Abstract
BackgroundPreterm birth is a leading cause of perinatal morbidity and mortality worldwide, resulting in a pressing need to identify risk factors leading to effective interventions. Limited evidence suggests potential relationships between maternal sleep or vital exhaustion and preterm birth, yet the literature is generally inconclusive.MethodsWe examined the relationship between maternal sleep duration and vital exhaustion in the first six months of pregnancy and spontaneous (non-medically indicated) preterm birth among 479 Peruvian women who delivered a preterm singleton infant (<37 weeks gestation) and 480 term controls who delivered a singleton infant at term (≥37 weeks gestation). Maternal nightly sleep and reports of vital exhaustion were ascertained through in-person interviews. Spontaneous preterm birth cases were further categorized as those following either spontaneous preterm labor or preterm premature rupture of membranes. In addition, cases were categorized as very (<32 weeks), moderate (32–33 weeks), and late (34- <37 weeks) preterm birth for additional analyses. Logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).ResultsAfter adjusting for confounders, we found that short sleep duration (≤6 hours) was significantly associated with preterm birth (aOR = 1.56; 95% CI 1.11-2.19) compared to 7–8 hours of sleep. Vital exhaustion was also associated with increased odds of preterm birth (aOR = 2.41; 95% CI 1.79-3.23) compared to no exhaustion (Ptrend <0.001). These associations remained significant for spontaneous preterm labor and preterm premature rupture of membranes. We also found evidence of joint effects of sleep duration and vital exhaustion on the odds of spontaneous preterm birth.ConclusionsThe results of this case–control study suggest maternal sleep duration, particularly short sleep duration, and vital exhaustion may be risk factors for spontaneous preterm birth. These findings call for increased clinical attention to maternal sleep and the study of potential intervention strategies to improve sleep in early pregnancy with the aim of decreasing risk of preterm birth.
Highlights
Preterm birth is a leading cause of perinatal morbidity and mortality worldwide, resulting in a pressing need to identify risk factors leading to effective interventions
Because a number of studies have suggested curvilinear relationships between sleep duration and pregnancy outcomes [25,26,27], we explored the possibility of a nonlinear relation between maternal sleep duration and preterm birth risk using the generalized additive modeling (GAM) procedure [28] by using S-PLUS
The results from these analyses suggest that vital exhaustion may be more strongly associated with preterm birth than sleep duration
Summary
Preterm birth is a leading cause of perinatal morbidity and mortality worldwide, resulting in a pressing need to identify risk factors leading to effective interventions. Preterm birth is a leading cause of perinatal morbidity and mortality worldwide, affecting 15 millions infants and constituting over one million deaths each year [1,2,3]. Because maternal sleep was assessed in the third trimester, the association may be the result of sleep insufficiency attributable to symptoms of preterm labor. Other investigative teams have assessed risk of preterm birth in relation to maternal habitual sleep duration during early pregnancy. The authors of a 2012 case–control study found no association between sleep duration (8 hours), measured in the second trimester, and risk of preterm birth [12]. The authors were unable to distinguish between spontaneous and medically indicated preterm birth
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