Poor sleep quality is associated with preterm birth

Prenatal sleep restriction altered learning ability and memory behaviour by decreasing hippocampal synaptic plasticity in offspring mice

Inadequate sleep during pregnancy can have profound effects on offspring neurodevelopment, particularly on learning and memory abilities. This study explored whether prenatal sleep restriction (SR) induces learning and memory impairment in offspring by affecting neural plasticity in the hippocampus using four groups of pregnant mice: short-sleep-restriction (S-SR, 4 h), mid-sleep-restriction (M-SR, 10 h), long-sleep-restriction (L-SR, 18 h), and a control group without SR. SR was implemented from gestation day 8 until delivery. Changes in adult offspring and fetal hippocampal synapse structures were observed and synapse-synthesis-related protein (BDNF and Syt7) levels were measured to establish changes indicative of neurodevelopmental impairment. Offspring learning and memory abilities were further evaluated using Morris water maze test, passive avoidance test, and open field test from postnatal day 35. The findings revealed significant declines in spatial learning and memory across all SR groups. Additionally, adult offspring exhibited reduced hippocampal synapse numbers, thinner postsynaptic densities in S-SR and M-SR groups, and widened synaptic clefts in the L-SR group. Synapse-synthesis-related proteins, including brain-derived neurotrophic factor (BDNF) and synaptotagmin-7 (Syt7), showed decreased expression in the hippocampus of offspring mice in all SR groups, with BDNF expression also reduced in fetal hippocampi. Moreover, BDNF methylation levels indicated significant decreases in BDNF_3 and increases in BDNF_5 specifically in the S-SR group. Notably, prenatal S-SR induced more pronounced impairments in offspring learning and memory compared to L-SR. These findings underscore how prenatal SR disrupts fetal neurodevelopment, emphasizing hippocampal synaptic plasticity as a critical mechanism contributing to impaired cognitive function in offspring. This can help with risk identification and early intervention.

Sleeping for two: a cross-sectional study on associations between objectively measured sleep during early to mid-pregnancy and maternal and fetal outcomes and inflammatory biomarker profiles

BACKGROUND

Pregnant women often experience subjective sleep disturbances shown to be associated with maternal and fetal outcomes. However, subjectively experienced sleep often deviates from objective measurements. Therefore, the aim of this study was to explore the relationship between objectively measured sleep in early to mid-pregnancy and maternal and fetal outcomes and inflammatory biomarkers.

METHODOLOGY

A total of 1,610 pregnant women aged 18 or older from the Safe Physical Activity in Pregnancy (SPAP) study were recruited during early (week 10-14) to mid-pregnancy (week 16-19). Blood samples were taken and sleep was monitored using an Actiwatch, tracking total sleep time, sleep efficiency, wake after sleep onset, and sleep onset latency for 7 days in early to mid-pregnancy. A combined sleep categorisation was created using total sleep time and sleep efficiency to categorise participants into three sleep quality groups: Good, Intermediate, and Poor. Maternal and fetal outcomes were collected via questionnaires, medical records, and plasma samples were analysed using the Olink cardiovascular paneI Il (n = 407).

RESULTS

A total of 1,444 participants were included. The women were categorized as good sleepers (50.4%), intermediate (32.6%), or poor sleepers (17.0%) based on the distribution of the participant's sleep parameters. Poor sleep was more common in women born outside Europe, those with higher pre-gestational BMI, and those with pre-pregnancy diabetes. Sleep groups did not differ in metabolic factors. Poor sleep was associated with an increased likelihood of requiring an emergency caesarean section (AOR = 1.86, 95% CI 1.13-3.05). No significant associations were found for other outcomes such as pre-eclampsia, premature birth, small for gestational age etc. Nine inflammatory biomarkers were significantly lower in poor sleepers, while one marker was higher.

CONCLUSION

Poor sleep in early to mid-pregnancy was more common in pregnant women with pre-pregnancy diabetes, obesity, and those born outside of Europe. Poor sleep was associated with a higher likelihood of emergency caesarean section, but no other maternal or fetal outcomes. An overall trend was observed towards lower levels of inflammatory markers in women that slept poorly; however, additional studies are needed to better understand the immune system's role in the relationship between sleep, maternal health, and maternal and fetal outcomes. Possible mechanisms underlying these associations warrant further research.

Construction and validation of a predictive model for sleep disorders among pregnant women

BACKGROUND

Sleep disorders are among the most common major problems during pregnancy. Most studies on sleep disorders of pregnant women are closely related to adverse birth outcomes. In this study, our aim was to develop and validate a predictive model for the risk of sleep disorders in pregnant women.

METHODS

A total of 2,467 healthy pregnant women were enrolled and randomly partitioned into a training set and a validation set at a ratio of 7:3. During the variable selection stage, the Pearson's chi-square test was employed to identify variables with a p-value below 0.05, which were then designated as candidate variables for subsequent logistic regression analysis. Concurrently, the LASSO regression technique was utilized to sift through and isolate the most valuable variables. Ultimately, we developed binary Logistic regression models predicated on the Pearson's chi-square test (Model 1) and the LASSO regression (Model 2). The performance of the nomograms was evaluated using the Bootstrap resampling procedure, the sensitivity and specificity of the receiver-operating characteristic (ROC), the area under the ROC curve (AUC), and decision curve analysis (DCA).

RESULTS

A total of 439 (25.4%) pregnant women in the training set and 208 (28.1%) in the validation set exhibited sleep disorder, respectively. The prediction models shared 6 risk factors (age, anxiety, depression, family functions, degree of pregnancy reaction, pre-pregnancy physical condition). In the Model 1, the sensitivity was 69.4%, and specificity was 59.6%. When pregnancy weeks, residence, only child were included in Model 2, the sensitivity was 82.4% and specificity was 54.8%. In the validation set, the areas under the curve of the Model 1 and Model 2 were 0.678 (0.635, 0.720), and 0.719 (0.678, 0.761), respectively. The risk prediction model of sleep disorders in pregnant women showed that the calibration curve is approximately distributed along the reference line. Decision curve analyses demonstrated a favorable net benefit within the range of the threshold probability in the nomograms.

CONCLUSION

Model 2 exhibited superior performance, can serve as a convenient and reliable tool for predicting the risk probability of sleep disorders in pregnant women.

Association between sleep during pregnancy and birth outcomes: a prospective cohort study

OBJECTIVE

A prospective cohort study was conducted to investigate sleep status during the early and second trimester of pregnancy in pregnant women on adverse birth outcome, such as preterm birth, low birth weight and small for gestational age.

METHODS

Multivariable logistic regression models were used to analyze the association of sleep status during the early and second trimester of pregnancy with adverse birth outcomes and generated the odds ratio and 95% confidence interval.

RESULTS

5,418 pregnant women were included in the analysis. In the multivariable model, compared with 7.1-8 h/night, sleep ≤ 7 h/night during second trimester increases the risk of preterm birth (OR: 1.43, 95% CI: 1.12,1.85), and the risk of preterm birth was decreased in pregnant women who slept > 9 h/night (OR: 0.79, 95% CI: 0.53,0.93). Sleep quality, and sleep changes in the early and second trimesters, and sleep duration in the early pregnancy were not statistically associated with preterm birth, low birth weight and small for gestational age.

CONCLUSIONS

Short sleep duration during pregnancy is associated with a higher risk of preterm birth and longer sleep duration at night is associated with a lower risk of preterm birth, but the latter needs further verification. Sleep status during pregnancy was not associated with low birth weight and small for gestational age. In order to reduce risk of adverse birth outcomes, sleep problems in pregnant women should be strengthened during pregnancy care.

CLINICAL TRIAL NUMBER

Not applicable.

Variability in perinatal sleep quality is associated with an atypical cortisol awakening response and increased mood symptoms

OBJECTIVE

Pregnancy is often typified with a decrease in sleep quality, which for many women, progressively worsens across gestation and into the postpartum. A mechanism linking poor sleep with certain adverse pregnancy outcomes is dysregulation of the HPA axis resulting in atypically elevated cortisol production. While total cortisol output normally increases across pregnancy, the cortisol awakening response (CAR), a response to waking up, is influenced by factors such as stress and mood. It attenuates as pregnancy progresses, with normalization in the first weeks after delivery. The goals of the present study were to (1) assess the temporal relationship between sleep quality and cortisol indices across the perinatal period; (2) evaluate whether sleep quality was associated with postpartum mood; and (3) assess whether cortisol mediated these associations.

METHOD

Data were collected as part of the Healthy Babies Before Birth (HB3) study. Sleep quality, depressive and anxiety symptoms, and cortisol from four time-points (8-16 weeks gestation, 30-36 weeks gestation, 6 months postpartum, and 1-year postpartum) were assessed. Participants (N = 223) who had sleep quality (PSQI) and cortisol data from at least 1 of 4 time-points were included in analyses. Three salivary cortisol indices were calculated: cortisol awakening response (CAR), diurnal slope, and area under the curve (AUC). Multi-level models were run to predict cortisol parameters based on deviations and typical maternal sleep quality at each wave as well as mood outcomes.

RESULTS

Multilevel (time, wave, and person) modeling indicated that sleep quality was not associated with any of the cortisol indices, and none significantly varied across time. However, when PSQI scores were higher than the woman's own mean sleep quality, the CAR slope was steeper (+1 point in PSQI, γ=0.18), and when PSQI scores were lower than mean, the CAR slope was flatter (-1 point, γ=0.11). Poorer sleep quality was associated with greater depression severity (γ = 0.367) and anxiety symptoms (γ = 0.120). Cortisol did not mediate the relationship between sleep quality and depression symptoms.

DISCUSSION

Increases in PSQI scores, but not higher mean PSQI scores, were associated with a larger CAR. There was no association between sleep quality and the diurnal slope or AUC. These data suggest that variability in sleep quality is significantly associated with the amount of cortisol secreted upon awakening.

Sleep During Pregnancy and Offspring Outcomes From Infancy to Childhood: A Systematic Review

OBJECTIVE

Prenatal sleep problems have been previously linked to poor birth outcomes. However, much less is known about the associations between poor prenatal maternal sleep and offspring outcomes after birth. The purpose of this systematic review was to synthesize the findings linking prenatal maternal sleep health and offspring health and development during infancy and childhood.

METHODS

A total of 4650 nonduplicate articles were identified via PsycInfo and PubMed databases. After screening and full-text review, 34 articles met the inclusion criteria and were extracted for information.

RESULTS

The bulk of studies in this review (n = 19; 76.5%) were published between 2019 and 2024. Measures of prenatal sleep included sleep timing, quality, sleep disorders and/or symptoms of disorders, and daytime sleepiness. Offspring outcomes were categorized as follows: a) sleep health (e.g., nighttime sleep duration, night wakings), b) physical health (e.g., body mass index, hospitalizations), c) child developmental outcomes (e.g., global development, negative affect, executive functioning), and d) brain structure and function (e.g., brain volume, event-related potentials). Evidence consistently links poor prenatal sleep health to poorer offspring sleep, higher body mass index, higher prevalence of physical health conditions, poorer global development, and more behavioral problems. Emerging evidence also links prenatal sleep to differences in offspring brain structure and function.

CONCLUSIONS

Poor prenatal maternal sleep health may be an environmental signal that informs offspring health. Future studies are needed to fully understand the pervasive, intergenerational, and long-lasting effects of sleep across pregnancy.

Factors associated with sleep quality in adolescent pregnant women

OBJECTIVE

To verify the association of sociodemographic, anthropometric, obstetric, lifestyle factors, and depressive symptoms with sleep quality in pregnant adolescents.

METHOD

This cross-sectional study involved pregnant adolescents aged 10 to 19 who received prenatal care in Recife, Pernambuco, Brazil. Data collection included an individual evaluation form and the administration of the Pregnancy Physical Activity Questionnaire (PPAQ), the Pittsburgh Sleep Quality Index (PSQI), and the Beck Depression Inventory (BDI). Prevalence and associations were calculated using Pearson's chi-square test or Fisher's exact test, followed by logistic regression analysis.

RESULTS

The study included 386 pregnant adolescents with a mean age of 17 ± 2 years. The prevalence of poor sleep quality was 67.5%. Poor sleep quality was associated with moderate to severe depressive symptoms (OR = 2.21; 95%CI 1.27-3.85), higher education levels (OR = 2.26; 95%CI 1.43-3.57), and the presence of gestational physical symptoms (OR = 1.18; 95%CI 1.10-1.27).

CONCLUSION

Pregnant adolescents exhibit a high prevalence of poor sleep quality, which is linked to depressive symptoms, higher education levels, and gestational physical symptoms. These findings highlight the importance of screening for sleep disorders in this population and emphasize the need for guidelines addressing physical symptoms and their impact on sleep, as well as the presence of depression.

Circadian Regulation of Lipid Metabolism during Pregnancy

A cluster of metabolic changes occur to provide energy for fetal growth and development during pregnancy. There is a burgeoning body of research highlighting the pivotal role of circadian rhythms in the pathogenesis of metabolic disorders and lipid homeostasis in mammals. Perturbations of the circadian system and lipid metabolism during gestation might be responsible for a variety of adverse reproductive outcomes comprising miscarriage, gestational diabetes mellitus, and preeclampsia. Growing studies have confirmed that resynchronizing circadian rhythms might alleviate metabolic disturbance. However, there is no clear evidence regarding the specific mechanisms by which the diurnal rhythm regulates lipid metabolism during pregnancy. In this review, we summarize previous knowledge on the strong interaction among the circadian clock, lipid metabolism, and pregnancy. Analyzing the circadian clock genes will improve our understanding of how circadian rhythms are implicated in complex lipid metabolic disorders during pregnancy. Exploring the potential of resynchronizing these circadian rhythms to disrupt abnormal lipid metabolism could also result in a breakthrough in reducing adverse pregnancy outcomes.

Sleeping for two: A randomized controlled trial of cognitive behavioural therapy for insomnia (CBTI) delivered in pregnancy and secondary impacts on symptoms of postpartum depression

BACKGROUND

Insomnia in pregnancy is common and highly comorbid with depression.

OBJECTIVE

To investigate if: 1) depressive symptoms decrease after cognitive behavioural therapy for insomnia (CBTI) delivered in pregnancy, and 2) changes in insomnia symptoms represent a mechanism linking CBT-I treatment and reduced symptoms of postpartum depression.

METHODS

A two-arm, single-blind, parallel groups randomized controlled trial (RCT) design was used to evaluate the impact of a 5-week CBT-I intervention adapted for pregnant people with insomnia (N = 62). Participants were eligible if they were pregnant, between 12 and 28 weeks gestation, and met diagnostic criteria for insomnia. Participants completed questionnaires assessing symptoms of insomnia and depression pre-intervention (T1), post-intervention (T2), and six months postpartum (T3). A path analysis model was used to test direct and indirect effects simultaneously.

RESULTS

There was a significant direct effect of CBT-I on postpartum depressive symptoms at T3. Additionally, significant indirect treatment effects on depressive symptoms at T3 emerged, through depressive symptoms at T2 and through improvements in insomnia that persisted from T2 to T3.

LIMITATIONS

Limitations to the current study include limited generalizability, the non-depressed sample, and variability in treatment and assessment delivery (in-person vs. online).

CONCLUSIONS

CBT-I treatment in pregnancy may indirectly reduce postpartum depressive symptoms, through sustained improvements in insomnia symptoms.

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.

Preventing postpartum insomnia: findings from a three-arm randomized-controlled trial of cognitive behavioral therapy for insomnia, a responsive bassinet, and sleep hygiene

STUDY OBJECTIVES

Insomnia symptoms are common during the perinatal period and are linked to adverse outcomes. This single-blind three-arm randomized-controlled trial examined whether two interventions targeting different mechanisms prevent postpartum insomnia.

METHODS

Participants were nulliparous females 26-32 weeks gestation with Insomnia Severity Index (ISI) scores ≥ 8, recruited in Australia and randomized 1:1:1 to: (1) a responsive bassinet (RB) designed to support infant sleep and reduce maternal sleep disruption until 6 months postpartum, (2) therapist-assisted cognitive behavioral therapy for insomnia (CBT-I) delivered during pregnancy and postpartum, or (3) a sleep hygiene booklet (control; CTRL). Outcomes were assessed at baseline (T1), 35-36 weeks gestation (T2), and 2, 6, and 12 months postpartum (T3-T5). The primary outcome was ISI scores averaged T3-T5. Primary analyses were regressions controlling for baseline outcomes.

RESULTS

One hundred and twenty-seven participants (age M ± SD = 32.62 ± 3.49) were randomized (RB = 44, CBT-I = 42, CTRL = 41). Both interventions were feasible and well-accepted, with few related adverse events reported. Compared to CTRL, the average ISI across T3-T5 was lower for CBT-I (p = .014, effect size [ES] = 0.56, medium) but not RB (p = .270, ES = 0.25, small). Exploratory findings on maternal insomnia diagnosis, sleep disturbance, sleep-related impairment, beliefs and attitudes about sleep, depression, anxiety, as well as infant sleep outcomes were also presented.

CONCLUSIONS

CBT-I but not RB reduced prenatal insomnia (very large effect) and prevented postpartum insomnia (medium effect). Further research is needed to examine the effects of both CBT-I and RB on other outcomes such as sleep-related well-being, postpartum depression, and maternal postpartum sleep duration.

CLINICAL TRIAL REGISTRATION

The Study for Mother-Infant Sleep (The SMILE Project): reducing postpartum insomnia using an infant sleep intervention and a maternal sleep intervention in first-time mothers. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377927, Australian New Zealand Clinical Trials Registry: ACTRN12619001166167.

Exposure to a mixture of metal(loid)s and sleep quality in pregnant women during early pregnancy: A cross-sectional study

Biological characteristics of pregnant women during early pregnancy make them susceptible to both poor sleep quality and metal/metalloid exposure. However, the effects of metal(loid) exposure on sleep quality in pregnant women remain unknown and unexplored. We aimed to examine the relationship between exposure to a mixture of metal(loid)s and pregnant women's sleep quality during early pregnancy. We recruited 493 pregnant women in the first trimester from prenatal clinics in Jinan, Shandong Province, China, and collected their spot urine samples. All urine specimens were assessed for eight metal(loid)s: arsenic (As), cadmium (Cd), iron (Fe), zinc (Zn), molybdenum (Mo), lead (Pb), selenium (Se), and mercury (Hg). We used the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality. Linear regression, logistic regression, generalized additive models (GAMs), quantile g-computation, and Bayesian kernel machine regression (BKMR) were applied to investigate the relationships between metal(loid) exposure and sleep quality. The results from single metal(loid) models, quantile g-computation models, and BKMR models consistently suggested that Fe was positively related to women's sleep quality. Moreover, in the quantile g-computation models, As was the most critical contributor to the negative effects of the metal(loid) mixture on sleep quality. In addition, we found significant As by Fe interaction for scores of PSQI and habitual sleep efficiency, Pb by Fe interaction for PSQI and sleep latency, and Hg by Fe interaction for PSQI, suggesting the interactive effects of As and Fe, Pb and Fe, Hg and Fe on sleep quality and specific sleep components. Our study provided the first-hand evidence of the effects of metal(loid) exposure on pregnant women's sleep quality. The underlying mechanisms need to be explored in the future.

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.

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.

Heat Exposure, Preterm Birth, and the Role of Greenness in Australia

Importance

Preterm birth (PTB) is associated with adverse health outcomes. The outcomes of heat exposure during pregnancy and the moderating association of greenness with PTB remain understudied.

Objective

To investigate associations between heat exposure, greenness, and PTB, as well as interactions between these factors.

Design, Setting, and Participants

Included in this cohort study were births occurring in Sydney, New South Wales, Australia, between 2000 and 2020, retrieved from New South Wales Midwives Data Collection. Participants with incomplete or missing data on their residential address or those who resided outside of New South Wales during their pregnancy were excluded. Data were analyzed from March to October 2023.

Exposures

Greenness measured using normalized difference vegetation index (NDVI) and tree cover derived from satellite images. Daily extreme heat and nighttime extreme heat were defined as above the 95th percentile of community- and trimester-specific daily mean temperatures and nighttime temperatures.

Main Outcomes and Measures

Logistic regression models estimated the independent association of extreme heat with PTB, adjusting for individual- and area-level covariates, season of conception, and long-term trend. An interaction term between extreme heat exposure and greenness was included to explore potential modification. With a significant interaction observed, the number of preventable heat-associated PTBs that were associated with greenness was estimated.

Results

A total of 1 225 722 births (median [IQR] age, 39 [38-40] weeks; 631 005 male [51.5%]) were included in the analysis, including 63 144 PTBs (median [IQR] age, 35 [34-36] weeks; 34 822 male [55.1%]). Compared with those without heat exposure, exposure to daily extreme heat and nighttime extreme heat in the third trimester was associated with increased risks of PTB, with an adjusted odds ratio (OR) of 1.61 (95% CI, 1.55-1.67) and 1.51 (95% CI, 1.46-1.56]), respectively (PTB rates: exposed, 4615 of 61 338 [7.5%] vs unexposed, 56 440 of 1 162 295 [4.9%] for daily extreme heat and 4332 of 61 337 [7.1%] vs 56 723 of 1 162 296 [4.9%] for nighttime extreme heat). Disparities in associations between extreme heat exposure and PTB were observed, with lower odds of PTB among pregnant individuals residing in greener areas. The associations between extreme heat exposure and PTB could be mitigated significantly by higher greenness. Improving NDVI and tree cover could reduce daily extreme heat-associated PTB by 13.7% (95% CI, 2.3%-15.1%) and 20.9% (95% CI, 5.8%-31.5%), respectively. For nighttime extreme heat-associated PTB, reductions were 13.0% (0.2%-15.4%) and 17.2% (4.1%-27.0%), respectively.

Conclusions and Relevance

Results of this large birth cohort study suggest that extreme heat exposure was adversely associated with PTB, with greenness playing a moderating role. Increasing greenness levels in residential communities could prevent heat-associated PTBs. These findings emphasize the importance of integrating heat mitigation strategies and improving green space in urban planning and public health interventions.

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.

Exploring the relationship between sunlight exposure, psychological health, and gestational weight gain: a prospective observational study

INTRODUCTION

Gestational weight gain (GWG) is influenced by various factors during pregnancy. This study attempts to explore the relationship between environmental factors i.e., sunlight exposure and psychological health i.e. psychological well-being and sleep quality during pregnancy with total gestational weight gain.

METHODS

This was a prospective observational study conducted in government maternity clinics in Kuala Lumpur. Pregnant women aged 19-39 years without comorbidities were recruited during second trimester and followed up until birth. The participants were required to wear a UVB dosimeter for a total of three consecutive days (2 weekdays and 1 weekend) to determine sunlight exposure (SED) during their second trimester. The PSQI and DASS-21 were used to determine sleep quality and psychological wellbeing, respectively. GWG data were collected from clinic health records. The association of sun exposure and psychological health with total GWG was determined using multiple linear regression.

RESULTS

A total of 73 pregnant women aged 27.9 ± 3.3 years were included in the analysis. The prevalence of pregnant women exhibiting stress, anxiety, and depression symptoms was 11%, 40%, and 16% respectively. The global PSQI median score was 5 (IQR = 3), with 59% having poor sleep quality. Median sleep duration was 7 h (IQR = 2) while median sleep efficiency was 92% (IQR = 14). The median SED was 0.04 (IQR = 0.09), with 51% of them being under the 50th percentile. The majority had adequate GWG (58%). Sleep parameters were not found to be correlated with total GWG except for sleep latency (ρ = -0.356, p = 0.002). Sunlight exposure was found to have no significant relationship with sleep and total GWG. Adjusted multiple linear regression showed that greater depression is associated with higher total GWG (β = 0.239, p = 0.039) while controlling for sleep quality.

CONCLUSION

Depression was associated with total GWG when sleep quality was controlled for while sunlight exposure had no significant association with GWG. Future studies should study the complex relationship between factors of mental health, sleep, and weight gain during pregnancy. Healthcare providers may be better equipped to develop interventions aimed to prevent negative maternal and fetal health outcomes.

Risk of pre-term birth as a function of sleep quality and obesity: prospective analysis in a large Prematurity Research Cohort

Study Objective

To investigate whether poor sleep quality is associated with pre-term birth (PTB) risk, overall and independent of sleep apnea and habitual snoring.

Methods

We used longitudinal data from the Washington University Prematurity Research Cohort to investigate the association between poor sleep quality (defined as a Pittsburgh Sleep Quality Index > 5) and PTB, overall and independent of sleep apnea and snoring (defined by the Berlin questionnaire and prior sleep clinic attendance). Associations were investigated for sleep quality early and throughout pregnancy. Stratified analyses were performed by factors previously shown to modify associations between sleep and PTB (race, pre-pregnancy obesity).

Results

Of the 976 eligible participants, 50.1% experienced poor sleep quality early in pregnancy (<20 completed weeks) and 14.2% delivered pre-term (n = 50 without and 89 with poor sleep quality). In multivariable-adjusted analyses, poor sleep quality early in pregnancy was associated with increased PTB risk (hazard ratio [HR] = 1.48, 95% confidence interval [CI] = 1.02-2.14). This association persisted after further adjustment for sleep apnea and snoring (HR = 1.50, 95% CI = 1.02-2.20) and in analyses stratified by race. It varied, however, by pre-pregnancy obesity. Among individuals without obesity, no association was observed between poor sleep and PTB (HR = 1.08, 95% CI = 0.65-1.79), whereas among those with obesity, a positive association was observed (HR = 2.94, 95% CI = 1.52-5.69, p-interaction = .05). This association was limited to individuals with obesity who experienced poor sleep both earlier and later in pregnancy (HR = 3.94, 95% CI = 1.56-9.99).

Conclusion

Our findings suggest that improving sleep quality early in pregnancy may be important for PTB prevention, particularly among individuals with obesity.

Maternal sleep disturbances during late pregnancy and child neuropsychological and behavioral development in early childhood

The present study aims to explore the association of maternal sleep disturbances during late pregnancy on child neuropsychological and behavioral development in preschool years. The study included 638 mother-child pairs from the prospective Rhea mother-child cohort in Crete, Greece. Information on antenatal sleep disturbances was collected through a computer-assisted interview. Children's neuropsychological and behavioral development was assessed using the McCarthy Scales of Children's Abilities (MSCA), the Attention-Deficit Hyperactivity Disorder Test (ADHDT), and the Strengths and Difficulties Questionnaire (SDQ). Multivariate analysis showed that maternal sleep duration less than 8 h was associated with reduced scores in the general cognitive scale (β = -2.28, 95% CI -4.54, -0.02, R2 = 0.417) and memory span (β = -3.24, 95% CI -5.72, -0.77, R2 = 0.304), while mild-severe daytime sleepiness was associated with reduced scores in the memory scale (β = -5.42, 95% CI -10.47, -0.37, R2 = 0.304), memory span (β = -5.44, 95% CI -10.68, -0.21, R2 = 0.304), nd functions of posterior cortex (β = -5.55, 95% CI -10.40, -0.70, R2 = 0.393) of MSCA. Snoring in late pregnancy was related to higher child hyperactivity scores in SDQ (β = 1.05, 95% CI 0.16, 1.95, R2 = 0.160). An interaction between child sex and maternal sleep duration in response to ADHD symptoms was also found (p for interaction < 0.05). Stratified analysis revealed increased hyperactivity, inattention, and ADHD total scores for girls of mothers with sleep duration less than 8 h. Maternal sleep disturbances during pregnancy may be associated with impaired child neuropsychological and behavioral development during the preschool years. Early detection and intervention is necessary to reduce sleep disturbances habits in pregnancy and improve child neurodevelopment.

The Insomnia Severity Index: Factor Structure and Measurement and Structural Invariance across Perinatal Time Points

Insomnia is associated with adverse outcomes in women in the perinatal period; thus, the assessment of insomnia is important for pregnant women. The Insomnia Severity Index (ISI) is an instrument used globally to assess the severity of insomnia. However, its factor structure and structural invariance for pregnant women have not been studied. Therefore, we aimed to conduct factor analyses to search for the best model to fit its structural invariance. A cross-sectional study with the ISI was conducted at one hospital and five clinics in Japan from January 2017 to May 2019. A set of questionnaires was administered on two occasions with a one-week interval. The study included 382 pregnant women ranging in gestational age from 10 to 13 weeks. One week later, 129 participants answered the retest. After exploratory and confirmatory factor analyses, the measurement and structural invariance between parity and two time points was tested. The two-factor structure model showed an acceptable fit for the ISI in pregnant women (χ² (12) = 28.516, CFI = 0.971, RMSEA = 0.089). The model also showed satisfactory measurement and structure invariance between parity and time points. The findings indicate that the ISI's use would be appropriate for pregnant women as a two-factor subscale of "severity" and "impact", regardless of the parity or time point. The ISI's factor structure may vary by subject; hence, it is necessary to confirm the measurement and structural invariance of the subject for whom the ISI will be used. Furthermore, interventions that focus not only on total scores and cutoff points but also on the phenomenon of subscales should be considered.

Association between frequency of breakfast intake before and during pregnancy and infant birth weight: the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study

BACKGROUND

Low birth weight is associated with an increased risk of developing chronic diseases in adulthood, with a particularly high incidence in Japan among developed countries. Maternal undernutrition is a risk factor for low birth weight, but the association between the timing of food intake and infant birth weight has not been investigated. This study aimed to examine the association between breakfast intake frequency among Japanese pregnant women and infant birth weight.

METHODS

Of all pregnant women who participated in the Tohoku Medical Megabank Project Three Generation Cohort Study, 16,820 who answered the required questions were included in the analysis. The frequency of breakfast intake from pre- to early pregnancy and from early to mid-pregnancy was classified into four groups: every day and 5-6, 3-4, and 0-2 times/week. Multivariate linear regression models were constructed to examine the association between breakfast intake frequency among pregnant women and infant birth weight.

RESULTS

The percentage of pregnant women who consumed breakfast daily was 74% in the pre- to early pregnancy period and 79% in the early to mid-pregnancy period. The average infant birth weight was 3,071 g. Compared to women who had breakfast daily from pre- to early pregnancy, those who had breakfast 0-2 times/week had lower infant birth weight (β = -38.2, 95% confidence interval [CI]: -56.5, -20.0). Similarly, compared to women who had breakfast daily from early to mid-pregnancy, those who had breakfast 0-2 times/week had lower infant birth weight (β = -41.5, 95% CI: -63.3, -19.6).

CONCLUSIONS

Less frequent breakfast intake before and mid-pregnancy was associated with lower infant birth weight.

Sleep disturbances and depressive and anxiety symptoms during pregnancy: associations with delivery and newborn health

BACKGROUND

Sleep disturbances and mood symptoms are common in late pregnancy; according to the literature, they can affect delivery and newborn outcomes. This study evaluated the effect of sleep and mood symptoms on delivery and newborn health, because there are insufficient and partly contradictory studies on the topic.

METHODS

A cohort of 1414 mothers in their third trimester was enrolled in this prospective cross-sectional questionnaire study. Validated questionnaires were assessed for the measurement of sleep disturbances and depressive and anxiety symptoms. The data on delivery and newborn outcomes were obtained from hospital medical records.

RESULTS

Sleep disturbances were very common. A higher insomnia score (β = - 0.06, p = 0.047) and longer sleep need (β = 0.07, p = 0.047) were related to delivery at a lower gestational age. In addition, a higher insomnia score (β = - 28.30, p = 0.010) and lower general sleep quality (β = - 62.15, p = 0.025) were associated with lower birth weight, but longer sleep duration and longer sleep need with a higher birth weight (β = 28.06, p = 0.019; β = 27.61, p = 0.028, respectively). However, the findings regarding birth weight lost their significance when the birth weight was standardized by gestational weeks. Concerning Apgar scores and umbilical artery pH, no associations were found. Snoring was associated with a shorter duration of the first phase of delivery (β = - 78.71, p = 0.015) and total duration of delivery (β = - 79.85, p = 0.016). Mothers with higher insomnia, depressive, or anxiety symptoms were more often treated with oxytocin (OR 1.54 95% CI 1.00-2.38, p = 0.049, OR 1.76, 95% CI 1.02-3.04, p = 0.049 and OR 1.91, CI 95% 1.28-2.84, p < 0.001, respectively) and those with higher depressive and anxiety symptoms were delivered more often with elective cesarean section (OR 4.67, 95% CI 2.04-12.68, p < 0.001 and OR 2.22, 95% CI 1.03-4.79, p = 0.042).

CONCLUSIONS

Maternal sleep disturbances and mood symptoms during pregnancy are associated with delivery and newborn health. However, nearly, all the outcomes fell within a normal range, implying that the actual risks are low.

Prior pregnancy loss and sleep experience during subsequent pregnancy

OBJECTIVE

To describe sleep characteristics in the third trimester of pregnancy for women who had a prior pregnancy loss compared to women with no history of loss.

DESIGN

Descriptive comparison of baseline data prior to randomization for a clinical trial.

SETTING

Participants' homes.

PARTICIPANTS

Eligible women recruited from childbirth education classes during third trimester were over 18 years old, in partnered relationships, spoke English, did not work nightshift or have a diagnosed sleep disorder, and had no current complications or prior pregnancy loss (n = 140). Women with prior miscarriage or stillbirth were offered enrollment in an ancillary study (n = 20).

MEASUREMENTS

Sleep was assessed with the Pittsburgh Sleep Quality Index (PSQI) and wrist actigraphy. Other measures included relationship satisfaction, perceived stress, and depressive symptoms. For this analysis, only third trimester data prior to randomization were compared.

RESULTS

Both groups had similar actigraphy-recorded sleep duration (7.1 ± 1.1 hours) and sleep efficiency (83.7 ± 7.9%). However, the pregnancy loss group had significantly (p = .050) worse PSQI scores (7.8 ± 2.6) than controls (6.7 ± 3.1), resulting primarily from the sleep disturbance component (p = .003), specifically bad dreams (p = .030) and legs twitching/jerking (p = .071). Controlling for demographic and health factors in multivariate analyses, prior pregnancy loss was significant for sleep disturbance (p = .047), bad dreams (p = .018), and partner-reported leg twitching/jerking (p = .048).

CONCLUSIONS

Long after the acute grief of a pregnancy loss, perceived sleep quality can be problematic during the next pregnancy. Whether poor sleep quality is present prior to the pregnancy loss or reflects long-term maternal sleep characteristics require further research.

Adverse infant outcomes among women with sleep apnea or insomnia during pregnancy: A retrospective cohort study

OBJECTIVE

To evaluate whether sleep apnea or insomnia among pregnant people is associated with increased risk for adverse infant outcomes.

DESIGN

Retrospective cohort study SETTING: California PARTICIPANTS: The sample included singleton live births. Sleep apnea and insomnia were defined based on ICD-9 and -10 codes. A referent group was selected using exact propensity score matching on maternal characteristics, obstetric factors, and infant factors among individuals without a sleep disorder.

MEASUREMENTS

Adverse infant outcomes were obtained from birth certificate, hospital discharge, and death records (eg, Apgar scores, neonatal intensive care unit (NICU) stay, infant death, long birth stay, etc.). Logistic regression was used to calculate odds of an adverse infant outcome by sleep disorder type.

RESULTS

Propensity-score matched controls were identified for 69.9% of the 3371 sleep apnea cases and 68.8% of the 3213 insomnia cases. Compared to the propensity-matched referent group, individuals with a diagnosis of sleep apnea (n = 2357) had infants who were more likely to have any adverse outcome, low 1-min Apgar scores, NICU stay, and an emergency room visit in the first year of life. Infants born to mothers with a diagnosis of insomnia (n = 2212) were at increased risk of few negative outcomes relative to the propensity matched referent group, with the exception of an emergency room visit.

CONCLUSIONS

In unadjusted analyses, infants born to individuals with a diagnosis of sleep apnea or insomnia were at increased risk of several adverse outcomes. These were attenuated when using propensity score matching, suggesting these associations were driven by other comorbidities.

Endorsement of a single-item measure of sleep disturbance during pregnancy and risk for postpartum depression: a retrospective cohort study

Poor prenatal sleep quality is associated with increased risk for depressive symptoms but may go undetected in brief, busy prenatal care visits. Among non-depressed pregnant participants, we evaluated whether 1) the endorsement of sleep disturbance on a depression questionnaire predicted postpartum depressive symptoms, 2) the strength of these associations was higher than other somatic symptoms of pregnancy and depression (i.e., fatigue, appetite disturbance), and 3) the endorsement of prenatal sleep disturbance varied by participant characteristics. In this retrospective cohort study, participants had a live birth and completed Patient Health Questionnaire (PHQ-9) during pregnancy and within 8 weeks postpartum between 2012 and 2017. Participants who were non-depressed during pregnancy (PHQ-9 < 10) were included (n = 3619). We operationalized sleep disturbance, fatigue, and appetite disturbance as endorsement of item 3, 4, and 5 on the PHQ-9, respectively, and postpartum depressive symptoms as PHQ-9 total score ≥ 10. Participant characteristic variables included age, race, ethnicity, parity, gestational age at delivery, and preterm birth. Prenatal sleep disturbance was associated with higher odds of postpartum depressive symptoms (aORs 1.9, 95% CI 1.2-3.1 for first trimester; 3.7, 95% CI 1.5-11.5 for second trimester; 3.4, 95% CI 1.9-6.8 for third trimester). Fatigue and appetite disturbance in the first and third trimesters were associated with higher odds of postpartum depressive symptoms. Sleep disturbance varied by race during the first and second trimesters (p < 0.05) and was highest among Black or African American participants (61.8-65.1%). A routinely administered single-item measure of sleep disturbance could identify otherwise lower-risk pregnant individuals who may benefit from depression prevention efforts.

A Comprehensive Review on Social Inequalities and Pregnancy Outcome-Identification of Relevant Pathways and Mechanisms

Scientific literature tends to support the idea that the pregnancy and health status of fetuses and newborns can be affected by maternal, parental, and contextual characteristics. In addition, a growing body of evidence reports that social determinants, measured at individual and/or aggregated level(s), play a crucial role in fetal and newborn health. Numerous studies have found social factors (including maternal age and education, marital status, pregnancy intention, and socioeconomic status) to be linked to poor birth outcomes. Several have also suggested that beyond individual and contextual social characteristics, living environment and conditions (or "neighborhood") emerge as important determinants in health inequalities, particularly for pregnant women. Using a comprehensive review, we present a conceptual framework based on the work of both the Commission on Social Determinants of Health and the World Health Organization (WHO), aimed at describing the various pathways through which social characteristics can affect both pregnancy and fetal health, with a focus on the structural social determinants (such as socioeconomic and political context) that influence social position, as well as on intermediary determinants. We also suggest that social position may influence more specific intermediary health determinants; individuals may, on the basis of their social position, experience differences in environmental exposure and vulnerability to health-compromising living conditions. Our model highlights the fact that adverse birth outcomes, which inevitably lead to health inequity, may, in turn, affect the individual social position. In order to address both the inequalities that begin in utero and the disparities observed at birth, it is important for interventions to target various unhealthy behaviors and psychosocial conditions in early pregnancy. Health policy must, then, support: (i) midwifery availability and accessibility and (ii) enhanced multidisciplinary support for deprived pregnant women.

Adverse and Benevolent Childhood Experiences Predict Prenatal Sleep Quality

The objective of the study was to investigate whether adverse and benevolent childhood experiences were associated with trajectories of sleep quality throughout pregnancy. The study was conducted at obstetrics and gynecology clinics in the Rocky Mountain region of the USA. The participants of the study were pregnant individuals (N = 164). Sleep quality was measured with the Pittsburgh Sleep Quality Index at three gestational time points, and adverse childhood experiences (ACEs) and benevolent childhood experiences (BCEs) were assessed once. Multilevel models were conducted to examine the trajectory of sleep quality across gestation in relation to ACEs and BCEs. Sleep quality was similar in early to mid-pregnancy, with a worsening of sleep quality late in pregnancy, following a quadratic trajectory. Higher levels of ACEs predicted poorer prenatal sleep quality (b = 0.36, SE = 0.13, p = .004) throughout pregnancy, while higher levels of BCEs predicted better sleep quality (b = -0.60, SE = 0.17, p < .001) throughout pregnancy. Examination of ACEs subtypes revealed that childhood maltreatment predicted poor sleep quality (b = 0.66, SE = 0.18, p < .001), while childhood household dysfunction was not significantly associated (b = 0.33, SE = 0.21, p = .11). Associations remained after covarying for socioeconomic status and current stressful life events. Both adverse and benevolent childhood experiences predict sleep health during pregnancy. Prevention and intervention strategies targeting resilience and sleep quality during pregnancy should be implemented to promote prenatal health and well-being.

Longitudinal and prospective assessment of prenatal maternal sleep quality and associations with newborn hippocampal and amygdala volume

BACKGROUND

The rapid maturation of the fetal brain renders the fetus susceptible to prenatal environmental signals. Prenatal maternal sleep quality is known to have important health implications for newborns including risk for preterm birth, however, the effect on the fetal brain is poorly understood.

METHOD

Participants included 94 pregnant participants and their newborns (53% female). Pregnant participants (Mage = 30; SDage= 5.29) reported on sleep quality three times throughout pregnancy. Newborn hippocampal and amygdala volumes were assessed using structural magnetic resonance imaging. Multilevel modeling was used to test the associations between trajectories of prenatal maternal sleep quality and newborn hippocampal and amygdala volume.

RESULTS

The overall trajectory of prenatal maternal sleep quality was associated with hippocampal volume (left: b = 0.00003, p = 0.013; right: b = 0.00003, p = .008). Follow up analyses assessing timing of exposure indicate that poor sleep quality early in pregnancy was associated with larger hippocampal volume bilaterally (e.g., late gestation left: b = 0.002, p = 0.24; right: b = 0.004, p = .11). Prenatal sleep quality was not associated with amygdala volume.

CONCLUSION

These findings highlight the implications of poor prenatal maternal sleep quality and its role in contributing to newborn hippocampal development.

Effect of maternal sleep on embryonic development

The concept of developmental origin of health and disease has ignited a search for mechanisms and health factors influencing normal intrauterine development. Sleep is a basic health factor with substantial individual variation, but its implication for early prenatal development remains unclear. During the embryonic period, the yolk sac is involved in embryonic nutrition, growth, hematopoiesis, and likely in fetal programming. Maternal body measures seem to influence its size in human female embryos. In this prospective, longitudinal observational study of 190 healthy women recruited before natural conception, we assessed the effect of prepregnant sleep duration (actigraphy) on the fetal crown-rump-length (CRL) and yolk sac size (ultrasound). All women gave birth to a live child. The prepregnancy daily sleep duration had an effect on the male yolk sac and CRL at the earliest measurement only (7 weeks). I.e., the yolk sac diameter decreased with increasing sleep duration (0.22 mm·h-1d-1, 95%CI [0.35-0.09], P < 0.01), and CRL increased (0.92 mm·h-1d-1, 95%CI [1.77-0.08], P = 0.03). Since there was no association at the second measurement (10 weeks), and in the group of female fetuses at any measure point, we suggest a sex- and time-dependent embryonic adaptation to sleep generated differences in the intrauterine environment in normal pregnancies.

Pharmacologic Treatment of Sleep Disorders in Pregnancy

Pregnancy is a unique physiologic state whose characteristics often predispose women to new-onset sleep disturbances or exacerbations of preexisting sleep disorders. Pregnancy-related factors that can disrupt sleep include heartburn, nocturnal oxytocin secretion, nocturia, and fetal movement. Sleep disorders in pregnancy include insomnia (primary and secondary), restless legs syndrome, and narcolepsy.

Poor sleep quality and associated factors among HIV-positive pregnant women in Northwest, Ethiopia: a facility-based, cross-sectional study

BACKGROUND

Poor sleep quality during pregnancy might have an impact on adverse birth outcomes like premature rupture of membrane, preterm birth, lifelong neurocognitive impairment, low birth weight, and increased the risk of neonatal morbidity and mortality. In Ethiopia, the magnitude of poor sleep quality among this group of people is extremely limited. So, this study aims to determine the magnitude of poor sleep quality and its associated factors among HIV-positive pregnant women attending public hospitals in Northwest Ethiopia.

METHODS

An institution-based cross-sectional study was done using a simple random sampling technique to recruit 411 HIV-positive pregnant women from January to March; 2021. Sleep quality over the last 1 month was measured using the Pittsburgh Sleep Quality Index (PSQI). General anxiety disorder (GAD-7), Sleep Hygiene Index (SHI), and List of Threatening of Experiences (LTE) instruments were used to identify factors associated with poor sleep quality. Bivariate and multivariable logistic regression with odds ratio and 95% CI were employed to identify determinant factors of poor sleep quality. Statistical significance association was declared at P-value < 0.05.

RESULTS

A total of 411 out of 423 HIV-positive pregnant women were interviewed, with a response rate of 97.1%. The overall magnitude of poor sleep quality among HIV-positive pregnant was found to be 39.4% with a 95% of confidence interval (CI) (34.3, 44.3). Stressful life events, [AOR = 3.10, 95% CI (1.60, 6.01)], having comorbid general anxiety symptoms [AOR = 2.46, 95% CI (1.58, 3.81)], unplanned pregnancy [AOR = 2.18, 95% CI (1.20, 3.96)], and poor sleep hygiene practice [AOR = 2.23, 95% CI (1.21, 4.10)] were significantly associated with poor quality of sleep.

CONCLUSION

The overall magnitude of poor sleep quality among HIV-positive pregnant women was high. Stressful life events, poor sleep hygiene, unplanned pregnancy, and comorbid general anxiety symptoms were the determinant factors of poor sleep quality that should be taken high consideration for early detection and appropriate intervention for poor sleep quality in HIV-positive pregnant women.

Mediterranean Diet on Sleep: A Health Alliance

The Mediterranean diet is a plant-based, antioxidant-rich, unsaturated fat dietary pattern that has been consistently associated with lower rates of noncommunicable diseases and total mortality, so that it is considered one of the healthiest dietary patterns. Clinical trials and mechanistic studies have demonstrated that the Mediterranean diet and its peculiar foods and nutrients exert beneficial effects against inflammation, oxidative stress, dysmetabolism, vascular dysfunction, adiposity, senescence, cognitive decline, neurodegeneration, and tumorigenesis, thus preventing age-associated chronic diseases and improving wellbeing and health. Nocturnal sleep is an essential physiological function, whose alteration is associated with health outcomes and chronic diseases. Scientific evidence suggests that diet and sleep are related in a bidirectional relationship, and the understanding of this association is important given their role in disease prevention. In this review, we surveyed the literature concerning the current state of evidence from epidemiological studies on the impact of the Mediterranean diet on nighttime sleep quantity and quality. The available studies indicate that greater adherence to the Mediterranean diet is associated with adequate sleep duration and with several indicators of better sleep quality. Potential mechanisms mediating the effect of the Mediterranean diet and its foods and nutrients on sleep are described, and gap-in-knowledge and new research agenda to corroborate findings are discussed.

Aircraft noise and vehicle traffic-related air pollution interact to affect preterm birth risk in Los Angeles, California

INTRODUCTION

Air pollution has been linked to preterm birth (PTB) while findings for noise exposure have been mixed. Few studies - none considering airports - have investigated combined exposures. We explore the relationship between joint exposure to airport-related noise, airport ultrafine particles (UFP), and vehicle traffic-related air pollution (TRAP) on risk of PTB near Los Angeles International Airport (LAX).

METHODS

We used comprehensive birth data for mothers living ≤15 km from LAX from 2008 to 2016 (n = 174,186) Noise data were generated by monitor-validated models. NO₂ was used as a TRAP proxy, estimated with a seasonally-adjusted, validated land-use regression model. We estimated the effects of exposure to airport-related noise and TRAP on PTB employing logistic regression models that adjusted for known maternal risk factors for PTB as well as aircraft-origin UFP and neighborhood characteristics.

RESULTS

The adjusted odds ratio (aOR) for PTB from high noise exposure (i.e. > 65 dB) was 1.10 (95% CI: 1.01-1.19). Relative to the first quartile, the aORs for PTB in the second, third, and fourth TRAP quartiles were 1.10 (95% CI: 1.05-1.16), 1.11 (95% CI: 1.05-1.16), and 1.15 (95% CI: 1.10-1.22), respectively. When stratifying by increasing TRAP quartiles, the aORs for PTB with high airport-related noise were 1.04 (95% CI: 0.91-1.18), 1.02 (95% CI: 0.88-1.19), 1.24 (95% CI: 1.03-1.48), and 1.44 (95% CI: 1.08-1.91) (p-interaction = 0.06).

CONCLUSION

Our results suggest a potential synergism between airport-related noise and TRAP exposures on increasing the risk of PTB in this metropolitan area.

Changes in Sleep Patterns during Pregnancy and Predictive Factors: A Longitudinal Study in Saudi Women

This study aimed to assess sleep patterns during the three trimesters of pregnancy and whether vitamin D concentrations, along with other risk factors, are associated with these alterations. In a longitudinal study, 140 pregnant women (age 18 to 39 years) were followed throughout their first, second, and third trimesters. Sleep was measured using the Pittsburgh Sleep Quality Index (PSQI) at each trimester, along with an assessment of biochemical parameters, including serum vitamin D levels. The information that was collected included anthropometric data, socio-economic status, dietary intake, and physical activity. The PSQI was higher in mid and late pregnancy than in early pregnancy (both p = 0.001), and the sleep duration was also higher in late versus early pregnancy. Linear regression analyses revealed independent predictors of deteriorating sleep quality from early to late pregnancy, including low income (B ± SE −0.60 ± 0.26, p = 0.03) and low serum vitamin D levels in the second trimester (B ± SE −0.20 ± 0.01, p = 0.04). Energy intake and sitting in the second half of pregnancy were positively associated with changes in the PSQI score from the second to third trimesters (B ± SE 0.15 ± 0.07, p = 0.048) and (B ± SE 0.01 ± 0.00, p = 0.044), respectively. Low socio-economic status, low serum vitamin D levels, greater energy intake, and sitting time were associated with worsening patterns of sleep quality from early to late pregnancy.

Insomnia evaluation and treatment during peripartum: a joint position paper from the European Insomnia Network task force "Sleep and Women," the Italian Marcè Society and international experts task force for perinatal mental health

Insomnia symptoms are frequent during peripartum and are considered risk factors for peripartum psychopathology. Assessing and treating insomnia and related conditions of sleep loss during peripartum should be a priority in the clinical practice. The aim of this paper was to conduct a systematic review on insomnia evaluation and treatment during peripartum which may be useful for clinicians. The literature review was carried out between January 2000 and May 2021 on the evaluation and treatment of insomnia during the peripartum period. The PubMed, PsycINFO, and Embase electronic databases were searched for literature published according to the PRISMA guidance with several combinations of search terms "insomnia" and "perinatal period" or "pregnancy" or "post partum" or "lactation" or "breastfeeding" and "evaluation" and "treatment." Based on this search, 136 articles about insomnia evaluation and 335 articles on insomnia treatment were found and we conducted at the end a narrative review. According to the inclusion/exclusion criteria, 41 articles were selected for the evaluation part and 22 on the treatment part, including the most recent meta-analyses and systematic reviews. Evaluation of insomnia during peripartum, as for insomnia patients, may be conducted at least throughout a clinical interview, but specific rating scales are available and may be useful for assessment. Cognitive behavioral therapy for insomnia (CBT-I), as for insomnia patients, should be the preferred treatment choice during peripartum, and it may be useful to also improve mood, anxiety symptoms, and fatigue. Pharmacological treatment may be considered when women who present with severe forms of insomnia symptoms do not respond to nonpharmacologic therapy.

Perceived social support predicts self-reported and objective health and health behaviors among pregnant women

Perinatal health and health behaviors play a crucial role in maternal and neonatal health. Data examining psychosocial factors which predict self-reported health and health behaviors as well as objective indicators downstream of health behaviors among pregnant women are lacking. In this longitudinal study design with 131 pregnant women, perceived social support was examined as a predictor of self-rated health and average levels of sleep quality, health-promoting and health-impairing behaviors, and red blood cell (RBC) polyunsaturated fatty acids across early, mid, and late pregnancy. Participants provided a blood sample and fatty acid methyl esters were analyzed by gas chromatography. Measures included the Multidimensional Scale of Perceived Social Support, Pittsburgh Sleep Quality Index, and Prenatal Health Behavior Scale. Regression models demonstrated that, after adjustment for income, race/ethnicity, age, relationship status, pre-pregnancy body mass index, greater social support was associated with better self-rated health (p = 0.001), greater sleep quality (p = 0.001), fewer health-impairing behaviors (p = 0.02), and higher RBC omega-3 fatty acids (p = 0.003). Associations among social support with health-promoting behaviors, RBC omega-6 fatty acids, or gestational weight gain were not significant. Findings underscore the benefits of perceived social support in the context of pregnancy. Examination of pathways that link social support with these outcomes will be meaningful in determining the ways in which perinatal psychosocial interventions may promote health.

Association between depressive symptoms and poor sleep quality among pregnant women in Northern Rural Bangladesh: a community-based cross-sectional study

BACKGROUND

Adequate good quality of sleep is essential for physical fitness during pregnancy as well as being a depressive symptoms-free mind. However, there is little evidence of the relationship between depressive symptoms and poor sleep quality among pregnant women in Bangladesh. This study aimed to find the association between depressive symptoms and poor sleep quality among pregnant women in northern rural Bangladesh.

METHODS

A community-based cross-sectional study was carried out from May 2021 to June 2021 among 481 pregnant women tested positive in the pregnancy test of Jaldhaka and Dimla Upazila of Nilphamari district, Rangpur Division. Data were collected with a structured questionnaire including socio-demographic conditions, sleep quality, and depressive symptoms, comprising the Pittsburgh Sleep Quality Index (PSQI) and the Patient Health Questionnaire- 9 (PHQ-9).

RESULTS

8.94% of the women had depressive symptoms, whereas 38.88% of the participants were bad sleepers. However, women who had depressive symptoms [Adjusted odds ratio (AOR) = 2.55; 95% CI 1.33-4.9] and educational qualifications above 10 years [AOR = 0.60; 95% CI: 0.39-0.92] were associated with poor sleep quality.

CONCLUSIONS

A higher percentage of pregnant women had poor sleep quality, whereas depressive symptoms and academic background of the participants were significantly associated with poor sleep quality. Ensuring adequate sleep time and better quality could be helpful to prevent depressive symptoms.

The effect of orthodontic treatment with fixed appliances on sleep quality in adults and adolescents in Saudi Arabia using Pittsburgh sleep quality index

Objectives:

The aim of this study was to investigate the effect of pain caused by orthodontic fixed appliances on sleep quality of participants using the Pittsburgh Sleep Quality Index (PSQI).

Materials and Methods:

A previously validated Arabic version of PSQI was electronically distributed through different social media platforms and in waiting areas of orthodontic offices. Eligibility criteria included healthy adults and adolescents with orthodontic fixed appliances and with no systemic conditions that may affect sleep. The cut-off point used to determine poor sleep quality was (>5).

Results:

Three hundred and eighteen participants were included in the final analysis (28.9% males and 71.1% females). Both males and females with orthodontic fixed appliances had poor sleep quality with (Mean = 6.48, SD = 2.85, P = 0.000) for males, and (Mean = 7.18, SD = 2.87, P = 0.000) for females. Comparing males and females, we found that females scored higher than males in both subjective sleep quality and PSQI global score.

Conclusion:

Individuals undergoing orthodontic treatment with fixed appliances have poor sleep quality. Females undergoing orthodontic treatment tend to have poorer sleep quality compared to males.

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.

Recurrent preterm birth risk assessment for two delivery subtypes: A multivariable analysis

OBJECTIVE

The study sought to develop and apply a framework that uses a clinical phenotyping tool to assess risk for recurrent preterm birth.

MATERIALS AND METHODS

We extended an existing clinical phenotyping tool and applied a 4-step framework for our retrospective cohort study. The study was based on data collected in the Genomic and Proteomic Network for Preterm Birth Research Longitudinal Cohort Study (GPN-PBR LS). A total of 52 sociodemographic, clinical and obstetric history-related risk factors were selected for the analysis. Spontaneous and indicated delivery subtypes were analyzed both individually and in combination. Chi-square analysis and Kaplan-Meier estimate were used for univariate analysis. A Cox proportional hazards model was used for multivariable analysis.

RESULTS

: A total of 428 women with a history of spontaneous preterm birth qualified for our analysis. The predictors of preterm delivery used in multivariable model were maternal age, maternal race, household income, marital status, previous caesarean section, number of previous deliveries, number of previous abortions, previous birth weight, cervical insufficiency, decidual hemorrhage, and placental dysfunction. The models stratified by delivery subtype performed better than the naïve model (concordance 0.76 for the spontaneous model, 0.87 for the indicated model, and 0.72 for the naïve model).

DISCUSSION

The proposed 4-step framework is effective to analyze risk factors for recurrent preterm birth in a retrospective cohort and possesses practical features for future analyses with other data sources (eg, electronic health record data).

CONCLUSIONS

We developed an analytical framework that utilizes a clinical phenotyping tool and performed a survival analysis to analyze risk for recurrent preterm birth.

Sleeping for two: study protocol for a randomized controlled trial of cognitive behavioral therapy for insomnia in pregnant women

BACKGROUND

Insomnia and sleep disturbances are common in pregnancy and have potentially significant consequences for both maternal and infant health. There is limited research examining the effectiveness of cognitive behavioral therapy for insomnia (CBT-I) during pregnancy. With increased distress and limited access to services during the COVID-19 pandemic, there is also an unprecedented need for telehealth delivery of treatment programs for pregnant women. The aims of this trial are to evaluate the impact of the Sleeping for Two adaptation of CBT-I in pregnancy (in-person or telehealth) versus treatment as usual (TAU) in reducing symptoms of insomnia (primary outcome), as well as increasing gestational length and reducing symptoms of depression (secondary outcomes).

METHODS

A two-arm, single-blinded, parallel group randomized controlled trial (RCT) design with repeated measures will be used to evaluate the impact of CBT-I compared to TAU among a sample of 62 pregnant women, enrolled between 12 and 28 weeks of gestation, who self-identify as experiencing insomnia. Five weekly individual sessions of CBT-I will be delivered in person or via telehealth depending on physical distancing guidelines. Assessment of insomnia diagnosis by structured interview, self-reported insomnia symptom severity and sleep problems, and sleep quantity and quality as measured by a daily diary and actigraphy will occur at 12-28 weeks of pregnancy (T1), 1 week post-treatment (T2), and 6 months postpartum (T3).

DISCUSSION

CBT-I delivered in pregnancy has the potential to reduce symptoms of insomnia and depression and could lead to reduced risk of preterm birth, all of which can minimize risk of negative maternal and child health and developmental consequences in the short (e.g., infant death) and long terms (e.g., developmental delays). This RCT builds on a successful open pilot trial conducted by our team and will provide further evaluation of a novel evidence-based treatment for pregnancy-related insomnia, which can be widely disseminated and used to treat individuals that are most in need of intervention. Findings will enhance understanding of pregnancy-related sleep problems, as well as means by which to improve the health and sleep of mothers and their children.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03918057. Registered on 17 April 2019.

Sleep and physical activity from before conception to the end of pregnancy in healthy women: a longitudinal actigraphy study

BACKGROUND

Sleep and physical activity changes are common in pregnancy, but longitudinal data starting before conception are scarce. Our aim was to determine the changes of the daily total sleep time (TST) and physical activity duration (PAD) from before conception to end of pregnancies in respect of pregestational maternal factors.

METHODS

This longitudinal observational study formed part of the CONIMPREG research project and recruited healthy women planning to become pregnant. Sleep and physical activity were recorded around-the-clock for ≥4 days via actigraphy before conception and during each trimester of pregnancy. Data were adjusted according to pregestational maternal body composition, parity and age.

RESULTS

Among 123 women with eligible data, the unadjusted mean (95% confidence interval) TST increased from 415.3 min (405.5-425.2 min) before conception to 458.0 min (445.4-470.6 min) in the 1st trimester, remaining high through the 2nd and 3rd trimesters. Variation was substantial before conception (±2SD range: 307-523 min). The unadjusted mean PAD before conception was 363.7 min (±2SD range: 120-608 min), decreasing sharply to 262.1 min in the first trimester and more gradually thereafter. Vigorous and moderate activity decreased more than light activity. TST and PAD were significantly associated with age, parity, and pregestational body fat percentage; lean body mass was negatively correlated with TST. Results were generally unaffected by seasonal variations.

CONCLUSION

Marked variations were found in pregestational TST and PAD. Healthy women slept ≥30 min longer during pregnancy, while PAD decreased by ≥ 90 min in early pregnancy and continued to decrease thereafter.

Associations between prenatal sleep and psychological health: a systematic review

STUDY OBJECTIVES

This systematic review aimed to examine the: (1) strength of associations between prenatal sleep (ie, duration, quality, and insomnia) and psychological health (ie, depression, anxiety, and stress); and (2) moderating influence of sociodemographic characteristics (ie, maternal age, gestational age/trimester, parity, marital and socioeconomic status [SES]), body mass index (BMI), and meeting sleep recommendations.

METHODS

A systematic search was conducted using PubMed, PsycINFO, Web of Science, and CINHAL to identify studies with at least one sleep measure and a psychological health outcome. Effect sizes (ES) were calculated by associations between individual components of sleep and psychological health (eg, sleep quality-depression).

RESULTS

Reviewed studies (n = 32) included 14,648 participants and yielded 219 ES. ES for anxiety/stress were combined due to insufficient data to analyze individually. Average strengths of associations for sleep duration-depression (ES = .52) and sleep duration-anxiety/stress (ES = .48), sleep quality-depression (ES = .55) and sleep quality-anxiety/stress (ES = .58), and insomnia-depression (ES = .67) ranged from medium to large. Marital status, parity, BMI, and meeting sleep recommendations moderated sleep duration-depression and sleep duration-anxiety/stress. SES, gestational age/trimester, parity, and BMI moderated sleep quality-depression and sleep quality-anxiety/stress associations.

CONCLUSIONS

Poor sleep quality and depression are prevalent during pregnancy and may negatively impact maternal and fetal outcomes. Moderating effects suggest that pregnant women of different BMI status and gestational age differ in their sleep habits and depression and anxiety/stress levels. Findings highlight the need to better understand the impact of these associations on maternal-fetal outcomes to inform interventions to improve sleep and psychological health.

A mixed methods study of perinatal sleep and breastfeeding outcomes in women at risk for postpartum depression

INTRODUCTION

Pregnant and postpartum women experience significant sleep disruption, but the role of perinatal sleep disturbances in breastfeeding is understudied.

METHODS

In this observational cohort study, we used mixed methods to examine associations between perinatal sleep and breastfeeding. Forty-eight women (mean age 28.2 ± 4.9 years) who were euthymic at enrollment but had a history of major depression (n = 43) or bipolar disorder (n = 5) had sleep recorded with wrist actigraphy. We determined feeding status through daily diaries and used semi-structured interviews to identify themes regarding participants' experiences, breastfeeding decisions, and behaviors. To examine whether sleep disturbance during pregnancy predicted breastfeeding (BF) rates, we defined "lower sleep efficiency" (LSE) and "higher sleep efficiency" (HSE) groups based on the median split of actigraphic SE at 33 weeks' gestation (cutoff SE = 84.9%) and classified mothers as No-BF, Mixed-BF (BF + formula), and Exclusive-BF at 2 weeks postpartum.

RESULTS

Percentages of women who did any breastfeeding were: Week 2 = 72.3%, Week 6 = 62.5%, Week 16 = 50%. LSE mothers were less likely than HSE mothers to initiate breastfeeding (percent No-BF: LSE = 45.8%, HSE = 16.7%, P < .05). Average actigraphic sleep onset, sleep offset, time in bed, sleep duration, and SE did not differ based on breastfeeding status at any time point. Qualitative themes included insufficient preparation for the demands of breastfeeding, interrupted and nonrestorative sleep, and unrelenting daytime tiredness.

CONCLUSIONS

In our sample, preserved actigraphic SE during pregnancy was associated with initiation and continuation of breastfeeding. Future work should examine whether improving sleep in pregnancy improves mothers' feeding experiences.

Poor sleep is associated with higher blood pressure and uterine artery pulsatility index in pregnancy: a prospective cohort study

OBJECTIVE

To elucidate the association between sleep disturbances and blood pressure as well as uterine artery Doppler during pregnancy in women with no pre-existing hypertension.

DESIGN

Prospective cohort study.

SETTING

Outpatient specialist clinics at KK Women's and Children's Hospital, Singapore.

POPULATION

Women with viable singleton pregnancies confirmed by ultrasonography at less than 14 weeks of amenorrhoea at first visit.

METHODS

In all, 926 subjects were recruited for this study in the outpatient specialist clinics at KK Women's and Children's Hospital, Singapore, between 1 September 2010 and 31 August 2014. They were followed up throughout pregnancy with sleep quality, blood pressure and uterine artery Doppler assessed at each visit.

MAIN OUTCOME MEASURES

Sleep quality, blood pressure and uterine artery Doppler.

RESULTS

Sleep progressively worsened as pregnancy advanced. Shorter sleep duration and poorer sleep efficiency were associated with higher blood pressure, especially in the first trimester. Mixed model analysis demonstrated an overall positive association between sleep quality represented by Pittsburgh Sleep Quality Index (PSQI) score and diastolic blood pressure (DBP) (P < 0.001) and mean arterial pressure (MAP) (P = 0.005) during pregnancy after considering all trimesters. Sleep duration was found to be negatively associated with both systolic blood pressure (SBP) (P = 0.029) and DBP (P = 0.002), whereas sleep efficiency was negatively correlated with DBP (P = 0.002) only. Overall poor sleep during pregnancy was also found to be associated with a higher uterine artery pulsatility index.

CONCLUSION

Our prospective study demonstrated that poor sleep quality is significantly associated with higher blood pressure and uterine artery pulsatility index during pregnancy.

TWEETABLE ABSTRACT

Poor sleep quality is significantly associated with higher blood pressure and higher uterine artery pulsatility index during pregnancy.