Sleep Disturbances During Pregnancy and Adverse Maternal and Fetal Outcomes: A Systematic Review and Meta-Analysis

Abstract

Background: Sleep disturbances are highly prevalent in pregnancy and are frequently overlooked as a potential cause of significant morbidity. The association between sleep disturbances and pregnancy outcomes remains largely controversial and needs to be clarified to guide management. We conducted a systematic review and meta-analyses to investigate the association between sleep disturbances and maternal and fetal adverse outcomes. Methods: We searched PubMed, Embase and Web of Science from inception to May 31, 2019, for observational English studies of pregnant women with and without sleep disturbances assessing the risk of obstetric complications in the antenatal, intrapartum or postnatal period, and neonatal complications. We used Newcastle-Ottawa Scales to assess the methodological quality of included studies. We quantified the risks of maternal and fetal complications by comparing pregnant women with and without sleep disturbances and undertook subgroup analyses and meta-regression stratified by several clinical and demographic characteristics. We pooled the associations as odds ratios (OR) and 95% confidence intervals (CI) using fixed-effect or random-effect models as appropriate based on the heterogeneity test. Findings: We included 114 studies with a total of 58,100,274 pregnant women in this meta-analysis. Sleep disturbances were assessed, including poor sleep quality, extreme sleep duration, insomnia, restless legs syndrome, subjective sleep-disordered breathing and diagnosed obstructive sleep apnea. Women with overall sleep disturbances versus those without had a significantly higher risk of pre-eclampsia (OR=2·81, 95% CI:2·38-3·32), gestational hypertension (1·74, 1·54-1·98), gestational diabetes mellitus (1·60, 1·45-1·77), cesarean section (1·50, 1·33-1·69), preterm birth (1·41, 1·27-1·56), large for gestational age (1·40, 1·11-1·77), and stillbirth (1·25, 1·08-1·45), but not low birth weight (1·27, 0·98-1·64), or small for gestational age (1·06, 0·92-1·21). Sleep disturbances were related to higher risks of morbidities in pregnant women who are 30 years or older and overweight before pregnancy. Interpretation: Significant associations exist between sleep disturbances in pregnancy and a variety of adverse maternal and fetal outcomes. Sleep disturbances are treatable and deserve more attention from health-care providers during counseling and should be a part of prenatal health care. Funding Statement: The National Key Research and Development Program of China (no. 2019YFA0706200), and the NSFC-CIHR Joint Health Research Program (no. 81761128036). Declaration of Interests: The authors declare they have no conflicts of interest. Ethics Approval Statement: The study protocol was registered with PROSPERO, number CRD42020148586.