Megan Brooks

June 12, 2015

SEATTLE — Short sleep duration during pregnancy is associated with increased risk for gestational diabetes mellitus (GDM), independent of maternal age and body mass index (BMI), a new study indicates.

Prior studies have shown that sleep restriction adversely affects appetite-regulating hormones, insulin sensitivity, inflammation, and autonomic function. However, data regarding the clinical consequences of short sleep durations during pregnancy are limited.

The new study suggests that short sleep duration is a "modifiable risk factor associated with the development of gestational diabetes," said study leader Kathyrn J. Reid, PhD, from Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Dr Reid presented her study during an oral presentation here at SLEEP 2015: the Annual Meeting of the Associated Professional Sleep Societies.

The study team investigated whether insufficient sleep is associated with increased risks for gestational hypertension (GHTN), pre-eclampsia, and/or GDM. Participants included 760 nulliparous women with singleton gestation enrolled in a multicenter prospective cohort study of adverse pregnancy outcomes.

Between 16 and 21 weeks gestation, they wore an actigraph to record objective sleep activity for 7 consecutive days. Women with pregestational diabetes and chronic hypertension were excluded. Short sleep duration was defined as average sleep of less than 7 hours per night.

The median nightly sleep duration was 7.4 hours; 28% of the women had short sleep duration, averaged over the 7 days. Overall, GHTN, pre-eclampsia, and GDM developed in 5.1%, 5.1%, and 4.1% of women, respectively.

For their analysis, the researchers grouped GHTN and pre-eclampsia together, and they found no significant association between short sleep duration and GHTN/pre-eclampsia. The rate was 11.3% with short sleep duration and 9.9% without (P = NS).

However, the rate of GDM was significantly increased in women with short sleep duration (6.6% vs 3.1%). Short sleep duration was associated with GDM even after adjustment for age and BMI (adjusted odds ratio, 2.12; 95% confidence interval, 1.02 - 4.41), Dr Reid reported.

Screen for Sleep Problems in Pregnancy?

She said further research is needed to figure out whether screening for sleep disturbances and education to modify sleep patterns in women with short sleep duration can lessen the risk for GDM.

"We also need to tease out why their sleep was disrupted, given that these were nulliparous women. In scoring all of these actigraphy studies, sleep fragmentation and wake after sleep onset seem to be the major issues, so we need to better understand what is causing pregnant women to have these sleep disturbances and develop and test interventions to promote sleep during pregnancy," Dr Reid said.

In an interview with Medscape Medical News, Michael Thorpy, MD, director of the Sleep-Wake Disorders Center at Montefiore Medical Center in New York City, who was not involved in the study, said the association between reduced sleep and metabolic disturbance is "well known in the sleep community. Some of the work originally came out of the University of Chicago showing that if you restrict sleep you can cause an increase in insulin resistance and glucose intolerance."

This new large study in 760 nurses, Dr Thorpy said, "is consistent with what we know about reduced sleep and it having metabolic disturbances. For any woman that might suffer from some glucose intolerance, this emphasizes the importance of getting an adequate amount of sleep in pregnancy," Dr Thorpy said.

The study had no commercial funding. The authors and Dr Thorpy have disclosed no relevant financial relationships.

SLEEP 2015: Annual Meeting of the Associated Professional Sleep Societies. Abstract 1145. Presented June 8, 2015.

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