Sleep Duration during Pregnancy using an Activity Tracking Device

Insights into maternal sleep: a large-scale longitudinal analysis of real-world wearable device data before, during, and after pregnancy

BACKGROUND

Current understanding of pregnancy and postpartum sleep is driven by limited lab or self-reported data. Our goal is to use consumer wearable devices through an observational study to reveal longitudinal, real-world sleep patterns in this population.

METHODS

We analysed retrospective, de-identified Fitbit device data from 2540 users in the United States and Canada who met strict wear-time requirements (≥80% daily usage for ≥80% of the time periods of interest [12 weeks prepregnancy, throughout pregnancy, and 20 weeks immediately postpartum]). We tracked sleep time and stages using Fitbit devices.

FINDINGS

Pregnant participants experienced a peak in total sleep time (TST) at 10 weeks (447.6 ± 47.6 min), exceeding their prepregnancy average (425.3 ± 43.5 min) before declining throughout pregnancy. This initial TST increase, mirrored by time in bed (TIB), was driven by more light sleep. Deep and rapid-eye movement sleep decreased significantly throughout pregnancy, with maximum reductions of 19.2 ± 13.8 min and 9.0 ± 19.2 min respectively by pregnancy end (two-sided t-test, p < 0.001 for both). Sleep efficiency also slightly declined during pregnancy (median drop: 88.3%-86.8%). Postpartum, TIB remained below prepregnancy levels by 14.7 ± 45.7 min one year after birth and 15.2 ± 47.7 min at 1.5 years after birth.

INTERPRETATION

This study revealed a previously unquantified initial increase in sleep followed by decreases in both quantity and quality as pregnancy progresses. Sleep deficits persist for at least 1.5 years postpartum. These quantified trends can assist clinicians and patients in understanding what to expect through their pregnancy and postpartum journey.

FUNDING

Google, LLC.

Sleep Deficiency in Pregnancy

Sleep is important for overall health of a person. It is always recommended that an adult should sleep for not less than 7 to 9 hours every day. However, there are a lot of adults who experience sleep deprivation, out of them mostly are women. Sleep deprivation can lead to a lot of health issues, including mortality risk, impaired metabolism, imbalance in cognitive function, and the overall quality of life. Women often face more difficulties falling asleep as compared to men, leading to greater levels of self-reported sleep deprivation and problems related to poor sleeping habits.

Association between sleep disturbances during pregnancy and adverse perinatal outcomes

OBJECTIVE

To describe the changes in sleep pattern throughout pregnancy and to evaluate the relationship between sleep and adverse perinatal outcomes.

METHODS

Pregnant women at Qianfoshan Hospital completed questionnaires regarding their sleep during each of the three trimesters. Additionally, a subset of participants engaged in objective sleep monitoring using actigraphy devices. In the perinatal period, the following data were collected: pregnancy complications; gestational age; mode of delivery; Apgar scores for the neonate; and birth weight.

RESULTS

The total night sleep time in the second trimester was about 15 minutes shorter than that in the first trimester (P=0.024), and about 31 minutes shorter in the third trimester than in the second trimester (P<0.001). The sleep efficiency in the second trimester was about 10.23% lower than in the first trimester (P<0.001), and the efficiency in the third trimester was about 5.16% lower than in the second trimester (P<0.001). The occurrence of pregnancy-induced hypertension (PIH) was associated with sleep duration (P=0.019), sleep efficiency (P<0.001) and PSQI scores (P<0.001) in the first trimester. Furthermore, the mode of delivery was also found to be associated with sleep duration (P=0.011), sleep efficiency (P<0.001) and PSQI scores (P<0.001) in the first trimester.

CONCLUSION

With the development of the pregnancy process, the sleep situation gets worse. Pregnant women's sleep situation in the first trimester of pregnancy is associated with the occurrence of PIH and delivery mode.

Sleep Quality in Individuals with and without Persistent Postpartum Hypertension

OBJECTIVE

This study aimed to compare sleep quality at 1 year postpartum following a hypertensive disorder of pregnancy (HDP) among individuals with persistent postpartum hypertension (HTN) compared with those with normal blood pressures (BPs).

STUDY DESIGN

We combined data from the Heart Health 4 New Moms pilot randomized trial (n = 118) and the Pathways prospective cohort study (n = 36). Individuals with a singleton pregnancy complicated by gestational HTN or preeclampsia underwent a research study visit at a mean 48.7 ± 9.5 weeks postpartum with standardized BP measurement and assessment of subjective sleep quality with the Pittsburgh Sleep Quality Index (PSQI). Persistent postpartum HTN was defined as Stage 1 HTN or greater (mean systolic BP ≥ 130 mm Hg or mean diastolic BP ≥ 80 mm Hg over three measurements at rest) or requiring antihypertensive medication. Statistical analysis was performed using univariate and multivariable logistic regression analyses.

RESULTS

Of 154 individuals with an HDP included in the analysis, 84 (55%) were normotensive at 1 year postpartum and 70 (45%) had persistent postpartum HTN. Individuals with persistent postpartum HTN were more likely to be older, self-identify as Black race, have higher prepregnancy and 1-year postpartum body mass index (BMI), be multiparous, and deliver at an earlier gestational age. The mean global PSQI score was 8.7 ± 3.7, with 81% reporting poor sleep (PSQI > 5), and scores were higher among individuals who were persistently hypertensive (9.6 ± 3.5) compared with those who were normotensive at 1 year postpartum (7.9 ± 3.6), p < 0.01. Findings were unchanged in a multivariable model adjusting for age, self-reported race, prepregnancy BMI, and parity.

CONCLUSION

Following an HDP, individuals reported poor sleep quality at 1 year postpartum. Individuals with persistent postpartum HTN reported lower sleep quality, suggesting that sleep behavior may be a target for intervention to improve maternal cardiovascular health following an HDP.

KEY POINTS

· After an HDP, poor sleep quality was common at 1 year postpartum.. · Those with persistent postpartum HTN reported worse sleep quality at 1 year postpartum.. · Sleep behavior may be a target for intervention to improve maternal cardiovascular health..

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.

Effects of Two Physical Activity Interventions on Sleep and Sedentary Time in Pregnant Women

Pregnancy is often associated with poor sleep and high sedentary time (SED). We investigated the effect of physical activity (PA) interventions on sleep and SED in pregnant women. A secondary analysis of a randomized controlled trial (n = 219) explored the effect of structured supervised exercise training (EXE) or motivational counseling on PA (MOT) compared to standard prenatal care (CON) on sleep and SED during pregnancy. Three times during pregnancy, sleep was determined by the Pittsburgh Sleep Quality Index (PSQI) and SED by the Pregnancy Physical Activity Questionnaire (PPAQ). Also, a wrist-worn consumer activity tracker measured sleep and SED continuously. Data from the activity tracker confirmed that sleep time decreases, and SED increases by approx. 30 and 24 min/day, respectively, from baseline (maximum gestational age (GA) week 15) to delivery. Compared to CON, the global PSQI score was better for EXE in GA week 28 (-0.8 [-1.5; -0.1], p = 0.031) and for both EXE and MOT in GA week 34 (-1 [-2; -0.5], p = 0.002; -1 [-2; -0.1], p = 0.026). In GA week 28, SED (h/day) from PPAQ was lower in EXE compared to both CON and MOT (-0.69 [-1; -0.0], p = 0.049; -0.6 [-1.0; -0.02], p = 0.042). In conclusion, PA interventions during pregnancy improved sleep quality and reduced SED.

Maternal sleep during pregnancy and adverse pregnancy outcomes: A systematic review and meta-analysis

AIMS/INTRODUCTION

Sleep problems are important public health concern worldwide. We carried out a meta-analysis to quantitatively evaluate whether sleep duration was associated with pregnancy outcomes, and the associations were modified by important characteristics of studies.

MATERIALS AND METHODS

Based on PubMed, Embase and the Cochrane Central Register of Controlled Trials databases, we searched for published literature related to maternal sleep duration and adverse pregnancy outcomes before 30 June 2021. We carried out risk of bias assessment, subgroup analyses and sensitivity analysis. The relative risks or odds ratios with 95% confidence intervals (CI) were used to estimate the pooled effects.

RESULTS

A total of 5,246 references were identified through a database search, and 41 studies were included in the study. Pregnant women with short sleep duration had 1.81-fold (95% CI 1.35-2.44, P < 0.001) the risk of developing gestational diabetes mellitus. The association between short sleep duration and the risk of gestational hypertension, cesarean section, low birthweight, preterm birth and small for gestational age were not significant (P > 0.05). Furthermore, long sleep duration was significantly correlated with gestational diabetes mellitus (odds ratio1.24. 95% CI 1.12-1.36, P < 0.001) and CS (odds ratio 1.13. 95% CI 1.04-1.22, P = 0.004), whereas long sleep duration was not linked with gestational hypertension, low birthweight, preterm birth and small for gestational age (P > 0.05).

CONCLUSIONS

Short/long sleep duration appeared to be associated with adverse pregnancy outcomes, specifically with an increased risk of gestational diabetes mellitus. Sleep should be systematically screened in the obstetric population.

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.

A Micro-Level Analysis of Physiological Responses to COVID-19: Continuous Monitoring of Pregnant Women in California

Continuous monitoring of perinatal women in a descriptive case study allowed us the opportunity to examine the time during which the COVID-19 infection led to physiological changes in two low-income pregnant women. An important component of this study was the use of a wearable sensor device, the Oura ring, to monitor and record vital physiological parameters during sleep. Two women in their second and third trimesters, respectively, were selected based on a positive COVID-19 diagnosis. Both women were tested using the polymerase chain reaction method to confirm the presence of the virus during which time we were able to collect these physiological data. In both cases, we observed 3-6 days of peak physiological changes in resting heart rate (HR), heart rate variability (HRV), and respiratory rate (RR), as well as sleep surrounding the onset of COVID-19 symptoms. The pregnant woman in her third trimester showed a significant increase in resting HR (p = 0.006) and RR (p = 0.048), and a significant decrease in HRV (p = 0.027) and deep sleep duration (p = 0.029). She reported experiencing moderate COVID-19 symptoms and did not require hospitalization. At 38 weeks of gestation, she had a normal delivery and gave birth to a healthy infant. The participant in her second trimester showed similar physiological changes during the 3-day peak period. Importantly, these changes appeared to return to the pre-peak levels. Common symptoms reported by both cases included loss of smell and nasal congestion, with one losing her sense of taste. Results suggest the potential to use the changes in cardiorespiratory responses and sleep for real-time monitoring of health and well-being during pregnancy.