Sleep Trajectories Among Pregnant Women and the Impact on Outcomes: A Population-Based Cohort Study

Abstract

Objectives Sleep problems and deprivation are common during pregnancy, particularly in the third trimester. Previous studies are mostly descriptive or focused on specific clinical groups and late pregnancy. We aimed to identify sleep duration trajectories during the pregnancy period, their associated factors, and impact on pregnancy and birth outcomes. Methods We studied 200 women from a mother-child cohort recruited in 2009-2011 from the French general population. We used semi-parametric models to analyze data collected through questionnaires. Results We detected three sleep duration trajectories during pregnancy: short-decreasing (<6.5h/night, 10.8% of the sample), medium-decreasing (6.5-8h/night, 57.6%), and long-increasing (>8h/night, 31.6%) trajectories. Factors associated with the short-decreasing trajectory relative to the medium-decreasing trajectory were older age (odds-ratio/year = 1.13 [95%Confidence-Interval 1.00-1.29]) and working > 28 weeks of gestational age (odds-ratio = 0.30 [0.10-0.90]). Sleep duration during pregnancy in this trajectory group was modified by insomniac symptoms (regression coefficient/trimester = -0.74 [Standard-Error 0.12]) and naps (regression coefficient/trimester = 0.58 [0.25]). Restless legs syndrome was the only factor associated with the long-increasing trajectory and decreased sleep duration (regression coefficient/trimester = -0.88 [0.25]). Assisted delivery (i.e. cesarean section and/or instrumental delivery) and post-partum depression were more frequent among women with the short-decreasing and long-increasing trajectories whereas cesarean section alone was more prevalent among those with the short-decreasing trajectory. Proportion of premature births was higher in the short-decreasing trajectory group. Birth-weight-z-score was lower in the long-increasing trajectory group. Conclusion We identified sleep trajectories among pregnant women with specific risk factors that could affect both pregnancy and birth outcomes. Taking these into consideration could improve both maternal and child health.

Association between maternal sleep duration and quality, and the risk of preterm birth: a systematic review and meta-analysis of observational studies

“…After full text review of the remaining 33 (1.01%) studies, sixteen studies analyzed disease and symptom related to sleep disorder, seven studies were lack of OR and 95% CI. Among these seven studies, three suggested no association between sleep and risk of preterm birth [24][25][26], two studies indicated short sleep was correlated with prematurity [10,27], one study showed short and long sleep increased estimated proportion of preterm birth [28], and one study analyzed the relationship of sleep, inflammatory cytokines and preterm birth, but failed to show the direct association between sleep and preterm birth [29]. Finally, 10 published studies detailing the associations between sleep duration and quality and the risk of preterm birth were included in the final analysis ( Figure 1).…”

Phenotypes of childhood wheeze in Japanese children: A group‐based trajectory analysis

“…[4][5][6] This method has been applied in psychology, medicine, and criminology over the past decade. [7][8][9][10][11][12][13][14][15][16][17][18] The purpose of this study was to classify trajectories of wheezing in children up to 9 years of age in Japan and to evaluate the individual and environmental risk factors for these trajectories.…”

Association between maternal sleep duration and quality, and the risk of preterm birth: a systematic review and meta-analysis of observational studies

“…However, since a limited number of the included studies met the criteria of linear/non-linear dose-response analysis, such analysis was not conducted in the present study. Also, although seven studies were excluded due to the lack of risk estimates for the association between sleep quantity/quality and preterm birth [10,[24][25][26][27][28][29], findings of three of these studies support the main findings of the present meta-analysis [10,27,28]. Of note, although the power of the main analysis suggested that the statistical power of this meta-analysis was greater than 80% to identify sleep duration/quality for preterm birth with minimum OR values of 1.20 (risk factor for sleep duration) and 1.5 (risk factor for sleep quality), limited sample sizes restricted subgroup analyses stratified by study characteristics and potential confounders.…”

“…After full text review of the remaining 33 (1.01%) studies, 16 analyzed diseases and symptoms related to sleep disorders, and seven lacked OR and 95% CI values. Among these seven studies, three suggested no association between sleep and risk of preterm birth [24][25][26], two indicated that short sleep was correlated with prematurity [10,27], one showed that short and long sleep durations were associated with increased risk of preterm birth [28], and one analyzed the relationships among sleep, inflammatory cytokine levels, and preterm birth, but failed to show a direct association between sleep and preterm birth [29]. Finally, 10 published studies detailing the associations of sleep duration and quality with the risk of preterm birth were included for analysis ( Fig.…”