Maternal Sleep and Related Pregnancy Outcomes: A Multicenter Cross-Sectional Study in 11 Provinces of Iran
-
Mahmoud Hajipour
,
Maryam Soltani
,
Roya Safari-Faramani
,
Salman Khazaei
,
Koorosh Etemad
,
Sharmin Rahmani
,
Tannaz Valadbeigi
,
Halime Yaghoobi
,
Shahab Rezaeian
Abstract
Objective: Sleep disturbance during pregnancy is one of the most common maternal complaints. Not only does it play a crucial role in a mother’s life, but also it comes with a multitude number of complications. This study aimed at assessing the association between sleep disturbance in pregnancy and maternal and child outcomes. Materials and methods: This was a multicenter cross-sectional study, conducted on pregnant women across 11 provinces in Iran in 2018. Sleep disturbance as a composite variable was defined using the principal component analysis based on five questions. Abortion, anemia in the first and third trimester, gestational diabetes, gestational age, glucose tolerance test (GTT), fasting blood sugar (FBS), mode of delivery, low birth weight and stillbirth were defined as study outcomes.
Results: Totally, 3675 pregnant women enrolled in the study. Most of the participants (84.5%) reported that their sleep duration is less than 8 hours per day. The prevalence of sleep disturbance was 20.7% (95% CI: 19.1, 22.3). After adjusting for maternal age, education, job, place of residency and physical violence, sleep disturbance would increase the odds of abortion (p=0.009), anemia in both first(p=0.001) and third (p=0.003) trimester, gestational age (p=0.049), abnormal FBS (p=0.015) and cesarean section (p<0.001).
Conclusion: Regarding the effect of sleep quality on maternal outcomes, planning and implementing a
suitable intervention in the context of primary health care is necessary. Increasing the awareness of
mothers, health workers and medical personnel about the suitable quality and quantity of sleep during
pregnancy is of great importance.
Okun ML, Roberts JM, Marsland AL, Hall M. How disturbed sleep may be a risk factor for adverse pregnancy outcomes a hypothesis. Obstet Gynecol Surv 2009; 64: 273-80.
2. Fuller PM, Gooley JJ, Saper CB. Neurobiology of the sleep-wake cycle: sleep architecture, circadian regulation, and regulatory feedback. J Biol Rhythms 2006; 21: 482-93.
3. García-Perdomo HA, Zapata-Copete J, Rojas-Cerón CA. Sleep duration and risk of all-cause mortality: a systematic review and meta-analysis. Epidemiol Psychiatr Sci 2019; 28: 578-88.
4. Grandner MA, Seixas A, Shetty S, Shenoy S. Sleep Duration and Diabetes Risk: Population Trends and Potential Mechanisms. Curr Diab Rep 2016; 16: 106.
5. Ouyang P, Sun W. Depression and sleep duration: findings from middle-aged and elderly people in China. Public health 2019; 166: 148-54.
6. Wu Y, Zhai L, Zhang D. Sleep duration and obesity among adults: a meta-analysis of prospective studies. Sleep Med 2014; 15: 1456-62.
7. Facco FL, Grobman WA, Kramer J, Ho KH, Zee PC. Self-reported short sleep duration and frequent snoring in pregnancy: impact on glucose metabolism. Am
J Obstet Gynecol 2010; 203: 142. e1-5.
8. Lee J, Eklund EE, Lambert-Messerlian G, Palomaki GE, Butterfield K, Curran P, et al. Serum Progesterone Levels in Pregnant Women with Obstructive Sleep Apnea: A Case Control Study. J Womens Health (Larchmt) 2017; 26: 259-65.
9. Lee KA, Gay CL. Sleep in late pregnancy predicts length of labor and type of delivery. Am J Obstet Gynecol 2004; 191: 2041-6.
10. Perez-Chada D, Videla AJ, O'flaherty ME, Majul C, Catalini AM, Caballer CA, et al. Snoring, witnessed sleep apnoeas and pregnancy induced hypertension. Acta Obstet Gynecol Scand 2007; 86: 788-92.
11. Franklin KA, Holmgren PA, Jonsson F, Poromaa N, Stenlund H, Svanborg E. Snoring, pregnancy-induced hypertension, and growth retardation of the fetus. Chest 2000; 117: 137-41.
12. Rezaei E, Behboodi Moghadam Z, Saraylu K. Quality of life in pregnant women with sleep disorder. J Family Reprod Health 2013; 7 :87-93.
13. Hajipour M, Tabatabaee HR, Etemad K, Ansari H, Ansari Moghadam A, Mohammadi M, et al. The
Pre-Pregnancy Risk Factors of Stillbirth in Pregnant Iranian Women: A Population-Based Case-Control Study. Health Scope 2019; 8: e64034.
14. World Health Organization. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization guideline. Diabetes Res Clin Pract 2014; 103: 341–63.
15. Palagini L, Gemignani A, Banti S, Manconi M, Mauri M, Riemann D. Chronic sleep loss during pregnancy as a determinant of stress: impact on pregnancy outcome. Sleep Med 2014; 15: 853-9.
16. Okun ML, Luther JF, Wisniewski SR, Sit D, Prairie BA, Wisner KL. Disturbed sleep, a novel risk factor for preterm birth? J Womens Health (Larchmt) 2012; 21: 54-60.
17. Micheli K, Komninos I, Bagkeris E, Roumeliotaki T, Koutis A, Kogevinas M, et al. Sleep patterns in late pregnancy and risk of preterm birth and fetal growth restriction. Epidemiology 2011; 22: 738-44.
18. Alihosseini E, Najar S, Haghighizadeh MH. The Relationship Between Sleep Disorders During Pregnancy and Miscarriage. Jundishapur J Chronic Dis Care 2017; 6: e41340.
19. Okun ML, Hall M, Coussons-Read ME. Sleep disturbances increase interleukin-6 production during pregnancy: implications for pregnancy complications. Reprod Sci 2007; 14: 560-7.
20. Okun ML, Luther JF, Wisniewski SR, Wisner KL. Disturbed sleep and inflammatory cytokines in depressed and nondepressed pregnant women: an exploratory analysis of pregnancy outcomes. Psychosom Med 2013; 75: 670-81.
21. Lee KA, Zaffke ME, McEnany G. Parity and sleep patterns during and after pregnancy. Obstet Gynecol 2000; 95: 14-8.
22. Hanif S. Frequency and pattern of urinary complaints among pregnant women. J Coll Physicians Surg Pak 2006; 16: 514-7.
23. Okun ML, Coussons-Read ME. Sleep disruption during pregnancy: how does it influence serum cytokines?
J Reprod Immunol 2007; 73: 158-65.
24. Samaraweera Y, Abeysena C. Maternal sleep deprivation, sedentary lifestyle and cooking smoke: Risk factors for miscarriage: A case control study. Aust N Z J Obstet Gynaecol 2010; 50: 352-7.
25. Louis JM, Auckley D, Sokol RJ, Mercer BM. Maternal and neonatal morbidities associated with obstructive sleep apnea complicating pregnancy. Am J Obstet Gynecol 2010; 202: 261.e1-5.
26. Okun ML, Roberts JM, Marsland AL, Hall M. How disturbed sleep may be a risk factor for adverse pregnancy outcomes. Obstet Gynecol Surv 2009; 64: 273-80.
27. Espiritu JR. Aging-related sleep changes. Clin Geriatr Med 2008; 24: 1-14, v.
28. Lee KA, Gay CL. Sleep in late pregnancy predicts length of labor and type of delivery. Am J Obstet Gynecol 2004; 191: 2041-6.
29. Zafarghandi N, Hadavand S, Davati A, Mohseni SM, Kimiaiimoghadam F, Torkestani F. The effects of sleep quality and duration in late pregnancy on labor and fetal outcome. J Matern Fetal Neonatal Med 2012; 25: 535-7.
30. Li R, Zhang J, Zhou R, Liu J, Dai Z, Liu D, et al. Sleep disturbances during pregnancy are associated with cesarean delivery and preterm birth. J Matern Fetal Neonatal Med 2017; 30: 733-8.
31. Teong ACA, Diong AX, Omar SZ, Tan PC. The Impact of Self-Reported Sleep on Caesarean Delivery in Women Undergoing Induction of Labour: A Prospective Study. Scientific Reports 2017; 7: 12339.
32. Evans ML, Dick MJ, Clark AS. Sleep during the week before labor: relationships to labor outcomes. Clinical nursing research 1995; 4: 238-49.
33. Beebe KR, Lee KA. Sleep disturbance in late pregnancy and early labor. J Perinat Neonatal Nurs 2007; 21: 103-8.
34. Nazarpour S. Sleep Disorders in Pregnancy and Its Effect on the Length of the Labor and Type of Delivery in Firuzabadi Hospital in Tehran in 2006. Iran Journal of Nursing 2007; 20: 63-73.
35. Vadasz D, Ries V, Oertel WH. Intravenous iron sucrose for restless legs syndrome in pregnant women with low serum ferritin. Sleep medicine 2013; 14: 1214-6.
36. Ghesquière L, Deruelle P, Ramdane Y, Garabedian C, Charley-Monaca C, Dalmas AF. Obstructive sleep apnea in obese pregnant women: A prospective study. PloS one 2020; 15: e0238733.
37. Myoga M, Tsuji M, Tanaka R, Shibata E, Askew DJ, Aiko Y, et al. Impact of sleep duration during pregnancy on the risk of gestational diabetes in the Japan environmental and Children's study (JECS). BMC Pregnancy Childbirth 2019; 19: 483.
38. Facco FL, Grobman WA, Reid KJ, Parker CB, Hunter SM, Silver RM, et al. Objectively measured short sleep
duration and later sleep midpoint in pregnancy are associated with a higher risk of gestational diabetes. Am J Obstet Gynecol 2017; 217: 447.e1-.e13.
39. Pamidi S, Pinto LM, Marc I, Benedetti A, Schwartzman K, Kimoff RJ. Maternal sleep-disordered breathing and adverse pregnancy outcomes: a systematic review and metaanalysis. Am J Obstet Gynecol 2014; 210:
52.e1-52.e14.
40. Reutrakul S, Van Cauter E. Interactions between sleep, circadian function, and glucose metabolism: implications for risk and severity of diabetes. Ann N Y Acad Sci 2014; 1311: 151-73.
41. Izci-Balserak B, Pien GW. The relationship and potential mechanistic pathways between sleep disturbances and maternal hyperglycemia. Current diabetes reports 2014; 14: 459.
42. Hedman C, Pohjasvaara T, Tolonen U, Suhonen-Malm AS, Myllylä VV. Effects of pregnancy on mothers' sleep. Sleep Med 2002; 3: 37-42.
43. Mindell JA, Jacobson BJ. Sleep disturbances during pregnancy. J Obstet Gynecol Neonatal Nurs 2000; 29: 590-7.
44. Ayas NT, White DP, Al-Delaimy WK, Manson JE, Stampfer MJ, Speizer FE, et al. A prospective study of self-reported sleep duration and incident diabetes in women. Diabetes care 2003; 26: 380-4.
45. Bassan H, Uliel-Sibony S, Katsav S, Farber M, Tauman R. Maternal Sleep Disordered Breathing and Neonatal Outcome. Isr Med Assoc J 2016; 18: 45-8.
46. Owusu JT, Anderson FJ, Coleman J, Oppong S, Seffah JD, Aikins A, et al. Association of maternal sleep practices with pre-eclampsia, low birth weight, and stillbirth among Ghanaian women. Int J Gynaecol Obstet 2013; 121: 261-5.
47. Aune D, Saugstad OD, Henriksen T, Tonstad S. Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis. JAMA 2014; 311: 1536-46.
48. Getiye Y, Fantahun M. Factors associated with perinatal mortality among public health deliveries in Addis Ababa, Ethiopia, an unmatched case control study. BMC Pregnancy Childbirth 2017; 17: 245.
2. Fuller PM, Gooley JJ, Saper CB. Neurobiology of the sleep-wake cycle: sleep architecture, circadian regulation, and regulatory feedback. J Biol Rhythms 2006; 21: 482-93.
3. García-Perdomo HA, Zapata-Copete J, Rojas-Cerón CA. Sleep duration and risk of all-cause mortality: a systematic review and meta-analysis. Epidemiol Psychiatr Sci 2019; 28: 578-88.
4. Grandner MA, Seixas A, Shetty S, Shenoy S. Sleep Duration and Diabetes Risk: Population Trends and Potential Mechanisms. Curr Diab Rep 2016; 16: 106.
5. Ouyang P, Sun W. Depression and sleep duration: findings from middle-aged and elderly people in China. Public health 2019; 166: 148-54.
6. Wu Y, Zhai L, Zhang D. Sleep duration and obesity among adults: a meta-analysis of prospective studies. Sleep Med 2014; 15: 1456-62.
7. Facco FL, Grobman WA, Kramer J, Ho KH, Zee PC. Self-reported short sleep duration and frequent snoring in pregnancy: impact on glucose metabolism. Am
J Obstet Gynecol 2010; 203: 142. e1-5.
8. Lee J, Eklund EE, Lambert-Messerlian G, Palomaki GE, Butterfield K, Curran P, et al. Serum Progesterone Levels in Pregnant Women with Obstructive Sleep Apnea: A Case Control Study. J Womens Health (Larchmt) 2017; 26: 259-65.
9. Lee KA, Gay CL. Sleep in late pregnancy predicts length of labor and type of delivery. Am J Obstet Gynecol 2004; 191: 2041-6.
10. Perez-Chada D, Videla AJ, O'flaherty ME, Majul C, Catalini AM, Caballer CA, et al. Snoring, witnessed sleep apnoeas and pregnancy induced hypertension. Acta Obstet Gynecol Scand 2007; 86: 788-92.
11. Franklin KA, Holmgren PA, Jonsson F, Poromaa N, Stenlund H, Svanborg E. Snoring, pregnancy-induced hypertension, and growth retardation of the fetus. Chest 2000; 117: 137-41.
12. Rezaei E, Behboodi Moghadam Z, Saraylu K. Quality of life in pregnant women with sleep disorder. J Family Reprod Health 2013; 7 :87-93.
13. Hajipour M, Tabatabaee HR, Etemad K, Ansari H, Ansari Moghadam A, Mohammadi M, et al. The
Pre-Pregnancy Risk Factors of Stillbirth in Pregnant Iranian Women: A Population-Based Case-Control Study. Health Scope 2019; 8: e64034.
14. World Health Organization. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization guideline. Diabetes Res Clin Pract 2014; 103: 341–63.
15. Palagini L, Gemignani A, Banti S, Manconi M, Mauri M, Riemann D. Chronic sleep loss during pregnancy as a determinant of stress: impact on pregnancy outcome. Sleep Med 2014; 15: 853-9.
16. Okun ML, Luther JF, Wisniewski SR, Sit D, Prairie BA, Wisner KL. Disturbed sleep, a novel risk factor for preterm birth? J Womens Health (Larchmt) 2012; 21: 54-60.
17. Micheli K, Komninos I, Bagkeris E, Roumeliotaki T, Koutis A, Kogevinas M, et al. Sleep patterns in late pregnancy and risk of preterm birth and fetal growth restriction. Epidemiology 2011; 22: 738-44.
18. Alihosseini E, Najar S, Haghighizadeh MH. The Relationship Between Sleep Disorders During Pregnancy and Miscarriage. Jundishapur J Chronic Dis Care 2017; 6: e41340.
19. Okun ML, Hall M, Coussons-Read ME. Sleep disturbances increase interleukin-6 production during pregnancy: implications for pregnancy complications. Reprod Sci 2007; 14: 560-7.
20. Okun ML, Luther JF, Wisniewski SR, Wisner KL. Disturbed sleep and inflammatory cytokines in depressed and nondepressed pregnant women: an exploratory analysis of pregnancy outcomes. Psychosom Med 2013; 75: 670-81.
21. Lee KA, Zaffke ME, McEnany G. Parity and sleep patterns during and after pregnancy. Obstet Gynecol 2000; 95: 14-8.
22. Hanif S. Frequency and pattern of urinary complaints among pregnant women. J Coll Physicians Surg Pak 2006; 16: 514-7.
23. Okun ML, Coussons-Read ME. Sleep disruption during pregnancy: how does it influence serum cytokines?
J Reprod Immunol 2007; 73: 158-65.
24. Samaraweera Y, Abeysena C. Maternal sleep deprivation, sedentary lifestyle and cooking smoke: Risk factors for miscarriage: A case control study. Aust N Z J Obstet Gynaecol 2010; 50: 352-7.
25. Louis JM, Auckley D, Sokol RJ, Mercer BM. Maternal and neonatal morbidities associated with obstructive sleep apnea complicating pregnancy. Am J Obstet Gynecol 2010; 202: 261.e1-5.
26. Okun ML, Roberts JM, Marsland AL, Hall M. How disturbed sleep may be a risk factor for adverse pregnancy outcomes. Obstet Gynecol Surv 2009; 64: 273-80.
27. Espiritu JR. Aging-related sleep changes. Clin Geriatr Med 2008; 24: 1-14, v.
28. Lee KA, Gay CL. Sleep in late pregnancy predicts length of labor and type of delivery. Am J Obstet Gynecol 2004; 191: 2041-6.
29. Zafarghandi N, Hadavand S, Davati A, Mohseni SM, Kimiaiimoghadam F, Torkestani F. The effects of sleep quality and duration in late pregnancy on labor and fetal outcome. J Matern Fetal Neonatal Med 2012; 25: 535-7.
30. Li R, Zhang J, Zhou R, Liu J, Dai Z, Liu D, et al. Sleep disturbances during pregnancy are associated with cesarean delivery and preterm birth. J Matern Fetal Neonatal Med 2017; 30: 733-8.
31. Teong ACA, Diong AX, Omar SZ, Tan PC. The Impact of Self-Reported Sleep on Caesarean Delivery in Women Undergoing Induction of Labour: A Prospective Study. Scientific Reports 2017; 7: 12339.
32. Evans ML, Dick MJ, Clark AS. Sleep during the week before labor: relationships to labor outcomes. Clinical nursing research 1995; 4: 238-49.
33. Beebe KR, Lee KA. Sleep disturbance in late pregnancy and early labor. J Perinat Neonatal Nurs 2007; 21: 103-8.
34. Nazarpour S. Sleep Disorders in Pregnancy and Its Effect on the Length of the Labor and Type of Delivery in Firuzabadi Hospital in Tehran in 2006. Iran Journal of Nursing 2007; 20: 63-73.
35. Vadasz D, Ries V, Oertel WH. Intravenous iron sucrose for restless legs syndrome in pregnant women with low serum ferritin. Sleep medicine 2013; 14: 1214-6.
36. Ghesquière L, Deruelle P, Ramdane Y, Garabedian C, Charley-Monaca C, Dalmas AF. Obstructive sleep apnea in obese pregnant women: A prospective study. PloS one 2020; 15: e0238733.
37. Myoga M, Tsuji M, Tanaka R, Shibata E, Askew DJ, Aiko Y, et al. Impact of sleep duration during pregnancy on the risk of gestational diabetes in the Japan environmental and Children's study (JECS). BMC Pregnancy Childbirth 2019; 19: 483.
38. Facco FL, Grobman WA, Reid KJ, Parker CB, Hunter SM, Silver RM, et al. Objectively measured short sleep
duration and later sleep midpoint in pregnancy are associated with a higher risk of gestational diabetes. Am J Obstet Gynecol 2017; 217: 447.e1-.e13.
39. Pamidi S, Pinto LM, Marc I, Benedetti A, Schwartzman K, Kimoff RJ. Maternal sleep-disordered breathing and adverse pregnancy outcomes: a systematic review and metaanalysis. Am J Obstet Gynecol 2014; 210:
52.e1-52.e14.
40. Reutrakul S, Van Cauter E. Interactions between sleep, circadian function, and glucose metabolism: implications for risk and severity of diabetes. Ann N Y Acad Sci 2014; 1311: 151-73.
41. Izci-Balserak B, Pien GW. The relationship and potential mechanistic pathways between sleep disturbances and maternal hyperglycemia. Current diabetes reports 2014; 14: 459.
42. Hedman C, Pohjasvaara T, Tolonen U, Suhonen-Malm AS, Myllylä VV. Effects of pregnancy on mothers' sleep. Sleep Med 2002; 3: 37-42.
43. Mindell JA, Jacobson BJ. Sleep disturbances during pregnancy. J Obstet Gynecol Neonatal Nurs 2000; 29: 590-7.
44. Ayas NT, White DP, Al-Delaimy WK, Manson JE, Stampfer MJ, Speizer FE, et al. A prospective study of self-reported sleep duration and incident diabetes in women. Diabetes care 2003; 26: 380-4.
45. Bassan H, Uliel-Sibony S, Katsav S, Farber M, Tauman R. Maternal Sleep Disordered Breathing and Neonatal Outcome. Isr Med Assoc J 2016; 18: 45-8.
46. Owusu JT, Anderson FJ, Coleman J, Oppong S, Seffah JD, Aikins A, et al. Association of maternal sleep practices with pre-eclampsia, low birth weight, and stillbirth among Ghanaian women. Int J Gynaecol Obstet 2013; 121: 261-5.
47. Aune D, Saugstad OD, Henriksen T, Tonstad S. Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis. JAMA 2014; 311: 1536-46.
48. Getiye Y, Fantahun M. Factors associated with perinatal mortality among public health deliveries in Addis Ababa, Ethiopia, an unmatched case control study. BMC Pregnancy Childbirth 2017; 17: 245.
| Files | ||
| Issue | Vol 15, No 1 (March 2021) | |
| Section | Original Articles | |
| DOI | https://doi.org/10.18502/jfrh.v15i1.6078 | |
| Keywords | ||
| Sleep Wake Disorders Pregnancy Outcome Stillbirth Iran | ||
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How to Cite
1.
Hajipour M, Soltani M, Safari-Faramani R, Khazaei S, Etemad K, Rahmani S, Valadbeigi T, Yaghoobi H, Rezaeian S. Maternal Sleep and Related Pregnancy Outcomes: A Multicenter Cross-Sectional Study in 11 Provinces of Iran. J Family Reprod Health. 2021;15(1):53-60.
