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Background: Cardiometabolic (CM) risk factors are linked to increased morbidity. Disturbed sleep is associated with CM risk factors in late pregnancy, but little is known about sleep in early pregnancy and CM risk factors. Methods: Diary and actigraphy-assessed sleep information, as well as CM outcomes (blood pressure (BP) and BMI), were collected thrice from pregnant women (N = 161) in early pregnancy: T1 (10-12 weeks), T2 (14-16 weeks), and T3 (18-20 weeks). The sleep variables evaluated included sleep onset latency (SOL), wake after sleep onset (WASO) and total sleep time (TST). Sleep variables were dichotomized using established clinical cutoffs. Results: BMI and BP significantly changed across time. Women with persistent SOL ≥ 20 minutes had greater BMI than women without persistent SOL ≥ 20 minutes prior to covariate adjustment at T1 and T2, but at T3 BMI values converged. .Similar results were observed for persistent WASO ≥ 30 minutes. Persistently long WASO, as measured by actigraphy, was associated with elevated SBP, after controlling for covariates. Conclusions: Consistent with anecdotal evidence, it appears as if a subset of women report substantial difficulty initiating and maintaining sleep during early pregnancy and this may augment risk for higher blood pressure and BMI. Understanding these relationships is important since CM risk factors are linked to maternal and infant morbidity. Assessing sleep in early pregnancy may bestow time necessary for appropriate intervention.

Sleep disturbances in the general population are associated with elevated blood pressure. This may be due to several mechanisms, including sympathetic activation and hypothalamic-pituitary-adrenal (HPA) axis disturbance. Elevated blood pressure in pregnancy can have devastating effects on both maternal and fetal health and is associated with increased risk for preeclampsia and poor delivery outcomes. Preliminary evidence suggests that mechanisms linking sleep and blood pressure in the general population may also hold in the pregnant population. However, the effects of disturbed sleep on physiologic mechanisms that may directly infl uence blood pressure in pregnancy have not been well studied. The role that sleep disturbance plays in gestational blood pressure elevation and its subsequent consequences warrant further investigation. This review evaluates the current literature on sleep disturbance and elevated blood pressure in pregnancy and proposes possible treatment interventions. T he association between sleep disturbances and elevated blood pressure has been extensively studied in the general population. However, relatively few studies have investigated this relationship in the pregnant population. Pregnancy predisposes women to a variety of sleep disturbances.1,2 Similar to non-pregnant individuals, sleep disturbance in pregnancy may be a risk factor for elevated blood pressure, which can lead to maternal and fetal morbidity . 3,4Gestational hypertension, defi ned as a blood pressure higher than 140/90 diagnosed after 20 weeks of gestation, is associated with fetal growth restriction and abruptio placentae and can predispose to preeclampsia, as well as cardiovascular disease later in lif e. 1,[4][5][6] There are few studies evaluating the link between sleep and blood pressure during pregnancy. In this paper, we fi rst review the relationship between sleep and blood pressure in non-pregnant adults. We then outline factors that predispose pregnant women to poor sleep. We conclude with a review of the emerging literature on the associations between sleep and blood pressure in pregnancy. SLEEP AND BLOOD PRESSURE IN THE NON-PREGNANT POPULATIONIn the U.S. the average sleep duration has decreased by 1.5-2 h/night, with > 30% of Americans sleeping < 6 h/night. 7This phenomenon and the concurrent increase in hypertension intimated a possible link between sleep duration and blood pressure. Recently, a series of epidemiological papers have noted an association between sleep duration (both short and long) and elevated blood press ure [8][9][10][11] ; for example, the Sleep Heart Health Study reported that participants who slept < 5 or ≥ 9 h/night had a greater frequency of hypertension than individuals sleeping

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