Short Nighttime Sleep Duration and High Number of Nighttime Awakenings Explain Increases in Gestational Weight Gain and Decreases in Physical Activity but Not Energy Intake among Pregnant Women with Overweight/Obesity.

Abigail M Pauley,Emily E Hohman,Krista S Leonard,Daniel E Rivera,Katherine M Mcnitt,Jennifer S Savage,Danielle Symons Downs,Penghong Guo

doi:10.3390/clockssleep2040036

Abstract

Pregnant women are at a high risk for experiencing sleep disturbances, excess energy intake, low physical activity, and excessive gestational weight gain (GWG). Scant research has examined how sleep behaviors influence energy intake, physical activity, and GWG over the course of pregnancy. This study conducted secondary analyses from the Healthy Mom Zone Study to examine between- and within-person effects of weekly sleep behaviors on energy intake, physical activity, and GWG in pregnant women with overweight/obesity (PW-OW/OB) participating in an adaptive intervention to manage GWG. The overall sample of N = 24 (M age = 30.6 years, SD = 3.2) had an average nighttime sleep duration of 7.2 h/night. In the total sample, there was a significant between-person effect of nighttime awakenings on physical activity; women with >1 weekly nighttime awakening expended 167.56 less physical activity kcals than women with <1 nighttime awakening. A significant within-person effect was also found for GWG such that for every increase in one weekly nighttime awakening there was a 0.76 pound increase in GWG. There was also a significant within-person effect for study group assignment; study group appeared to moderate the effect of nighttime awakenings on GWG such that for every one increase in weekly nighttime awakening, the control group gained 0.20 pounds more than the intervention group. There were no significant between- or within-person effects of sleep behaviors on energy intake. These findings illustrate an important need to consider the influence of sleep behaviors on prenatal physical activity and GWG in PW-OW/OB. Future studies may consider intervention strategies to reduce prenatal nighttime awakenings.

Highlights

The model of energy balance to regulate gestationaall weight gain (GWG) does not take into account the extent to which prenatal sleep behaviors influence energy intake and physical activity despite the growing evidence to suggest that sleep behaviors may be influential [4,27,28,29,30,31]
These equivocal findings suggest that sleep behaviors appear to be related to GWG, but further research is needed to elucidate the direction of associations, especially among PW-OW/OB who may be at increased risk for poorer sleep behaviors and higher GWG
A significant within-person effect was found for GWG such that for every increase in 1 weekly nighttime awakening there was 0.76 lb increase in GWG (p = 0.07, effect size = 0.37)

Summary

Introduction

Existing evidence from randomized control trial interventions shows moderating energy intake and increasing physical activity can effectively regulate GWG in pregnant women with normal weight, there is some but limited impact on regulating GWG among PW-OW/OB due to lack of adherence to energy intake and physical activity recommendations [11,26,27]. Pauley and colleagues systematically reviewed associations between prenatal sleep behaviors (e.g., nighttime sleep duration and awakenings, sleep quality, daytime nap duration) and energy intake, physical activity, and GWG [28]. One gap in the literature is the lack of studies measuring prenatal sleep with objective devices such as actigraphy [34] Another limitation is the limited number of studies assessing prenatal sleep behaviors, energy intake, physical activity, and GWG at the weekly level. It was hypothesized that: (1) decreases in weekly nighttime sleep duration, increases in the number of weekly nighttime awakenings, and increases in weekly daytime nap duration would predict increases in weekly energy intake and GWG, and decreases in weekly physical activity [4,29,31]

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