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28.09.2017 Category: News

Sleep disorders during pregnancy and risk of preterm birth

Image: Pixabay, Claudio Scott

Many women suffer from sleep disorders during pregnancy. The nightly sleep of more than 50% of pregnant women, for example, is disturbed due to insomnia, also known as sleeplessness. According to a study by researchers from the University of California, San Francisco (UCSF), pregnant women who are diagnosed with sleep disorders could be at risk for delivering babies before 37 week’s gestation. 

In an observational study, published in Obstetrics & Gynecology, Felder et al. investigated the relationship between different types of sleep disorders (e.g. insomnia, sleep apnea, restless legs syndrome, or narcolepsy) and subtypes of preterm birth (e.g. early vs. late preterm birth, or spontaneous or medically indicated preterm birth). They analysed data from a large cohort of nearly 3 million women in California between 2007 and 2012 with singleton neonates live born between 20 and 44 weeks of gestation. The researchers used a case-control design to separate the effects of poor sleep from other factors that also contribute to a risk of preterm birth: 2,265 women with a sleep disorder diagnosis during pregnancy were matched to controls who did not have such a diagnosis, but had identical maternal risk factors for preterm birth, such as previous preterm birth, smoking during pregnancy, or hypertension.

The results showed that women with a recorded sleep disorder diagnosis during pregnancy were at increased risk of preterm birth compared with women without a sleep disorder diagnosis. The prevalence of preterm birth was 14.6%for women diagnosed with a sleep disorder during pregnancy, compared to 10.9% for women who were not. The odds of preterm birth were more than double for women with sleep apnea and nearly double for women with insomnia. 

More work is urgently needed to test whether this is a causal relationship, identify biological mechanisms, and test the efficacy of interventions for sleep disorders during pregnancy and the effect on preterm birth. The findings also raise questions about reasons of which sleep disorders increase the risk of preterm birth. Inflammation could be a potential mechanism because high levels of inflammatory cytokines in amniotic fluid are associated with increased risk of preterm birth. Further research is needed to test this hypothesis and the extent to which treatment of sleep disorders during pregnancy may modulate inflammatory activity. Alternatively, sleep disorders may have a more indirect path to preterm birth through increased stress. 

Treating sleep disorders during pregnancy could be a way to reduce the preterm rate. Considering the high prevalence of sleep disorders during pregnancy and the availability of evidence-based nonpharmacologic interventions, current findings suggest that screening for severe sleep disorders are recommendable. 

To find out if a cognitive behavioural therapy is effective among pregnant women with insomnia, and ultimately whether it may improve birth outcomes, Felder and colleagues are conducting the UCSF Research on Expecting Moms and Sleep Therapy (REST) Study.

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