INTRODUCTION: The purpose of this study was to evaluate whether positive questionnaire-based screening for obstructive sleep apnea (OSA) was associated with higher rates of miscarriage (SAB). METHODS: Secondary analysis of a prospective observational study of participants enrolled in an OSA screening study between 2010–2012. This analysis received an IRB exemption. A screening questionnaire with standard Epworth (ESS), Berlin (BQ), and novel items was administered at a prenatal care visit. The results of women who completed the survey in the first trimester (1T) were assessed for association with SAB. RESULTS: In a cohort of 213 women screened in the 1T, 30% (n=64) had elevated BQ or ESS scores, 18.8% (n=40) had high ESS scores and 14.6% (n=31) had elevated BQ scores suggestive of risk of OSA. 3.29% (n=7) had high ESS and BQ scores. Women who had both elevated ESS and BQ scores were more likely to experience SAB than those who had elevated scores on one or neither (P=.018). Women who reported snoring (P=.042) or hypertension (P=.013) in the 1T were more likely to experience SAB than women who did not. In contrast, women who reported napping in the 1T were less likely to experience SAB than women who did not (P=.045). CONCLUSION: Elevated BQ and ESS scores are statistically significantly associated with SAB. Snoring, naps and hypertension were the only individual questions from the BQ and ESS with statistically significant associations with SAB. Further investigation into this topic is warranted.

Background Shift work has been associated with adverse pregnancy outcomes. The objective of this study was to evaluate the association between sleep disturbances and adverse pregnancy outcomes. Methods and findings This was a secondary analysis of a prospective study of participants enrolled in a prospective observational study wherein gravidae were screened for sleep apnea (2010–2012). A screening questionnaire with standard sleep apnea questionnaires as well as novel items about shift work and nocturnal sleep duration was administered at a prenatal care visit. Short sleep duration was defined as less than 7 hours. Prolonged sleep duration was defined as greater than 9 hours. In a cohort of 1125 pregnant people, 9.4% reported shift work at the time of screening. Gravidae who reported shift work were more likely than gravidae who reported no shift work to develop preeclampsia (28.3% versus 13.0%, P<0.001), preeclamspsia with severe features (16.0% versus 8.5%, P = 0.010), gestational diabetes (28.3% versus 19.9%, P = 0.041), and a composite of adverse obstetric outcomes (61.3% versus 47.8%, P = 0.008). After adjusting for potentially confounding variables, shift work was associated with an increased risk for preeclampsia with (adjusted relative risk (aRR) 1.70, 95% CI 1.03–2.79, p = 0.036) and without (aRR 2.03, 95% CI 1.43–2.90, p<0.001) severe features, and gestational diabetes mellitus class A1 (aRR 1.47, 95% CI 1.05–2.05, p = 0.023) and class A2 (aRR 1.67, 95% CI 1.13–2.44, p = 0.009). Sleep duration was associated with gestational diabetes (31.3% among those with short sleep duration, 25.2% among those with normal sleep duration and 14.0% among those with prolonged sleep duration, P<0.001) and gestational diabetes class A2 (29.5%, 17.9%, and 10.1%, respectively, P<0.001). Gravidae with prolonged sleep duration experienced less composite adverse pregnancy outcomes at 42.6% compared to 57.4% for those with short sleep duration or 52.5% for those with normal sleep duration, P = 0.002. Conclusions Shift work and sleep duration are both associated with adverse pregnancy outcomes. Further research on the impact of sleep disturbance on pregnancy outcomes is warranted.

In 2012, a public tertiary care hospital in Houston, TX promoted its TOLAC services on social media, resulting in a surge of self-referrals. In 2018, an electronic survey was distributed by email to 200 women who had previously contacted the hospital regarding TOLAC and posted on 2 local social media TOLAC sites. Women were asked to participate if they ever sought TOLAC in the Houston area. Data were analyzed for trends in patient experience seeking TOLAC and comparisons were made based on number of prior cesarean deliveries (CD) and race/ethnicity. RESULTS: The survey was open for responses for 1 month, with 128 completed surveys by the end of the study time period. Of the respondents, most (64%) had 1 prior CD and identified as White (63%). 60% of all women reported contacting >3 providers before finding one that offered TOLAC, with no difference reported for women with 1 vs 2 prior CD (p¼.2). Most women (52%) reported their experience seeking TOLAC to be difficult (5 on Likert scale 1-5), with more difficulty noted by those with 2 vs 1 prior CD, but not statistically significant (p ¼ .06). White women were more likely to report an easier experience seeking TOLAC (Likert 1-4) compared to Black/African women (p¼.04). Of all respondents, 37% attempted TOLAC at the reference hospital. Of those, 70% sought care specifically for TOLAC and only 4% had received care at the hospital previously; 26% were referred by a friend, family, or obstetric provider; 70% were referred through social media information. Black/African women (p¼.02) and Hispanics (p¼.0001) were more likely to have delivered at the reference hospital than White women. CONCLUSION: Our results suggest that women seeking TOLAC have trouble finding providers who offer the service. This may be especially true for Black/African and Hispanic women and women with >1 prior CD. Women may utilize social media forums for resources and recommendations and such platforms may represent an underutilized opportunity to identify regional TOLAC services.

The purpose of this project was to evaluate whether screening positive on obstructive sleep apnea questionnaires in the first trimester of pregnancy was associated with miscarriage. This was a secondary analysis of a prospective observational cohort study of participants who were screened for sleep apnea during pregnancy with the Epworth Sleepiness Scale, Berlin Questionnaire, and novel items related to sleep and napping. This secondary analysis was IRB exempt. Our primary outcome was miscarriage in the index pregnancy. An association between responses to the sleep apnea screening questions with miscarriage of the index pregnancy was queried via Poisson regression. We found that gravidae who had elevated scores on both the Epworth Sleepiness Scale and the Berlin Questionnaire were more likely to experience miscarriage than those who had elevated scores on only one questionnaire or neither (p = 0.018). Gravidae who reported snoring (p = 0.042) or hypertension (p = 0.013) in the first trimester were more likely to experience miscarriage than gravidae who did not. Gravidae who reported napping in the first trimester were less likely to experience miscarriage (p = 0.045), even after adjusting for confounding variables (p = 0.007). In conclusion, we found that screening positive on both the Berlin Questionnaire and Epworth Sleepiness Scale was statistically significantly associated with miscarriage prior to adjustment for confounding variables, as did snoring and hypertension. After adjusting for confounding variables, only not napping was associated with miscarriage. Given the small sample size, further investigation into this topic is warranted.

INTRODUCTION: The purpose of this study was to evaluate the association between measures of sleep deprivation (SD) and adverse pregnancy outcomes. METHODS: A screening questionnaire which included novel items intended to assess sleep deprivation, was administered at the time of prenatal care; this was a secondary analysis of participants enrolled (2010-2012). SD was defined as a 3 hour or more difference between weekday and weekend self-reported sleep duration. This analysis received an IRB exemption. RESULTS: Of 1172 women, 17.41% (n=204) had SD. Women with SD were more likely to have large for gestational age (LGA) babies (6.5% vs. 2.99%, P=.015) and babies admitted to the neonatal intensive care unit (NICU) (21.1% vs. 15.4%, P=.048). Women who reported falling asleep while driving were more likely to have gestational hypertension (gHTN) (18.6% vs. 9.3%, P=.030), preeclampsia (PreE) (27.1% vs. 13.8%, P=.010), PreE with severe features (18.8% vs. 8.68%, P=.017) and to experience adverse composite obstetric outcomes (64.7% vs. 50%, P=.040). Women who reported napping were more likely to have PreE with severe features (11.1% vs. 7.59%, P=.049), preterm birth (PTB) (16.6% vs. 9.71%, P=.001), and NICU admission (20.9% vs. 14.4%, P=.005). Women who reported napping more than 3x/week were more likely to have gHTN (12.0% vs. 8.12%, P=.024), PTB (16.0% vs. 10.3%, P=.003), and adverse composite obstetric outcomes (54.0% vs. 48.3%, P=.047). CONCLUSION: Sleep deprivation, falling asleep while driving, and napping are associated with various adverse obstetric outcomes and composite obstetric outcomes. Further research into the effects of sleep deprivation during pregnancy is warranted.