in the group of SBC of normal sleep duration were significantly lower than the participants in the group of sleep after 23 o'clock of normal sleep duration. There were negative correlations of sleep duration with FS-14 physical score and total score in the SBC of short sleep duration group.

CONCLUSION

Sleep less than 7 h or bedtime after 23 o'clock was associated with increased fatigue levels of pregnant women in the third trimester. Therefore, it is necessary to develop good sleep habits (enough sleep duration and early bedtime) to keep fatigue at a low level for pregnant women in the third trimester.

Comparison of longitudinal diary and actigraphy-assessed sleep in pregnant women

STUDY OBJECTIVES

Various methods are employed to assess sleep in pregnant women, including self-report, sleep diary, and actigraphy. Unfortunately, the data are often contradictory, and interpretations are often inconsistent. The current aims are to compare subjective and objective sleep data in pregnant women collected longitudinally in early pregnancy.

METHODS

In this secondary analysis of 104 pregnant women, sleep was collected via diary and actigraphy for 14 days during three separate occasions (10-12 weeks; 14-16 weeks; and 18-20 weeks). Sleep variables included wake after sleep onset (WASO), sleep efficiency (SE), bedtime/lights out, sleep onset latency (SL), and total sleep duration (TST). Repeated measures ANOVAs compared each sleep variable across Time and by Method of data collection, while controlling for parity and daytime naps.

RESULTS

Significant differences were noted for only the method of data collection for sleep component studied for WASO, F (1, 98) = 147.20, p < 0.001; SE, F (1, 98) = 129.41, p < 0.001); bedtime/lights out, F (1, 103) = 5.33, p < 0.05); and sleep duration, F (1, 104) = 182.75, p < 0.001). Significant variation was not seen in any variable across time-period.

CONCLUSIONS

There are substantial discrepancies between diary- and actigraphy-assessed sleep measures in pregnant women which is in alignment with previous literature. These data highlight that these methodologies assess different constructs. We contend that these data may be useful as a reference to compare high-risk women or those with sleep disorders. Using a multi-modal approach to identify sleep disturbance in pregnancy is likely a more clinically useful option.

Data-Driven Modeling of Pregnancy-Related Complications

A healthy pregnancy depends on complex interrelated biological adaptations involving placentation, maternal immune responses, and hormonal homeostasis. Recent advances in high-throughput technologies have provided access to multiomics biological data that, combined with clinical and social data, can provide a deeper understanding of normal and abnormal pregnancies. Integration of these heterogeneous datasets using state-of-the-art machine-learning methods can enable the prediction of short- and long-term health trajectories for a mother and offspring and the development of treatments to prevent or minimize complications. We review advanced machine-learning methods that could: provide deeper biological insights into a pregnancy not yet unveiled by current methodologies; clarify the etiologies and heterogeneity of pathologies that affect a pregnancy; and suggest the best approaches to address disparities in outcomes affecting vulnerable populations.

Fatigue and sleep quality in different trimesters of pregnancy

OBJECTIVES

Fatigue is one of the most common and persistent complaints of pregnant women. Increased severity of fatigue during pregnancy can increase the risk of preterm labor, prolonged labor, cesarean section, and postpartum depression. Therefore, this study aimed to determine the fatigue status in different trimesters of pregnancy and its relationship with sleep quality in pregnant women.

MATERIAL AND METHODS

This cross-sectional study was performed by two-stage cluster sampling on pregnant women referred to Tabriz health centers. Data were collected using socio-demographic questionnaire, multidimensional assessment of fatigue and Pittsburgh sleep quality index.

RESULTS

Among the 605 pregnant women studied, 94.2% of women suffered from fatigue during pregnancy. The mean (standard deviation) of fatigue score in the first, second and third trimesters of pregnancy was 23.53 (8.05), 25.78 (6.56) and 26.46 (6.72), respectively. There was also significant reverse correlation between total fatigue score with total sleep quality score (p=0.031) and with an increase in fatigue, sleep quality was reduced.

DISCUSSION

The findings of this study may be used to design interventional measures for fatigue and medical care to improve quality of sleep in pregnancy.

Pregnant women do not display impaired memory formation across one night of sleep

Forgetfulness is a common complaint of pregnant women, who also often report impaired nocturnal sleep. Considering sleep's well-known beneficial role in consolidating newly encoded memory content, we hypothesized that pregnant women would display detrimental changes in objective sleep measures and associated memory deficits. We compared the consolidation of declarative as well as procedural memory across sleep in 21 healthy, third-trimester pregnant women versus 20 matched non-pregnant controls. Subjects encoded and were tested on visuospatial and procedural memory tasks before and after, respectively, a night of sleep spent at home. The emergence of gist-based memories was tested with the Deese-Roediger-McDermott (DRM) paradigm. Sleep was polysomnographically recorded and subjective sleep quality was assessed with questionnaires. Although pregnant in comparison to non-pregnant women reported markedly impaired subjective sleep quality and efficiency, quantitative changes were limited to increases in wakefulness after sleep onset and reductions in rapid eye movement (REM) sleep. Retention of newly learned memory contents, which is believed to reflect sleep-associated memory consolidation, was comparable between groups, as was the formation of gist-based memories. The findings indicate that subjective deteriorations in sleep quality experienced by pregnant women are not necessarily linked to objective impairments. They raise the possibility that sufficient slow wave sleep towards the end of pregnancy allows for normal sleep-related memory consolidation. Although these results were obtained in a small number of pregnant women in very good health and should be corroborated in larger samples, they challenge the assumption of poor sleep and impaired memory as hallmarks of the "pregnancy brain".

Effects of exercise on pregnancy and postpartum fatigue: A systematic review and meta-analysis

OBJECTIVE

Fatigue is a common adverse experience in pregnant and postpartum women and is associated with poor outcomes and can seriously affect maternal and infant health and quality of life. However, data from existing studies are inconsistent, and no studies have examined the effects of exercise on pregnancy and postpartum fatigue. The aim of this review is to evaluate the effects of exercise on pregnancy and postpartum fatigue.

STUDY DESIGN

PubMed, EMBASE, Web of Science and the Cochrane Library database were used to retrieve literature. Eligible studies were clinical trials that reported the effects of exercise on pregnancy and postpartum fatigue in women. The methodological quality of the included studies was assessed using the Cochrane Collaboration Risk of Bias Assessment Tool. A fixed-effect model was used to analyse the pooled results. Subgroup analyses were used to explore sources of heterogeneity. Sensitivity analysis was used to validate the robustness of the pooled results.

RESULTS

Seven studies were included. The results of meta-analysis of five studies showed that exercise during pregnancy and the postpartum period may have beneficial effects on women's fatigue ([SMD = 0.29, 95 % CI (0.10, 0.47), P = 0.003]). Subgroup analyses reported that compared with the control, long exercise programmes, postpartum exercise and supervised exercise significantly improved fatigue levels.

CONCLUSIONS

Postpartum exercise in a supervised programme lasting more than eight weeks may be beneficial for reducing postpartum fatigue. More available data from large-scale and high-quality trials are needed to demonstrate the effects of exercise on pregnant and postpartum fatigue.

Prevalence and associated risk factors of insomnia among pregnant women in China

BACKGROUND

Insomnia is common during pregnancy but the prevalence and risk factors of insomnia in Chinese women during pregnancy is not well studied. This study aimed to examine the prevalence of insomnia and its risk factors in Chinese women during pregnancy.

METHODS

In this cross sectional study, 436 Chinese pregnant women with Insomnia Severity Index (ISI) ≥ 8 were clinically assessed using the insomnia criteria based on the combination of DSM-IV (Diagnostic and Statistical Manual-4th Edition) and ICD-10 (International Classification of Dieases, 10th Edition). Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), Pregnancy Pressure Scale (PPS), Perceived physical discomfort level and number, Epworth Sleepiness Scale (ESS), and a general socio-demographic questionnaire were administered.

RESULTS

The results showed that about 20% of the pregnant women met the strict diagnosis criteria of insomnia. Independent-samples t-test revealed that several risk factors were correlated with the group with insomnia (N = 84) compared to the group without insomnia (N = 352). Binary Logistic regression analysis found that more significant bed partner influence (OR = 1.92, 95% CI: 1.03-3.60), depressive symptoms (OR = 1.07, 95% CI: 1.00-1.14), daytime sleepiness (OR = 1.07, 95% CI: 1.01-1.14), subjective somatic discomfort (OR = 2.27, 95% CI: 1.11-4.65), kinds of somatic discomfort (OR = 1.14, 95% CI: 1.03-1.27) and later gestation (OR = 1.05, 95% CI: 1.01-1.09) were significantly associated with insomnia.

CONCLUSION

In this cohort of Chinese pregnant women, about a fifth of women suffered from clinically significant insomnia. Measures to prevent the adverse effects of insomnia should be provided to pregnant women with depressive symptoms, Sleep disturbance of the bed partner, excessive daytime sleepiness and somatic discomfort, especially late in gestation.

Relationship between sleep characteristics and depressive symptoms in last trimester of pregnancy

BACKGROUND

Sleep problems during pregnancy may cause many complications that reduce quality of life.

AIM

This study aims to determine the relationship between pregnant women's sleep characteristics and depressive symptoms.

METHODS

A hospital-based, cross-sectional study was conducted. Pregnant women were selected from the population by using the an improbable random sampling method. This study sample included 436 pregnant women who met the study's inclusion criteria. To collect data, this study used an information form that was developed by the researcher after reviewing relevant literature, the Women's Health Initiative Insomnia Rating Scale (WHIIRS), and the Beck Depression Inventory (BDI). The researchers used face-to-face interviews method to collect data from the participants, pregnant women who were examined in the polyclinic.

RESULTS

This study found that 36% of participating pregnant women reported insomnia, and 38.1% experienced depressive symptoms. It also determined that participants who had problems with insomnia, who experienced a change in sleep habits, and who did not wake up feeling rested experienced depressive symptoms 1.64, 2.79, and 2.59 times more than those who didn't have these problems, respectively. who experienced a decrease in sleep, who experienced an increase in sleep, and who did not wake up feeling rested experienced depressive symptoms 1.61, 3.22, 3.53, and 2.59 times more, respectively, than those who did not have insomnia, who did not experience a change in sleep habits in pregnancy, and who woke up feeling rested, respectively.

CONCLUSION

This study determined that there is a relationship between insomnia and depressive symptoms and that pregnant women experiencing insomnia presented with more depressive symptoms.

Effect of maternal sleep in late pregnancy on leptin and lipid levels in umbilical cord blood

OBJECTIVES

To study the impact of maternal sleep in late pregnancy on birth weight (BW) and leptin and lipid levels in umbilical cord blood.

STUDY DESIGN

A total of 277 healthy and singleton pregnancy women were recruited for participation in the Shanghai Sleep Birth Cohort Study (SSBC) during their 36-38 weeks of pregnancy, from May 2012 to July 2013. Maternal night sleep time (NST), sleep efficiency (SE), sleep onset latency (SOL) and the percentage of wake after sleep onset (WASO) in NST and midpoint of sleep (MSF) were measured by actigraphy for seven consecutive days. The leptin and lipid levels were determined in cord blood samples collected from the umbilical vein immediately after delivery. Birth information (birth weight, gender, delivery type, etc.) was extracted from medical records. A multivariable linear regression model was applied to examine the effect of maternal sleep in late pregnancy on newborn leptin and lipid levels in umbilical cord blood.

RESULTS

A total of 177 women and their infants were included in the analysis. Maternal mean NST was 7.03 ± 1.10 h in late pregnancy, and 48% had a shorter sleep time (NST < 7 h). The average maternal SE was 72.54% ± 9.66%. The mean percentage WASO/NST was 21.62% ± 9.98%; the average MSF was about 3:34 (0:53); and the SOL was 46.78 ± 36.00 min. After adjustment for confounders, both maternal NST and SE were found to be significantly associated with triglyceride levels (β = -0.219, p = 0.006; β = -0.224, p = 0.006) in umbilical cord blood; and maternal NST was also observed to have positive association with newborn leptin levels (β = 0.146, p = 0.047). However, we did not find significant association between other maternal sleep parameters in late pregnancy and leptin and lipid levels and birth weight.

CONCLUSIONS

Short sleep duration and poor sleep quality during late pregnancy were associated with newborn leptin and lipid levels, and efforts on improving maternal sleep during late pregnancy should be advocated for children's health.

Fatigue in Pregnancy: The validity and reliability of the Farsi Multidimensional Assessment of Fatigue scale

Objectives

Fatigue is a common discomfort experienced during pregnancy and may contribute to severe labour pain and postpartum depression. This study aimed to translate the Multidimensional Assessment of Fatigue (MAF) scale into Farsi and validate it in a sample of pregnant Irani women.

Methods

This cross-sectional questionnaire study was conducted between January and June 2016 at eight healthcare centres in Sabzevar, Iran. The English version of the MAF scale was translated into Farsi and assessed for content validity. Participants completed the Farsi MAF scale and the Farsi World Health Organization-5 Well-being index (WHO-5). Construct validity was assessed through exploratory factor analysis (EFA). Cronbach's alpha coefficient and the intraclass correlation coefficient (ICC) were used to determine the internal consistency and stability of the Farsi MAF scale.

Results

A total of 582 women met the inclusion criteria, of which 541 completed the MAF scale (response rate: 93%). The EFA of the 15 items confirmed the previously proposed one-factor structure with a Cronbach's alpha coefficient of 0.957 for the Farsi MAF scale. Stability was confirmed by the ICC value (0.702) for the Global Fatigue Index (GFI) and the mean GFI was 20.33 ± 12.71. Concurrent validity was confirmed by a moderate negative correlation (r = -0.35; P <0.001) between the scores of the Farsi MAF scale and the Farsi WHO-5. Women who received a high level of support from their husbands, who were satisfied with the quality of their marital relationship and with a well-being score of >50 reported a lower level of fatigue than the other groups (P ≤0.012).

Conclusion

The Farsi MAF scale is a reliable and valid questionnaire to investigate fatigue in pregnant Irani women. Interventions to promote marital satisfaction and women's well-being are recommended.

Cognitive Behavioral Therapy for Insomnia and Women's Health: Sex as a Biological Variable

Differences in sleep for men and women begin at a very early age, with women reporting poorer sleep and having a higher risk for insomnia compared with men. Women are particularly vulnerable to developing insomnia during times of reproductive hormonal change. Sleep across the woman's lifespan and special treatment considerations for using cognitive behavioral therapy for insomnia (CBT-I) in women will be addressed in this review.

Objective sleep in pregnant women: a comparison of actigraphy and polysomnography

OBJECTIVES

To compare different actigraphy scoring settings with polysomnography (PSG) for 1 night of total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), and sleep onset latency (SOL) in healthy pregnant women between 6 and 7 months of gestation.

DESIGN

Secondary analysis using data from a case-control study.

SETTING

A large university-affiliated hospital in the Midwestern United States.

PARTICIPANTS

A total of 78 pregnant women were recruited, among which 38 healthy women with uncomplicated pregnancies were included for this analysis.

MEASUREMENTS

Participants had an overnight PSG assessment at a sleep center while simultaneously wearing an actigraph (Minimitter; Philips Respironics, Andover, MA). Sleep parameters from both devices included TST, SE, WASO, and SOL. Four scoring settings were used to obtain these parameters from actigraphy. Bland-Altman tests were used to evaluate the agreement between sleep variables scored independently from actigraphy and PSG.

RESULTS

The default scoring setting (10-by-40) yielded significantly different results from the PSG (P < .01). The 10 immobile/mobile minutes for sleep onset/end with an activity threshold of 10 (10-by-10) produced estimations of TST, SE, and WASO closest to those produced by PSG. When this setting was used, the mean differences between PSG- and actigraphy-assessed TST, SE, and WASO were -1.9 minutes, -0.4%, and 7.4 minutes. When the 10 and 15 immobile/mobile minutes for sleep onset/end were used, the difference between PSG- and actigraphy-assessed SOL was approximately 4 to 5 minutes.

CONCLUSIONS

Findings from this study do not support the use of default actigraph settings in pregnant women. In contrast, the 10-by-10 scoring setting provided the greatest agreement and least bias in comparison with PSG for sleep measurements. The 10-by-10 scoring setting is recommended to be used in studies consisting of pregnant women.

Changes in Sleep Characteristics and Breathing Parameters During Sleep in Early and Late Pregnancy

STUDY OBJECTIVES

Few studies have objectively evaluated sleep characteristics during pregnancy or investigated the relationship between altered spectral electroencephalogram (EEG) bands and sleep-disordered breathing (SDB). The study aimed to describe changes in sleep as measured by polysomnography (PSG) and spectral EEG bands during pregnancy and to examine the relationship between delta power in non-rapid eye movement (NREM) sleep and SDB.

METHODS

This is a secondary analysis of a prospective study. One hundred twenty-three women underwent full PSG in early pregnancy, and 97 repeated PSG in late pregnancy. Spectral analysis of the EEG in NREM sleep was performed. We used linear and logistic mixed-model regression to analyze the sleep measures and linear regression to explore the association between delta power and apnea-hypopnea index (AHI) changes during pregnancy.

RESULTS

In late pregnancy, women had shorter sleep duration, poorer sleep efficiency, more awakenings, more stage N2 sleep, less slow wave sleep, less REM sleep, higher AHI, and higher periodic limb movement index compared to early pregnancy. The percentage of stage N1 sleep, sleep latency, REM sleep latency, and arousal index frequency did not change. Regarding EEG-spectra, delta and theta powers decreased, but beta-2 power increased during pregnancy. In multivariable analyses, greater reduction of delta power was associated with larger increases in AHI (β [95% confidence interval] = -0.038 [-0.073, -0.002], P = .040). Estimates suggest that each one-unit increase in AHI reduces delta power by 4% in late pregnancy.

CONCLUSIONS

PSG-measured sleep characteristics change during pregnancy. Delta power decreases when the severity of SDB increases during pregnancy.

COMMENTARY

A commentary on this article appears in this issue on page 1095.

Sleep Duration and Quality in Pregnant Women: A Cross-Sectional Survey in China

Objectives: Good maternal health and fetal development require sufficient and good quality of sleep during pregnancy. This study investigated sleep duration and quality in pregnant women, assessing factors with possibly influence on sleep. Method: A cross-sectional survey was conducted on pregnant women between June and August in 2015 in 16 hospitals in five provinces in China. A total of 2345 pregnant women aged 18 years and older were surveyed. Insufficient sleeping duration was defined as sleeping of less than 7 h per day. Excessive sleep duration was defined as sleeping of more than 9 h per day. Results: A total of 561 (23.9%) participants reported insufficient sleeping duration, whereas 485 (20.9%) claimed excessive sleep duration. A total of 358 (15.2%) of pregnant women reported problems regarding sleep quality. Compared to pregnant women with sufficient sleeping duration, those with insufficient sleeping duration were prone to have poor sleep quality, whereas those with excessive sleeping duration featured low possibility of poor sleep quality. High-risk groups of insufficient sleep duration include women of Han nationality, with siblings, in their first trimester of pregnancy, receiving care in low-capacity/quality hospital settings, and with daily or 1-3 days of secondhand smoke exposure. High-risk groups of excessive sleep duration include women living in rural areas, unemployed, in their third trimester of pregnancy, and receiving care in medium-capacity/quality hospital settings. High-risk groups of poor sleep quality include women of non-Han nationality, low income level, in their third trimester of pregnancy, and with insufficient sleep duration. Conclusions: Insufficient/excessive sleep duration and poor sleep quality commonly occur during pregnancy in China. Findings provide a better understanding of the influencing factors of insufficient/excessive sleep duration and poor quality of sleep. These findings have some implications for future interventions on sleep among pregnant women.

Who are the Women Who Work in Their Last Month of Pregnancy? Social and Occupational Characteristics and Birth Outcomes of Women Working Until the Last Month of Pregnancy in France

Introduction The prenatal leave law in France protects women during pregnancy and their employment. We aimed to estimate the proportion of women who worked late in their pregnancy, to analyze the occupational, social and medical factors associated with late prenatal leave and to compare the pregnancy outcome of these women and those who left earlier in the pregnancy. Methods The sample was extracted from the 2010 French National Perinatal Survey. All women who delivered within a 1-week period were interviewed before discharge from the maternity unit. Women with a singleton live birth at or after 37 weeks' gestation and who were working during pregnancy (n = 8463) were included. Data were collected on employment, date of leave, and sociodemographic and medical characteristics. Results Overall, 328 women (3.9 %) took a late prenatal leave (at or after 37 weeks' gestation). Women who left late were older than 30 years old, with a high educational level and were living in an urban area. Being self-employed and having a managerial or upper-intellectual occupation was highly associated with late leave, before and after controlling for relevant variables. Perinatal and delivery outcomes were similar for women who took a late leave and those who left before 37 weeks' gestation. Discussion Occupational characteristics are the main determinants of late prenatal leave. Women working in the last month of pregnancy had a favorable social and occupational situation and did not did not experience an adverse pregnancy or birth outcome. Other studies are needed to understand the reasons for late leave and evaluate the post-partum fatigue and health of these women.

Objective and subjective sleep during pregnancy: links with depressive and anxiety symptoms

The aims of this paper are to study the associations between objective and subjective sleep in pregnant women, to examine which specific aspects of women's sleep are associated with depressive and anxiety symptoms and to test the moderating role of depressive and anxiety symptoms in the relations between objective and subjective sleep. The sample included 148 pregnant women. Objective sleep was measured by actigraphy for five nights at the participants' home, and subjective sleep was measured with the Pittsburgh sleep quality index. Depressive symptoms were assessed with the Edinburgh postnatal depression scale and anxiety symptoms with the Beck anxiety inventory. Significant associations were found between the subjective sleep measures and the depressive and anxiety scores, but there were no significant associations between actigraphic sleep measures and the depressive and anxiety scores. Depressive and anxiety scores emerged as significant moderators of the links between objective and subjective sleep. The findings suggest that emotional distress (i.e., depressive and anxiety symptoms severity) during pregnancy is associated with subjective sleep disturbances but not with objective sleep disturbances. Importantly, only among women with higher levels of emotional distress was subjective sleep quality associated with objective sleep quality. These findings may suggest that women with higher levels of emotional distress are not necessarily biased in their perception of sleep quality. However, they may perceive fragmented sleep as more detrimental to their wellbeing.

Cross-sectional and longitudinal associations between sleep and health-related quality of life in pregnant women: A prospective observational study

BACKGROUND

Sleep disturbances are common in women, especially during pregnancy. Previous studies have confirmed the importance of sleep disturbances as a risk factor of adverse pregnancy outcomes and the need for screening and treatment of inadequate sleep. These reports, however, did not examine health-related quality of life which may be affected by sleep long before adverse clinical consequences are detectable in women during pregnancy.

OBJECTIVES

To examine the cross-sectional and longitudinal association between sleep and health-related quality of life in pregnant women.

DESIGN

A prospective observational study.

SETTING

A university-affiliated hospital in Taiwan and participants' homes.

PARTICIPANTS

A total of 164 pregnant women completed questionnaires and wore a wrist actigraphy monitor for 7 days each trimester.

METHODS

Objective sleep was measured by actigraphy, subjective sleep was measured by the Pittsburgh Sleep Quality Index, and health-related quality of life was measured using the SF-12v2 questionnaire across three trimesters. Multiple linear regression analyses were performed to evaluate the cross-sectional and longitudinal associations between sleep and health-related quality of life.

RESULTS

Sixty-four (39.0%) women consistently had an average sleep efficiency<85% by actigraphy and 40 (24.4%) had a Pittsburgh Sleep Quality Index global score>5 in all three trimesters. Cross-sectionally, more actigraphic daytime sleep (p=0.04) and better subjective sleep quality (p<0.01) were associated with better physical health-related quality of life in first-trimester pregnant women. Better actigraphic sleep efficiency (p=0.04) and better subjective sleep quality (p<0.01) were associated with better mental health-related quality of life in second-trimester pregnant women. Longer actigraphic total nighttime sleep (p<0.01) and better subjective sleep quality (p<0.01) were associated with better mental health-related quality of life in third-trimester pregnant women. Longitudinally, first-trimester actigraphic total nighttime sleep (p<0.05) and subjective sleep quality (p<0.01) predicted mental health-related quality of life in the second and third trimester.

CONCLUSIONS

Sleep disturbances are a highly prevalent and persistent problem in pregnant women. Adequate sleep is essential for women at all pregnancy stages and improving nocturnal sleep quantity and quality in early gestation is of utmost importance for an optimal health-related quality of life later in pregnancy.

Health-care utilisation amongst pregnant women who experience sleeping problems and/or tiredness or fatigue: secondary analysis of a cross-sectional survey of 1835 pregnant women

INTRODUCTION

Sleeping problems and fatigue in pregnancy are often accepted as a normal part of pregnancy; however, these conditions can be linked to serious consequences for both the mother and child. Despite established links between sleeping disturbance and a wide range of pregnancy complications, little is known about the health-care utilisation of women experiencing sleeping problems and fatigue. This study addresses the existing gap in the literature by examining cross-sectional data to identify health service utilisation patterns of pregnant women experiencing sleeping problems and/or tiredness or fatigue.

METHODS

In 2010, a sub-study of the Australian Longitudinal Study on Women's Health was conducted as a cross-sectional survey of 2445 women who had recently given birth. Associations between reported symptoms of sleeplessness and/or tiredness or fatigue and health service utilisation were determined using logistic regression analysis.

RESULTS

During their pregnancy, 15.2 % of women experienced sleeping problems while 35.4 % experienced tiredness or fatigue. Women most commonly consulted with an obstetrician (n = 96) or a general practitioner (GP) (n = 74) for their tiredness or fatigue rather than a midwife (n = 56). A substantial number of women sought help from a complementary and alternative medicine (CAM) practitioner for sleeping problems (33 %) or tiredness/fatigue (28 %).

DISCUSSION

Sleeping problems and/or tiredness or fatigue is reported by a reasonable percentage of pregnant women, and women obtain assistance from conventional and CAM practitioners for their symptoms, but not all seek help. Given the serious implications of untreated sleep- and fatigue-related symptoms for mother and baby, this area of research deserves and requires more attention.

The potential value of sleep hygiene for a healthy pregnancy: a brief review

The quality of the intrauterine environment influences maternal-fetal health and also offspring predisposition to obesity and cardiometabolic disease later in life. Several determinants, including but not limited to pregravid obesity and excessive gestational weight gain, alter the developmental milieu, fetal growth, and child obesity risk. However, the role of sleep and its relationship to healthy pregnancy is not fully established. Given the host of psychosocial and physiological complications associated with childhood obesity, targeting the gestational period is purported to be an opportune time for preventive intervention. Many longitudinal studies suggest that short sleep duration is a risk factor for the development of impaired glycemia and obesity. However, there is a dearth of information concerning the role of sleep hygiene and its role in a healthy pregnancy. Reports note disrupted and poorer quality of sleep during gestation and highlight an association between reduced sleep and risk of gestational diabetes mellitus. Given the lack of well-designed human trials assessing the value of sleep and healthy pregnancy outcomes, this review summarizes current evidence which suggests that incorporating sleep recommendations and utilizing time management strategies that encourage a healthful night 's sleep may improve the health of the mom and the baby.

Sleep and Women's Health

Sex differences in sleep begin at a very early age and women report poorer sleep quality and have higher risk for insomnia than do men. Sleep may be affected by variation in reproductive hormones, stress, depression, aging, life/role transitions, and other factors. The menstrual cycle is associated with changes in circadian rhythms and sleep architecture. Menstruating women (even without significant menstrual-related complaints) often report poorer sleep quality and greater sleep disturbance during the premenstrual week compared to other times of her menstrual cycle. In addition to these sleep disturbances, women with severe premenstrual syndrome often report more disturbing dreams, sleepiness, fatigue, decreased alertness and concentration during the premenstrual phase. Sleep disturbances are also commonly reported during pregnancy and increase in frequency and duration as the pregnancy progresses. The precipitous decline in hormones and unpredictable sleep patterns of the newborn contribute to and/or exacerbate poor sleep and daytime sleepiness during the early postpartum period. Insomnia is also among the most common health complaints that are reported by perimenopausal women. Women are particularly vulnerable to developing insomnia disorder during these times of reproductive hormonal change. In this review, we present a discussion on the most relevant and recent publications on sleep across the woman's lifespan, including changes in sleep related to menstruation, pregnancy, postpartum, and the menopausal transition. Treatment for sleep disturbances and insomnia disorder and special considerations for treating women will also be discussed.

Reduced sleep duration and daytime naps in pregnant women in Taiwan

BACKGROUND

Napping is highly prevalent in pregnant women, but the relation between nighttime sleep and daytime naps in pregnant women is poorly understood.

OBJECTIVES

The aim of this study was to examine the temporal association of nighttime sleep quality and quantity with subsequent daytime naps and the temporal association of daytime naps with sleep quality and quantity the following night in women during the third trimester of pregnancy in Taiwan.

METHODS

Sleep was assessed in 80 Taiwanese nulliparous women aged 31.70 years (SD = 4.58 years) using actigraphy and diaries for 7 consecutive days. Subjective sleep quality was examined using the Pittsburgh Sleep Quality Index. Multiple linear regressions with generalized estimating equations were used to examine the temporal associations of nighttime sleep and daytime naps.

RESULTS

All women napped sometime during the study week, and mean Pittsburgh Sleep Quality Index global score was 6.6, indicating poor sleep quality. Fewer weekly work hours and shorter sleep duration the preceding night were associated with longer nap duration the next day. More work hours, longer nap duration, and more intense fatigue were associated with shorter sleep duration the following night.

DISCUSSION

Naps during pregnancy might indicate insufficient nighttime sleep, and longer daytime naps could compromise subsequent nighttime sleep. Further research is needed to determine if short sleep duration and longer daytime naps are associated with negative pregnancy outcomes.

Do pregnant women accurately report sleep time? A comparison between self-reported and objective measures of sleep duration in pregnancy among a sample of urban mothers

PURPOSE

Survey questions are commonly used to assess sleep duration because of their low cost and convenience. Responses to these questions correlate moderately with objectively measured sleep duration in nonpregnant individuals, but little is known about the validity of self-reported sleep measures in pregnancy. The aim of the present study was to determine the extent to which self-reported gestational sleep duration assessed by questionnaire predicted objectively measured gestational sleep duration via actigraphy.

METHODS

We analyzed data from 80 mothers enrolled in an ancillary study of Project BABIES, a prospective cohort study of urban, pregnant women. Sleep measurements were collected in midpregnancy and included 7 days of wrist actigraphy, a sleep log, and survey questions about sleep time adapted from the Pittsburgh Sleep Quality Index.

RESULTS

Mean measured gestational sleep duration derived from actigraphy was 6.87 h [standard deviation (SD) 0.87], and questionnaire-assessed nocturnal sleep time averaged 7.29 h (SD 1.84). While the difference between measures did not reach statistical significance (p = 0.07 for paired samples t test), over half (62 %) of participants reported a habitual average nightly sleep time that differed more than 1 h from their average actigraphically measured sleep duration (39 % overestimated by more than an hour; 23 % underestimated by more than an hour). There was no correlation between measures (r = 0.007; 95 % confidence interval -0.21, 0.23).

CONCLUSION

Questionnaire-derived reports of usual sleep hours do not reflect objectively measured sleep time in urban, pregnant women. Actigraphy is preferable to accurately assess gestational sleep duration.

High prevalence of fibromyalgia symptoms among healthy full-term pregnant women

The impact of fibromyalgia on the course of pregnancy is not clearly defined. We evaluate the frequency of FMS symptoms among full-term healthy pregnant women and the impact on the course of delivery. The 2011 modification of the ACR 2010 criteria for FMS diagnosis was used as well as the FIQ, SF-36 and AIMS questionnaires. The 1990 ACR classification criteria were documented. Data were collected relating to course of the delivery, induction, length of stage 1, 2 and 3 of delivery, epidural anesthesia, artificial rupture of membranes, instrumental delivery and cesarean section. A VAS recording pain intensity during delivery was documented. Out of 100 women recruited, 27 (27 %) fulfilled Modified FMS criteria. Only one of these women fulfilled ACR 1990 criteria, women who fulfilled the ACR criteria differed significantly from women who did not fulfill these criteria on a broad range of parameters including widespread pain and fatigue, social functioning, emotional well-being, role limitation and physical functioning. A significant correlation was found between length of stage 2 and results of the FIQ as well as with components of the SF-36. The intensity of pain during birth however was not correlated with the presence of FMS criteria. FMS symptoms were highly prevalent among healthy pregnant women at term. The presence of such symptoms may impact on the course of delivery and the need for anesthesia. Evaluating for features of centrally mediated pain may be of clinical relevance for physicians involved in the treatment of pregnant women.

A postal survey of maternal sleep in late pregnancy

Background

Sleep disturbances in late pregnancy are common. This study aimed to survey sleep problems in third trimester pregnant women and to compare sleep in the pre-pregnancy period with the third trimester.

Methods

Third-trimester women (n=650) were sent a postal survey containing questions relating to sleep experience, including perceived sleep quality, sleep difficulties, night waking, sleep environment, snoring, daytime tiredness and daytime napping. Time periods reported on were before pregnancy and in the last week.

Results

Respondents numbered 244 (38%). Before pregnancy, the mean reported duration of night-time sleep was 8.1 (SD 1.1) hours; in the last week this had decreased to 7.5 (SD 1.8) hours (p<.0001). Only 29% rated their sleep quality in the last week as very good or fairly good, compared with 82% rating their sleep this way before the pregnancy. The main reasons for sleeping difficulties were discomfort (67%) and pain (36%). Snoring increased significantly over the course of the pregnancy, with 37% reporting snoring often or every night in the last week. Those with a pre-pregnancy body mass index of greater than 25 were significantly more likely to snore (p=.01). Only 4% of women had an abnormal Epworth Sleepiness Scale score (i.e. >10) prior to pregnancy, whereas in the last week 33% scored in the abnormal range. Likewise, 5% had regularly napped during the daytime before pregnancy, compared with 41% in the last week.

Conclusions

Sleep problems are common in women in late pregnancy, and increase markedly compared with before pregnancy.