Poor Maternal Sleep Quality May Lead to Preterm Births

Larry Hand

November 01, 2011

November 1, 2011 — Poor sleep quality during early and late pregnancy, in conjunction with other established risk factors, puts women at increased risk for preterm delivery, researchers report in the November issue of Sleep. Behavioral interventions could improve maternal sleep, reduce negative effects of psychosocial pathways, and improve outcomes, they write.

The researchers, led by Michele Okun, PhD, assistant professor of psychiatry and psychology at the University of Pittsburgh School of Medicine in Pennsylvania, evaluated the experiences of 166 women receiving care from a large university medical center during their first trimester of pregnancy. The authors assessed sleep quality during at least 1 visit at 14 to 16, 24 to 26, or 30 to 32 weeks of pregnancy. Fifteen of the women delivered preterm, and 151 delivered at term. Women delivering preterm reported sleep disruptions at the first and last intervals.

"This supports the growing evidence that poor sleep is an important risk factor for preterm birth," Dr. Okun said in news release. "The data suggest that beneficial outcomes may be possible through modifications in behavior," she added.

The researchers used the Pittsburgh Sleep Quality Index, which has 18 questions for study participants to answer. It provides a method to assess sleep duration, nocturnal disruptions, sleep latency, sleep quality, daytime dysfunctions, medication use, and efficiency.

With every 1-point increase in the Pittsburgh Sleep Quality Index score, preterm birth odds rose 25% during early pregnancy and 18% in later pregnancy compared with those for women not experiencing sleep difficulties, the authors note.

Dr. Okun and colleagues suggest that there might be a biological cause for sleep disturbance. Previous research has shown that poorer sleep quality can initiate inflammation, and that sleep disruption in combination with stress may activate childbirth processes prematurely.

"We speculate that the timing and chronicity of poor sleep in pregnancy may affect different physiological pathways that may increase the vulnerability of women to subsequent infection, stress, or other psychosocial risk factors," they write. Whether it is poor sleep quality or short sleep duration, sleep disturbance has been linked, in previous research, with an inflammatory response (namely, elevated circulating and stimulated levels of cytokines).

Limitations of the trial include small sample size and lack of generalizability.

The authors found no explanation as to why sleep disturbances were not reported for the second period.

The study was supported by the Eunice Kennedy Shriver National Institutes of Child Health and Human Development and by the National Institute of Nursing Research. The authors have disclosed no relevant financial relationships.

Sleep. 2011;34:1493-1498. Abstract

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