Sleep in Pregnancy and Maternal Hyperglycemia: a Narrative Review
- 37 Downloads
Purpose of Review
Prevalence of gestational diabetes is increasing globally and sleep may be a modifiable lifestyle factor associated with it. However, existing findings have been inconsistent.
Majority of studies reviewed found a link between extreme sleep durations and elevated risk of maternal hyperglycemia. The findings with sleep-disordered breathing are less consistent. Methodological differences across studies, in terms of sleep assessment methods (subjective vs. objective), study population (low vs. high risk), classification of gestational diabetes and sleep problems, may have contributed to the inconsistent findings. Some studies also suggest the possibility of trimester-specific association between sleep and maternal hyperglycemia.
Large-scale prospective studies comprising objective measurements of sleep, preferably over three trimesters and preconception, are needed to better evaluate the relationship between sleep and maternal hyperglycemia.
KeywordsSleep duration Sleep quality Sleep-disordered breathing Pregnancy Gestational diabetes mellitus
S.C is the corresponding author for the manuscript. N.K.J., D.Z.E and S.C reviewed the literature and drafted the paper. All authors critically reviewed and approved the manuscript.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards and international/national/institutional guidelines).
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 5.Clausen TD, Mathiesen ER, Hansen T, Pedersen O, Jensen DM, Lauenborg J, et al. High prevalence of type 2 diabetes and pre-diabetes in adult offspring of women with gestational diabetes mellitus or type 1 diabetes: the role of intrauterine hyperglycemia. Diabetes Care. 2008;31(2):340–6. https://doi.org/10.2337/dc07-1596.CrossRefPubMedGoogle Scholar
- 11.Reid KJ, Facco FL, Grobman WA, Parker CB, Herbas M, Hunter S, et al. Sleep during pregnancy: the nuMoM2b pregnancy and sleep duration and continuity study. Sleep. 2017;40(5). https://doi.org/10.1093/sleep/zsx045.
- 20.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 Obstetrics Gynecol. 2017;217(4):447 e1–e13. https://doi.org/10.1016/j.ajog.2017.05.066.CrossRefGoogle Scholar
- 21.Karacay Ö, Sepici-Dincel A, Karcaaltincaba D, Sahin D, Yalvaç S, Akyol M, et al. A quantitative evaluation of total antioxidant status and oxidative stress markers in preeclampsia and gestational diabetic patients in 24–36 weeks of gestation. Diabetes Res Clin Pract. 2010;89(3):231–8.CrossRefGoogle Scholar
- 34.Redfern KM, Hine RS, Hollands HJ, Welch CR, Pinkney JH, Rees GA. Objectively measured sleep duration and plasma glucose values following an oral glucose tolerance test amongst pregnant women with obesity in the UK. Sleep Med. 2019;59:110–3. https://doi.org/10.1016/j.sleep.2019.01.017.CrossRefPubMedGoogle Scholar
- 36.Cai S, Tan S, Gluckman PD, Godfrey KM, Saw SM, Teoh OH, et al. Sleep quality and nocturnal sleep duration in pregnancy and risk of gestational diabetes mellitus. Sleep. 2017;40(2). https://doi.org/10.1093/sleep/zsw058.
- 39.Facco FL, Parker CB, Hunter S, Reid KJ, Zee PC, Silver RM, et al. Association of adverse pregnancy outcomes with self-reported measures of sleep duration and timing in women who are nulliparous. J Clin Sleep Med. 2018;14(12):2047–56. https://doi.org/10.5664/jcsm.7534.CrossRefPubMedPubMedCentralGoogle Scholar
- 41.•• Rawal S, Hinkle SN, Zhu Y, Albert PS, Zhang C. A longitudinal study of sleep duration in pregnancy and subsequent risk of gestational diabetes: findings from a prospective, multiracial cohort. Am J Obstet Gynecol. 2017;216(4):399 e1–8. https://doi.org/10.1016/j.ajog.2016.11.1051. This study shows U-shaped association between sleep duration and gestational diabetes and that napping and pre-pregnancy obesity status may modify this association. It was also shown that association of sleep duration and GDM may be trimester-specific, with sleep duration during the second trimester (and not the first trimester) significantly associated with GDM risk. CrossRefGoogle Scholar
- 43.Jenum AK, Morkrid K, Sletner L, Vangen S, Torper JL, Nakstad B, et al. Impact of ethnicity on gestational diabetes identified with the WHO and the modified International Association of Diabetes and Pregnancy Study Groups criteria: a population-based cohort study. Eur J Endocrinol. 2012;166(2):317–24. https://doi.org/10.1530/EJE-11-0866.CrossRefPubMedPubMedCentralGoogle Scholar
- 47.• Zhong C, Chen R, Zhou X, Xu S, Li Q, Cui W, et al. Poor sleep during early pregnancy increases subsequent risk of gestational diabetes mellitus. Sleep Med. 2018;46:20–5. https://doi.org/10.1016/j.sleep.2018.02.014. This study showed trimester-specific association between sleep quality and GDM risk. CrossRefPubMedGoogle Scholar
- 50.• Liu L, Su G, Wang S, Zhu B. The prevalence of obstructive sleep apnea and its association with pregnancy-related health outcomes: a systematic review and meta-analysis. Sleep Breath. 2019;23(2):399–412. https://doi.org/10.1007/s11325-018-1714-7. This review paper only included studies with objectively measured OSA and found that pregnant women with OSA have increased GDM risk.CrossRefPubMedGoogle Scholar
- 53.Tishler PV, Larkin EK, Schluchter MD, Redline S. Incidence of sleep-disordered breathing in an urban adult population: the relative importance of risk factors in the development of sleep-disordered breathing. JAMA. 2003;289(17):2230–7. https://doi.org/10.1001/jama.289.17.2230.CrossRefPubMedGoogle Scholar
- 55.Luque-Fernandez MA, Bain PA, Gelaye B, Redline S, Williams MA. Sleep-disordered breathing and gestational diabetes mellitus: a meta-analysis of 9,795 participants enrolled in epidemiological observational studies. Diabetes Care. 2013;36(10):3353–60. https://doi.org/10.2337/dc13-0778.CrossRefPubMedPubMedCentralGoogle Scholar
- 62.• Facco FL, Parker CB, Reddy UM, Silver RM, Koch MA, Louis JM, et al. Association between sleep-disordered breathing and hypertensive disorders of pregnancy and gestational diabetes mellitus. Obstet Gynecol. 2017;129(1):31–41. https://doi.org/10.1097/AOG.0000000000001805. This study used PSG and demonstrated increasing exposure-response relationships were observed between AHI and GDM.CrossRefPubMedPubMedCentralGoogle Scholar
- 65.• Wanitcharoenkul E, Chirakalwasan N, Amnakkittikul S, Charoensri S, Saetung S, Chanprasertyothin S, et al. Obstructive sleep apnea and diet-controlled gestational diabetes. Sleep Med. 2017;39:101–7. https://doi.org/10.1016/j.sleep.2017.08.010. Experiments in this study showed that OSA severity, as measured by different parameters of hypoxia (e.g. oxygen desaturation), is associated with various metabolic effects in pregnant women with GDM. CrossRefPubMedGoogle Scholar
- 68.Qiu C, Lawrence W, Gelaye B, Stoner L, Frederick IO, Enquobahrie DA, et al. Risk of glucose intolerance and gestational diabetes mellitus in relation to maternal habitual snoring during early pregnancy. PLoS One. 2017;12(9):e0184966. https://doi.org/10.1371/journal.pone.0184966.CrossRefPubMedPubMedCentralGoogle Scholar