Background
Although uterine contractions have a diurnal periodicity and increase in frequency
during hours of darkness, data on the relationship between sleep duration and sleep
timing patterns and preterm birth are limited.
Objective
We sought to examine the relationship of self-reported sleep duration and timing in
pregnancy with preterm birth.
Study Design
In the prospective Nulliparous Pregnancy Outcome Study: Monitoring Mothers-to-be cohort,
women completed a survey of sleep patterns at 6–13 weeks gestation (visit 1) and again
at 22–29 weeks gestation (visit 3). Additionally, at 16–21 weeks gestation (visit
2), a subgroup completed a weeklong actigraphy recording of their sleep. Weekly averages
of self-reported sleep duration and sleep midpoint were calculated. A priori, sleep
duration of <7 hours was defined as “short,” and sleep midpoint after 5 am was defined as “late.” The relationships among these sleep characteristics and all
preterm birth and spontaneous preterm birth at <37 weeks gestation were examined in
univariate analyses. Multivariable logistic regressions that controlled for age and
body mass index alone (model 1) and with additional covariates (race, smoking, insurance,
and employment schedule) following a backward elimination process (model 2) were performed.
Results
Of the 10,038 women who were enrolled, sleep survey data were available on 7524 women
at visit 1 and 7668 women at visit 3. The rate of short sleep duration was 17.1% at
visit 1 and 20.7% at visit 3. The proportion with a late sleep midpoint was 11.6%
at visit 1 and 12.2% at visit 3. There was no significant relationship between self-reported
short sleep and preterm birth across all visits. However, self-reported late sleep
midpoint (>5 am) was associated with preterm birth . Women with a late sleep midpoint (>5 am) in early pregnancy had a preterm birth rate of 9.5%, compared with 6.9% for women
with sleep midpoint ≤5 am (P=.005). Similarly, women with a late sleep midpoint had a higher rate of spontaneous
preterm birth (6.2% vs 4.4%; P=.019). Comparable results were observed for women with a late sleep midpoint at visit
3 (all preterm birth 8.9% vs 6.6%; P=.009; spontaneous preterm birth 5.9% vs 4.3%; P=.023). All adjusted analyses on self-reported sleep midpoint (models 1 and 2) maintained
statistical significance (P<.05), except for visit 1, model 2 for spontaneous preterm birth (P=.07). The visit 2 objective data from the smaller subgroup (n=782) demonstrated similar
trends in preterm birth rates by sleep midpoint status.
Conclusion
Self-reported late sleep midpoint in both early and late pregnancy, but not short
sleep duration, is associated with an increased rate of preterm birth.
Key words
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Article Info
Publication History
Accepted:
August 26,
2019
Received in revised form:
August 6,
2019
Received:
May 23,
2019
Footnotes
Supported by funding from the National Heart, Lung, and Blood Institute and the Eunice Kennedy Shriver National Institute of Child Health and Human Development : U10-HL119991 ; U10-HL119989 ; U10-HL120034 ; U10-HL119990 ; U10-HL120006 ; U10-HL119992 ; U10-HL120019 ; U10-HL119993 ; and U10-HL120018 ; R01HL105549 . Supplemental funding for this analysis was provided by the National Institutes of Health Office of Behavioral and Social Sciences Research through U10-HL119992 ; support was provided by the National Center for Advancing Translational Sciences–UL-1-TR000124, UL-1-TR000153, and UL-1-TR001108.
ClinicalTrials.gov Registration number NCT02231398.
The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
P.P.Z. serves as a consult to Philips Respironics, the makers of the actiwatches that were purchased for use in this study. The remaining authors report no conflict of interest.
Cite this article as: Facco FL, Parker CB, Hunter S, et al. Later sleep timing is associated with an increased risk of preterm birth in nulliparous women. Am J Obstet Gynecol MFM 2019;1:100040.
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