Morningness/eveningness in gestational diabetes mellitus: clinical characteristics and maternal-neonatal outcomes

Abstract

Objective: This study aims to evaluate the impact of morning-evening preference in pregnancy outcomes in gestational diabetes mellitus (GDM). Materials and methods: This is a prospective cohort study of 2nd-3rd trimester GDM outpatient care in Fortaleza, Brazil (2018-2020. Eveningness was defined by the Horne-Östberg Morningness-Eveningness-Questionnaire (MEQ ≤ 41). Furthermore, we obtained a 7-day actigraphic register. Subjective sleep quality, daytime somnolence, insomnia, fatigue and depressive symptoms were also evaluated. Associations with pregnancy outcomes were investigated. Results: Among 305 patients with GDM, evening preference was found in 21 (6.9%). Patients with evening preference had worse sleep quality (p < 0.01), greater severity of insomnia (p < 0.005), fatigue (p < 0.005) and depressive symptoms (<0.009). Evening chronotype was associated with preeclampsia [p = 0.01; OR = 0.27; CI 0.09-0.79] and a greater need for admission to a neonatal intensive care unit (NICU) [p = 0.02; OR = 0.23; CI .0.06-0.80]. A lower MEQ score confirmed an association with preeclampsia [p = 0.002; OR = 0.94; CI 0.90-0.97] and this was maintained after controlling for age, arterial hypertension, sleep quality, fatigue and depressive symptoms [p < 005; OR = 0.91; CI 0.87-0.95]. Conclusion: In GDM, patients with evening preference had worse sleep quality, more insomnia, fatigue, and depressive symptoms. Furthermore, eveningness was independently associated with preeclampsia. These results indicate the important role of eveningness in adverse pregnancy outcomes.

Eveningness and preeclampsia in gestational diabetes – a response to the letter “Chronotype of pregnant women with diabetes mellitus: what is the relationship with maternal and fetal outcomes”

“…This work evaluates differences in women with gestational diabetes mellitus (GDM) regarding the presence of morningness/eveningness or identified chronotypes investigated during pregnancy in a robust cohort of 305 GDM patients. Our results show that GDM women with evening preference are more likely to develop pre-eclampsia (PE), their offspring were more likely to be admitted on neonatal intensive care unit and there was a marginal increased risk of prematurity ( 1 ).…”

Eating Patterns, Chronotypes, and Their Relationship with Metabolic Health in the Early Postpartum Period in Women after Gestational Diabetes Mellitus

“…Women with GDM face a 7–10-fold higher risk of developing diabetes after pregnancy [ 23 ] and are more prone to future cardiovascular disease [ 24 ]. Notably, within the GDM population, those with an evening chronotype exhibit poorer sleep quality and more depressive symptoms, along with an elevated risk of obstetric complications such as preeclampsia [ 25 ]. Furthermore, the chronotype may influence their metabolic health, as evidenced by a study implementing chrononutrition and sleep hygiene interventions among women with GDM, resulting in improved glycemic control [ 26 ].…”

Association of sleep traits with risk of hypertensive disorders of pregnancy: a mendelian randomization study

“…A comprehensive meta-analysis, incorporating 120 observational studies comprising approximately 60 million pregnant women, evidenced a significant positive correlation between overall sleep disturbances and the incidence of preeclampsia and gestational hypertension [ 3 ]. Specific sleep disturbances, including short sleep duration [ 3 ], obstructive sleep apnea (OSA) [ 8 ], insomnia [ 9 ], excessive daytime sleepiness (EDS) [ 10 ], and chronotype [ 11 ], have been identified in observational studies as factors associated with HDPs. However, due to the limitations inherent in observational studies, causal relationships cannot be inferred, as confounding factors such as cardiometabolic risk factors may impact the observed associations.…”