Self-Reported Shortened Sleep Duration and Adverse Maternal and Infant Outcomes Open Access

Williams, Jennifer (2017)

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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

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