Physical activity and sleep duration during pregnancy have interactive effects on caesarean delivery: a population-based cohort study in Tianjin, China

Abstract

Background There were inconsistent findings in the literature regarding the associations of physical activity and sleep duration during pregnancy with caesarean delivery for different reasons. It was also unknown whether physical activity and sleep duration during pregnancy had interactive effects on the risks of different types of caesarean delivery. The study aimed to investigate the effects of physical activity, sleep duration and their interactions on the risk of caesarean delivery for medical reasons and non-medical reasons. Methods From October 2010 to August 2012, a prospective population-based cohort of 13,015 pregnant women was established in six central urban districts of Tianjin, China. Pregnancy outcomes were retrieved from an electronic database and caesarean delivery was divided into caesarean delivery for medical reasons and caesarean delivery for non-medical reasons. Physical activity and sleep status were collected at 24–28 weeks of gestation using self-reported questionnaires. Logistic regression and additive interaction were used to examine physical activity, sleep duration and their interactive effects on risk of caesarean delivery. Results In the cohort, 5692 (43.7%) and 2641 (20.3%) of women had caesarean delivery for medical reasons and non-medical reasons, respectively. Low physical activity increased the risk of caesarean delivery for medical reasons (adjusted OR: 1.13, 95%CI 1.04–1.23) but not caesarean delivery for non-medical reasons. Sleep duration < 7 h/day and poor sleep quality were not associated with caesarean delivery. Sleep duration ≥9 h/day increased the risk of caesarean delivery for medical reasons (1.12, 1.02–1.22) and caesarean delivery for non-medical reasons (1.16, 1.05–1.29). Co-presence of low physical activity and sleep duration ≥9 h/day increased risk of caesarean delivery (1.25, 1.12–1.41), and their additive interaction was statistically significant for caesarean delivery for medical reasons but not for caesarean delivery for non-medical reasons. Conclusions Low physical activity and excessive sleep duration during pregnancy each increased the risk of caesarean delivery, and they had an interactive effect on the risk of caesarean delivery for medical reasons but not on the risk of caesarean delivery for non-medical reasons. Increasing physical activity and maintaining recommended sleep duration during pregnancy may have benefits for perinatal health.

Maternal sleep during pregnancy and adverse pregnancy outcomes: A systematic review and meta‐analysis

“…Figure 1 shows a flowchart outlining the selection of eligible literature. There were 5,246 articles initially identified, after removing duplicates and double assessment, 41 of which were ultimately included in the meta‐analysis 8 , 14 , 15 , 21 , 22 , 23 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 . These studies took place mainly in the USA ( n = 13) 8 , 31 , 32 , 33 , 34 , 35 , 38 , 39 , ...…”

“…These studies took place mainly in the USA ( n = 13) 8 , 31 , 32 , 33 , 34 , 35 , 38 , 39 , 47 , 49 , 50 , 58 , 59 . Most studies were cohorts ( n = 32) 8 , 14 , 15 , 21 , 22 , 23 , 30 , 31 , 32 , 33 , 34 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 58 , 59 , 62 , whereas there were seven case–control studies 35 , 37 , 55 , 56 , 57 , 60 , 61 and two cross‐sectional studies ...…”

“…A total of 16 studies ( n = 24, 58.8%) reported data for the second trimester. The measurement of sleep time included a questionnaire ( n = 28) 8 , 14 , 15 , 21 , 22 , 29 , 31 , 33 , 34 , 35 , 36 , 37 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 48 , 49 , 50 , 54 , 56 , 59 , 60 , 61 , 63 , PSQI ( n = 8) 23 , 30 , 51 , 53 , 55 , 57 , 58 , 62 , structured interview ( n = 1) 47 , monitor ( n = 2) 38 , 39 , sleep log ( n = 1) 32 and one study did not report 52 . Notably, studies were published from 2004 to 2021.…”

“…Figure 1 shows a flowchart outlining the selection of eligible literature. There were 5,246 articles initially identified, after removing duplicates and double assessment, 41 of which were ultimately included in the meta‐analysis 8,14,15,21–23,29–63 . These studies took place mainly in the USA ( n = 13) 8,31–35,38,39,47,49,50,58,59 .…”

“…These studies took place mainly in the USA (n = 13) 8,[31][32][33][34][35]38,39,47,49,50,58,59 . Most studies were cohorts (n = 32) 8,14,15,[21][22][23][30][31][32][33][34]36,[38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54]58,59,62 , whereas there were seven case-control studies 35,37,[55][56][57]60,61 and two cross-sectional st...…”