Association of maternal self-reported sleep quality with gestational diabetes

Abstract

Poor sleep quality has been linked to adverse health outcomes, including obesity, insulin resistance, and diabetes. One mechanism by which poor sleep quality may lead to adverse outcomes is increased cortisol levels, which may contribute to weight gain and impaired glucose metabolism. Our objective was to evaluate the association between maternal self-reported sleep quality in the first half of pregnancy and the development of gestational diabetes mellitus (GDM). A prospective cohort study of 744 pregnant individuals was conducted from 2013-2015 at 4 US sites. Participants were ≥18 yrs. old with a singleton pregnancy, < 21 weeks pregnant, English speaking, and without fetal anomalies, progesterone treatment, or corticosteroid use during pregnancy. We excluded those with pre-gestational diabetes. Participants completed the Sleep Quality Index (SQI) between 12w0d-20w6d gestation. Logistic regression was used to evaluate the association between self-reported poor sleep quality (score >5) and GDM. Covariates included age, income, parity, race/ethnicity (as a social construct), and study site. By including an interaction term in the model, we also tested whether the association between sleep quality and GDM was moderated by obesity status. Among 650 eligible subjects, 60% were white, 16% Black, and 17% Hispanic. The mean BMI was 27.5 kg/m2 (SD: 7.3), and 55 (8.5%) subjects developed GDM. Individuals with GDM were significantly more likely to be older, multiparous, have higher pre-pregnancy BMI, and have lower income. Poor sleep quality was similar between those who developed GDM and those who did not (36.4% vs 37.3%, respectively, p = 0.98). The odds of developing GDM among those reporting poor sleep quality (score >5) was 0.77 (95% CI: 0.42, 1.43). Similarly, those scoring in the upper quartile on the SQI (score > 6) were not at increased risk of developing GDM (aOR: 0.81, 95% CI: 0.41, 1.59). There was no interaction with BMI or obesity (p >0.05). Poor sleep quality in the first half of pregnancy was not associated with an increased risk of developing GDM.View Large Image Figure ViewerDownload Hi-res image Download (PPT)