Mothers' Sleep Issues Promote Poor Outcomes for Infants

Heidi Splete

December 14, 2022

Several adverse infant outcomes were significantly more likely for infants whose mothers had diagnoses of sleep apnea or insomnia, based on data from approximately 5000 infants.

Sleep disturbance is common during pregnancy, and "sleep disorders during pregnancy can have significant consequences for both the pregnant person and their infant," write Jennifer N. Felder, PhD, of the University of California San Francisco, and colleagues.

However, data on the impact of maternal insomnia on specific infant outcomes are limited, they said.

In a study published recently in the journal Sleep Health, the researchers reviewed data from 3371 pregnant women diagnosed with sleep apnea and 3213 with insomnia. Of these, 2357 and 2212 were matched with controls in a propensity-score analysis. The referent controls were matched for maternal characteristics, obstetric factors, and infant factors among individuals without a sleep disorder. All were singleton pregnancies.

Adverse infant outcomes included:

  • 1- and 5-minute Apgar scores less than 7

  • respiratory distress syndrome

  • neonatal intensive care unit admission

  • hypoglycemia

  • infant death

  • hospital stay of longer than 2 days for vaginal delivery or longer than 4 days for cesarean delivery

  • emergency department visit before 3 months of age

  • emergency department visit in the first year of life

  • composite measure of adverse infant outcomes

Compared with matched controls, the infants born to mothers with sleep apnea had a significantly increased risk for any adverse outcome (50.1% vs 53.5%) and of the specific outcomes of low 1-minute Apgar scores (6.3% vs 9.6%), NICU stays (6.3% vs 8.4%), and an emergency department visit in the first year of life (33.6% vs 36.9%).

For infants born to mothers with insomnia, the only significant difference in outcomes compared with controls was an increased likelihood of an emergency department visit (37.2% vs 32.3%).

"Research on possible mechanisms of the relation between maternal prenatal sleep apnea and poorer birth and infant outcomes associations is small but growing, implicating systemic inflammation and late or prolonged fetal heart rate decelerations," the researchers write in their discussion.

Research on insomnia during pregnancy and adverse infant outcomes is limited, and the largest studies have been complicated by the effects of insomnia medication; therefore, "our finding that infants born to mothers with an insomnia diagnosis were at increased risk of only emergency room visit, but no other analyzed infant outcomes, is important and novel," they note.

The findings were limited by several factors, including the reliance on medical records, which may lack details on how routinely healthcare professionals assessed sleep disorders, the researchers noted. "Consequently, the findings presented here may reflect more severe cases of insomnia and sleep apnea, and may not represent the population of individuals with diagnosed sleep apnea or insomnia during pregnancy generally," the authors say. Other limitations included a lack of information on treatment of sleep disorders and on the timing of diagnosis (before pregnancy or during pregnancy).   

However, the results were strengthened by the large, population-based sample and use of codes to highlight research questions, the researchers said.

In light of the health consequences of sleep disorders in pregnancy, the data suggest that sleep apnea and insomnia in pregnant women may serve as targets for risk assessment of adverse infant outcomes, and more research is needed to determine whether addressing sleep issues reduces these outcomes, they concluded.

The study was supported by the UCSF California Preterm Birth Initiative and by grants to lead author Jennifer Felder, MD, from the National Center for Complementary and Integrative health and to a co-author from the National Heart, Lung, and Blood Institute. The researchers reported no relevant financial relationships.

Sleep Health. Published online November 10, 2022. Full text

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