Abstract
Abstract Shortened Sleep Duration in Pregnancy and Adverse Maternal
and Infant Outcomes By Jennifer Lynn Williams Background: Women's
sleep needs increase during pregnancy. Most pregnant women need
more sleep than the 7-8 hours needed by non-pregnant individuals.
One-quarter to one-third of pregnant women experience short sleep
duration (<7 hours) as early as the first trimester; with the
proportion experiencing shortened sleep duration increasing as
pregnancy progresses. Limited evidence suggests that self-reported
shortened sleep duration (SRSSD) in pregnancy adversely affects
maternal cardiometabolic and infant birth outcomes. The purpose of
this study is to determine if SRSSD is independently associated
with clinically diagnosed gestational diabetes mellitus (GDM),
incident hypertension in pregnancy, preeclampsia, preterm birth
(PTB) or small for gestational age (SGA). Sample and Design: Data
was derived from the Pregnancy and Influenza Study (PIP), a
prospective, observational cohort of pregnant women receiving
prenatal care through two managed health care systems. Data from a
subset of PIP enrollees (n=1271) were obtained from enrollment
interviews, and electronic medical records. Univariate associations
between SRSSD and dependent clinical outcomes, between SRSSD and
covariates, and between clinical outcomes and covariates was
conducted using Pearson chi-squared tests. Multinomial logistic
regression models were conducted for each outcome. Analyses were
conducted with SPSS version 21(SPSS Inc., Chicago, IL). Results:
The majority of women reported sleeping seven to nine hours a night
(69%). SRSSD was reported by 11% of respondents. Factors associated
with SRSSD at a p value <0.05 included maternal age at
conception, race/ethnicity, education, cohabiting with a spouse or
partner, and smoke exposure. Percentages of women with selected
outcomes were: GDM (9%); incident hypertension in pregnancy (7%);
preeclampsia (3%), preterm (3%) and SGA (6%). In logistic
regression models, SRSSD was not associated with clinically
diagnosed GDM (Adjusted Odds Ratio (aOR) 1.18, 95% confidence
interval (CI) 0.55-1.98), incident hypertension in pregnancy (aOR
0.69, CI 0.29-1.66), preeclampsia, (aOR 1.54 CI 0.56-4.25), PTB
(aOR 0.87, 95% CI 0.25-2.98) or SGA (aOR 1.39, 95% CI 0.86-2.70).
Conclusion: Results from this analysis did not find associations
between SRSSD and clinically diagnosed GDM, incident hypertension
in pregnancy, preeclampsia, PTB or SGA. Further research is needed
on the effects of sleep duration and adverse pregnancy and infant
outcomes.
Table of Contents
Table of Contents Chapter 1: Introduction and Specific Aims
Introduction 1 Specific aims 3 Chapter 2: Background and
Significance Sleep duration in U.S. adults 4 Effects of shortened
sleep duration (general population) 5 Cardiovascular disease 5
Diabetes 7 Dyslipidemias 9 Obesity 10 Metabolic syndrome 11
Summary(general population) 13 Sociodemographic factors of short
sleep duration 13 Shortened sleep duration in pregnant women 14
Preterm birth 15 Labor length and delivery type 17 Gestational
diabetes and impaired glucose tolerance 18 Hypertensive disorders
21 Depression and mood disorders 22 Birth weight, fetal growth
restriction, APGAR 23 Conceptual Framework 24 Chapter 3: Research
Design and Methods Study design 26 Description of parent study 26
Procedures of parent study 28 Secondary analysis study methods 31
Exclusion criteria for secondary analysis 31 Secondary analysis
power calculation 31 Statistical analysis 32 Instruments and
measures 33 Variables 35 Data analysis for Specific Aim 1 39 Data
analysis for Specific Aim 2 41 Data analysis for Specific Aim 3 42
Limitations 42 Summary 43 Tables Table 1. Data collection points 44
Table 2. Sample size calculations for outcomes of interest 45 Table
3. Variables and measures 46 References 56 Paper 1. 71 Paper 2. 118
Integrative Summary and Synthesis 160 Appendices Shortened sleep
duration and pregnancy outcomes Appendix A PIP maternal enrollment
interview Appendix B Infant birth outcomes variable creation plan
Appendix C Maternal outcomes variable creation plan Appendix D
Vitals and labs variable creation plan Appendix E High risk
variable creation plan Appendix F Adaptation of Lee's Conceptual
Model of Impaired Sleep Appendix G
About this Dissertation
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