Sleep duration, vital exhaustion, and odds of spontaneous preterm birth: a case–control study

Abstract

BackgroundPreterm birth is a leading cause of perinatal morbidity and mortality worldwide, resulting in a pressing need to identify risk factors leading to effective interventions. Limited evidence suggests potential relationships between maternal sleep or vital exhaustion and preterm birth, yet the literature is generally inconclusive.MethodsWe examined the relationship between maternal sleep duration and vital exhaustion in the first six months of pregnancy and spontaneous (non-medically indicated) preterm birth among 479 Peruvian women who delivered a preterm singleton infant (<37 weeks gestation) and 480 term controls who delivered a singleton infant at term (≥37 weeks gestation). Maternal nightly sleep and reports of vital exhaustion were ascertained through in-person interviews. Spontaneous preterm birth cases were further categorized as those following either spontaneous preterm labor or preterm premature rupture of membranes. In addition, cases were categorized as very (<32 weeks), moderate (32–33 weeks), and late (34- <37 weeks) preterm birth for additional analyses. Logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).ResultsAfter adjusting for confounders, we found that short sleep duration (≤6 hours) was significantly associated with preterm birth (aOR = 1.56; 95% CI 1.11-2.19) compared to 7–8 hours of sleep. Vital exhaustion was also associated with increased odds of preterm birth (aOR = 2.41; 95% CI 1.79-3.23) compared to no exhaustion (Ptrend <0.001). These associations remained significant for spontaneous preterm labor and preterm premature rupture of membranes. We also found evidence of joint effects of sleep duration and vital exhaustion on the odds of spontaneous preterm birth.ConclusionsThe results of this case–control study suggest maternal sleep duration, particularly short sleep duration, and vital exhaustion may be risk factors for spontaneous preterm birth. These findings call for increased clinical attention to maternal sleep and the study of potential intervention strategies to improve sleep in early pregnancy with the aim of decreasing risk of preterm birth.

Maternal sleep practices and stillbirth: Findings from an international case‐control study

“…There is a large literature demonstrating that maternal sleep disturbance, such as sleep-disordered breathing, short sleep duration, and poor sleep quality are common during pregnancy and have strong associations with poor outcomes such as gestational hypertension and preeclampsia, [15][16][17][18] gestational diabetes, 16,19,20 fetal growth restriction, [21][22][23] and preterm birth. 17,21,24,25 Importantly, the latter outcomes are known risk factors for stillbirth. 26 Since nocturnal events may influence pregnancy outcomes, possibly by induction of inflammatory and oxidative stress responses, endothelial damage, and metabolic derangement, [27][28][29] the link between maternal sleep and stillbirth warrants urgent investigation.…”

Sleep Disturbances and Symptoms of Depression and Daytime Sleepiness in Pregnant Women

“…Our sample size was relatively large compared with the limited actigraphic sleep studies in pregnant women . Unlike most pregnancy outcome research primarily focusing on nighttime sleep , objective and self‐reported measures of nighttime and daytime sleep were assessed concurrently in the present study. There are also several limitations to our analysis.…”

“…More than 75 percent of pregnant women complain of disturbed sleep during the third trimester , approximately 15–36 percent report significant depressive symptomatology , and up to 19.2–47 percent experience daytime sleepiness . These symptoms are distressing to pregnant women and are linked with adverse obstetric conditions, including gestational hypertension and diabetes , prolonged labor and cesarean delivery , preterm labor , small‐for‐gestational‐age infants , and postpartum depression . Available data on the association between sleep disturbances and symptoms of depression and daytime sleepiness in pregnant women are sparse and methodological limitations have been acknowledged, with most studies relying on participants' subjective and retrospective reports of sleep .…”

Childhood abuse is associated with stress-related sleep disturbance and poor sleep quality in pregnancy

“…1 Available evidence suggests that sleep disturbances during pregnancy are associated with adverse perinatal outcomes, including maternal depression, preeclampsia, and preterm birth. 2–4 For example, investigators have reported that short sleep duration (6 or fewer nightly hours) in early pregnancy is associated with elevated trimester-specific blood pressures, 3 increased risks of preeclampsia 3 and spontaneous preterm birth. 4 Given the adverse maternal and perinatal health outcomes associated with disturbed sleep during pregnancy, it is important to identify factors associated with disturbed sleep that may serve as clinically useful screening indicators for poor sleep health.…”