Current Diabetes Reports

, 19:150 | Cite as

Sleep in Pregnancy and Maternal Hyperglycemia: a Narrative Review

  • Nur Khairani Farihin Abdul Jafar
  • Derric Zenghong Eng
  • Shirong CaiEmail author
Diabetes and Pregnancy (M-F Hivert and CE Powe, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Diabetes and Pregnancy


Purpose of Review

Prevalence of gestational diabetes is increasing globally and sleep may be a modifiable lifestyle factor associated with it. However, existing findings have been inconsistent.

Recent Findings

Majority of studies reviewed found a link between extreme sleep durations and elevated risk of maternal hyperglycemia. The findings with sleep-disordered breathing are less consistent. Methodological differences across studies, in terms of sleep assessment methods (subjective vs. objective), study population (low vs. high risk), classification of gestational diabetes and sleep problems, may have contributed to the inconsistent findings. Some studies also suggest the possibility of trimester-specific association between sleep and maternal hyperglycemia.


Large-scale prospective studies comprising objective measurements of sleep, preferably over three trimesters and preconception, are needed to better evaluate the relationship between sleep and maternal hyperglycemia.


Sleep duration Sleep quality Sleep-disordered breathing Pregnancy Gestational diabetes mellitus 


Author Contributions

S.C is the corresponding author for the manuscript. N.K.J., D.Z.E and S.C reviewed the literature and drafted the paper. All authors critically reviewed and approved the manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards and international/national/institutional guidelines).


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Buckley BS, Harreiter J, Damm P, Corcoy R, Chico A, Simmons D, et al. Gestational diabetes mellitus in Europe: prevalence, current screening practice and barriers to screening. A review. Diabet Med. 2012;29(7):844–54. Scholar
  2. 2.
    Zhu Y, Zhang C. Prevalence of gestational diabetes and risk of progression to type 2 diabetes: a global perspective. Curr Diab Rep. 2016;16(1):7. Scholar
  3. 3.
    Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358(19):1991–2002. Scholar
  4. 4.
    Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care. 2002;25(10):1862–8.CrossRefGoogle Scholar
  5. 5.
    Clausen TD, Mathiesen ER, Hansen T, Pedersen O, Jensen DM, Lauenborg J, et al. High prevalence of type 2 diabetes and pre-diabetes in adult offspring of women with gestational diabetes mellitus or type 1 diabetes: the role of intrauterine hyperglycemia. Diabetes Care. 2008;31(2):340–6. Scholar
  6. 6.
    Kim SY, Sharma AJ, Callaghan WM. Gestational diabetes and childhood obesity: what is the link? Curr Opin Obstet Gynecol. 2012;24(6):376–81. Scholar
  7. 7.
    Fraser A, Lawlor DA. Long-term health outcomes in offspring born to women with diabetes in pregnancy. Current Diab Rep. 2014;14(5):489. Scholar
  8. 8.
    Driver HS, Shapiro CM. A longitudinal study of sleep stages in young women during pregnancy and postpartum. Sleep. 1992;15(5):449–53. Scholar
  9. 9.
    Wilson DL, Barnes M, Ellett L, Permezel M, Jackson M, Crowe SF. Decreased sleep efficiency, increased wake after sleep onset and increased cortical arousals in late pregnancy. Aust N Z J Obstet Gynaecol. 2011;51(1):38–46. Scholar
  10. 10.
    Kizilirmak A, Timur S, Kartal B. Insomnia in pregnancy and factors related to insomnia. ScientificWorldJournal. 2012;2012:197093. Scholar
  11. 11.
    Reid KJ, Facco FL, Grobman WA, Parker CB, Herbas M, Hunter S, et al. Sleep during pregnancy: the nuMoM2b pregnancy and sleep duration and continuity study. Sleep. 2017;40(5).
  12. 12.
    Mindell JA, Cook RA, Nikolovski J. Sleep patterns and sleep disturbances across pregnancy. Sleep Med. 2015;16(4):483–8. Scholar
  13. 13.
    Pien GW, Schwab RJ. Sleep disorders during pregnancy. Sleep. 2004;27(7):1405–17.CrossRefGoogle Scholar
  14. 14.
    Izci-Balserak B, Pien GW. Sleep-disordered breathing and pregnancy: potential mechanisms and evidence for maternal and fetal morbidity. Curr Opin Pulm Med. 2010;16(6):574–82. Scholar
  15. 15.
    Izci-Balserak B, Pien GW. The relationship and potential mechanistic pathways between sleep disturbances and maternal hyperglycemia. Curr Diab Rep. 2014;14(2):459. Scholar
  16. 16.
    Reutrakul S, Van Cauter E. Interactions between sleep, circadian function, and glucose metabolism: implications for risk and severity of diabetes. Ann N Y Acad Sci. 2014;1311:151–73. Scholar
  17. 17.
    Facco FL, Grobman WA, Kramer J, Ho KH, Zee PC. Self-reported short sleep duration and frequent snoring in pregnancy: impact on glucose metabolism. Am J Obstet Gynecol. 2010;203(2):142 e1–5. Scholar
  18. 18.
    Izci Balserak B, Jackson N, Ratcliffe SA, Pack AI, Pien GW. Sleep-disordered breathing and daytime napping are associated with maternal hyperglycemia. Sleep Breathing. 2013;17(3):1093–102. Scholar
  19. 19.
    Reutrakul S, Zaidi N, Wroblewski K, Kay HH, Ismail M, Ehrmann DA, et al. Sleep disturbances and their relationship to glucose tolerance in pregnancy. Diabetes Care. 2011;34(11):2454–7. Scholar
  20. 20.
    Facco FL, Grobman WA, Reid KJ, Parker CB, Hunter SM, Silver RM, et al. Objectively measured short sleep duration and later sleep midpoint in pregnancy are associated with a higher risk of gestational diabetes. Am J Obstetrics Gynecol. 2017;217(4):447 e1–e13. Scholar
  21. 21.
    Karacay Ö, Sepici-Dincel A, Karcaaltincaba D, Sahin D, Yalvaç S, Akyol M, et al. A quantitative evaluation of total antioxidant status and oxidative stress markers in preeclampsia and gestational diabetic patients in 24–36 weeks of gestation. Diabetes Res Clin Pract. 2010;89(3):231–8.CrossRefGoogle Scholar
  22. 22.
    Retnakaran R, Hanley AJ, Raif N, Connelly PW, Sermer M, Zinman B. C-reactive protein and gestational diabetes: the central role of maternal obesity. J Clin Endocrinol Metab. 2003;88(8):3507–12.CrossRefGoogle Scholar
  23. 23.
    Winkler G, Cseh K, Baranyi É, Melczer Z, Speer G, Hajós P, et al. Tumor necrosis factor system in insulin resistance in gestational diabetes. Diabetes Res Clin Pract. 2002;56(2):93–9.CrossRefGoogle Scholar
  24. 24.
    Chua EC-P, Tan W-Q, Yeo S-C, Lau P, Lee I, Mien IH, et al. Heart rate variability can be used to estimate sleepiness-related decrements in psychomotor vigilance during total sleep deprivation. Sleep. 2012;35(3):325–34.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Reutrakul S, Mokhlesi B. Obstructive sleep apnea and diabetes: a state of the art review. Chest. 2017;152(5):1070–86.CrossRefGoogle Scholar
  26. 26.
    O’Keeffe M, St-Onge M. Sleep duration and disorders in pregnancy: implications for glucose metabolism and pregnancy outcomes. Int J Obes. 2013;37(6):765.CrossRefGoogle Scholar
  27. 27.
    Palagini L, Gemignani A, Banti S, Manconi M, Mauri M, Riemann D. Chronic sleep loss during pregnancy as a determinant of stress: impact on pregnancy outcome. Sleep Med. 2014;15(8):853–9.CrossRefGoogle Scholar
  28. 28.
    Rizza RA, Mandarino LJ, Gerich JE. Cortisol-induced insulin resistance in man: impaired suppression of glucose production and stimulation of glucose utilization due to a postreceptor defect of insulin action. J Clin Endocrinol Metab. 1982;54(1):131–8.CrossRefGoogle Scholar
  29. 29.
    Reutrakul S, Anothaisintawee T, Herring SJ, Balserak BI, Marc I, Thakkinstian A. Short sleep duration and hyperglycemia in pregnancy: aggregate and individual patient data meta-analysis. Sleep Med Rev. 2018;40:31–42.CrossRefGoogle Scholar
  30. 30.
    Xu Y-H, Shi L, Bao Y-P, Chen S-J, Shi J, Zhang R-L, et al. Association between sleep duration during pregnancy and gestational diabetes mellitus: a meta-analysis. Sleep Med. 2018;52:67–74.CrossRefGoogle Scholar
  31. 31.
    Qiu C, Enquobahrie D, Frederick IO, Abetew D, Williams MA. Glucose intolerance and gestational diabetes risk in relation to sleep duration and snoring during pregnancy: a pilot study. BMC Womens Health. 2010;10:17. Scholar
  32. 32.
    Gooley JJ, Mohapatra L, Twan DCK. The role of sleep duration and sleep disordered breathing in gestational diabetes mellitus. Neurobiol Sleep Circadian Rhythms. 2018;4:34–43. Scholar
  33. 33.
    Herring SJ, Nelson DB, Pien GW, Homko C, Goetzl LM, Davey A, et al. Objectively measured sleep duration and hyperglycemia in pregnancy. Sleep Med. 2014;15(1):51–5. Scholar
  34. 34.
    Redfern KM, Hine RS, Hollands HJ, Welch CR, Pinkney JH, Rees GA. Objectively measured sleep duration and plasma glucose values following an oral glucose tolerance test amongst pregnant women with obesity in the UK. Sleep Med. 2019;59:110–3. Scholar
  35. 35.
    Twedt R, Bradley M, Deiseroth D, Althouse A, Facco F. Sleep duration and blood glucose control in women with gestational diabetes mellitus. Obstet Gynecol. 2015;126(2):326–31. Scholar
  36. 36.
    Cai S, Tan S, Gluckman PD, Godfrey KM, Saw SM, Teoh OH, et al. Sleep quality and nocturnal sleep duration in pregnancy and risk of gestational diabetes mellitus. Sleep. 2017;40(2).
  37. 37.
    Wang H, Leng J, Li W, Wang L, Zhang C, Li W, et al. Sleep duration and quality, and risk of gestational diabetes mellitus in pregnant Chinese women. Diabet Med. 2017;34(1):44–50. Scholar
  38. 38.
    Xu X, Liu Y, Liu D, Li X, Rao Y, Sharma M, et al. Prevalence and determinants of gestational diabetes mellitus: a cross-sectional study in China. Int J Environ Res Public Health. 2017;14(12). Scholar
  39. 39.
    Facco FL, Parker CB, Hunter S, Reid KJ, Zee PC, Silver RM, et al. Association of adverse pregnancy outcomes with self-reported measures of sleep duration and timing in women who are nulliparous. J Clin Sleep Med. 2018;14(12):2047–56. Scholar
  40. 40.
    Ahmed AH, Hui S, Crodian J, Plaut K, Haas D, Zhang L, et al. Relationship between sleep quality, depression symptoms, and blood glucose in pregnant women. West J Nurs Res. 2018;193945918809714. Scholar
  41. 41.
    •• Rawal S, Hinkle SN, Zhu Y, Albert PS, Zhang C. A longitudinal study of sleep duration in pregnancy and subsequent risk of gestational diabetes: findings from a prospective, multiracial cohort. Am J Obstet Gynecol. 2017;216(4):399 e1–8. This study shows U-shaped association between sleep duration and gestational diabetes and that napping and pre-pregnancy obesity status may modify this association. It was also shown that association of sleep duration and GDM may be trimester-specific, with sleep duration during the second trimester (and not the first trimester) significantly associated with GDM risk. CrossRefGoogle Scholar
  42. 42.
    Cheung NW, Wasmer G, Al-Ali J. Risk factors for gestational diabetes among Asian women. Diabetes Care. 2001;24(5):955–6.CrossRefGoogle Scholar
  43. 43.
    Jenum AK, Morkrid K, Sletner L, Vangen S, Torper JL, Nakstad B, et al. Impact of ethnicity on gestational diabetes identified with the WHO and the modified International Association of Diabetes and Pregnancy Study Groups criteria: a population-based cohort study. Eur J Endocrinol. 2012;166(2):317–24. Scholar
  44. 44.
    Sedov ID, Cameron EE, Madigan S, Tomfohr-Madsen LM. Sleep quality during pregnancy: a meta-analysis. Sleep Med Rev. 2018;38:168–76.CrossRefGoogle Scholar
  45. 45.
    August EM, Salihu HM, Biroscak BJ, Rahman S, Bruder K, Whiteman VE. Systematic review on sleep disorders and obstetric outcomes: scope of current knowledge. Am J Perinatol. 2013;30(04):323–34.CrossRefGoogle Scholar
  46. 46.
    Naud K, Ouellet A, Brown C, Pasquier J-C, Moutquin J-M. Is sleep disturbed in pregnancy? J Obstet Gynaecol Can. 2010;32(1):28–34.CrossRefGoogle Scholar
  47. 47.
    • Zhong C, Chen R, Zhou X, Xu S, Li Q, Cui W, et al. Poor sleep during early pregnancy increases subsequent risk of gestational diabetes mellitus. Sleep Med. 2018;46:20–5. This study showed trimester-specific association between sleep quality and GDM risk. CrossRefPubMedGoogle Scholar
  48. 48.
    Chirwa S, Nwabuisi CR, Ladson GM, Korley L, Whitty JE, Atkinson R, et al. Poor sleep quality is associated with higher hemoglobin A1c in pregnant women: a pilot observational study. Int J Environ Res Public Health. 2018;15(10). Scholar
  49. 49.
    Li L, Zhao K, Hua J, Li S. Association between sleep-disordered breathing during pregnancy and maternal and fetal outcomes: an updated systematic review and meta-analysis. Front Neurol. 2018;9:91. Scholar
  50. 50.
    • Liu L, Su G, Wang S, Zhu B. The prevalence of obstructive sleep apnea and its association with pregnancy-related health outcomes: a systematic review and meta-analysis. Sleep Breath. 2019;23(2):399–412. This review paper only included studies with objectively measured OSA and found that pregnant women with OSA have increased GDM risk.CrossRefPubMedGoogle Scholar
  51. 51.
    Ding XX, Wu YL, Xu SJ, Zhang SF, Jia XM, Zhu RP, et al. A systematic review and quantitative assessment of sleep-disordered breathing during pregnancy and perinatal outcomes. Sleep Breath. 2014;18(4):703–13. Scholar
  52. 52.
    Pamidi S, Pinto LM, Marc I, Benedetti A, Schwartzman K, Kimoff RJ. Maternal sleep-disordered breathing and adverse pregnancy outcomes: a systematic review and metaanalysis. Am J Obstet Gynecol. 2014;210(1):52 e1–e14. Scholar
  53. 53.
    Tishler PV, Larkin EK, Schluchter MD, Redline S. Incidence of sleep-disordered breathing in an urban adult population: the relative importance of risk factors in the development of sleep-disordered breathing. JAMA. 2003;289(17):2230–7. Scholar
  54. 54.
    Xu T, Feng Y, Peng H, Guo D, Li T. Obstructive sleep apnea and the risk of perinatal outcomes: a meta-analysis of cohort studies. Sci Rep. 2014;4:6982. Scholar
  55. 55.
    Luque-Fernandez MA, Bain PA, Gelaye B, Redline S, Williams MA. Sleep-disordered breathing and gestational diabetes mellitus: a meta-analysis of 9,795 participants enrolled in epidemiological observational studies. Diabetes Care. 2013;36(10):3353–60. Scholar
  56. 56.
    Bin YS, Cistulli PA, Ford JB. Population-based study of sleep apnea in pregnancy and maternal and infant outcomes. J Clin Sleep Med. 2016;12(6):871–7. Scholar
  57. 57.
    Bourjeily G, Danilack VA, Bublitz MH, Lipkind H, Muri J, Caldwell D, et al. Obstructive sleep apnea in pregnancy is associated with adverse maternal outcomes: a national cohort. Sleep Med. 2017;38:50–7. Scholar
  58. 58.
    Louis JM, Mogos MF, Salemi JL, Redline S, Salihu HM. Obstructive sleep apnea and severe maternal-infant morbidity/mortality in the United States, 1998-2009. Sleep. 2014;37(5):843–9. Scholar
  59. 59.
    Spence DL, Allen RC, Lutgendorf MA, Gary VR, Richard JD, Gonzalez SC. Association of obstructive sleep apnea with adverse pregnancy-related outcomes in military hospitals. Eur J Obstet Gynecol Reprod Biol. 2017;210:166–72. Scholar
  60. 60.
    Ancoli-Israel S, Cole R, Alessi C, Chambers M, Moorcroft W, Pollak CP. The role of actigraphy in the study of sleep and circadian rhythms. Sleep. 2003;26(3):342–92. Scholar
  61. 61.
    Bisson M, Series F, Giguere Y, Pamidi S, Kimoff J, Weisnagel SJ, et al. Gestational diabetes mellitus and sleep-disordered breathing. Obstet Gynecol. 2014;123(3):634–41. Scholar
  62. 62.
    • Facco FL, Parker CB, Reddy UM, Silver RM, Koch MA, Louis JM, et al. Association between sleep-disordered breathing and hypertensive disorders of pregnancy and gestational diabetes mellitus. Obstet Gynecol. 2017;129(1):31–41. This study used PSG and demonstrated increasing exposure-response relationships were observed between AHI and GDM.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Pien GW, Pack AI, Jackson N, Maislin G, Macones GA, Schwab RJ. Risk factors for sleep-disordered breathing in pregnancy. Thorax. 2014;69(4):371–7. Scholar
  64. 64.
    Facco FL, Ouyang DW, Zee PC, Strohl AE, Gonzalez AB, Lim C, et al. Implications of sleep-disordered breathing in pregnancy. Am J Obstet Gynecol. 2014;210(6):559 e1–6. Scholar
  65. 65.
    • Wanitcharoenkul E, Chirakalwasan N, Amnakkittikul S, Charoensri S, Saetung S, Chanprasertyothin S, et al. Obstructive sleep apnea and diet-controlled gestational diabetes. Sleep Med. 2017;39:101–7. Experiments in this study showed that OSA severity, as measured by different parameters of hypoxia (e.g. oxygen desaturation), is associated with various metabolic effects in pregnant women with GDM. CrossRefPubMedGoogle Scholar
  66. 66.
    O’Brien LM, Bullough AS, Shelgikar AV, Chames MC, Armitage R, Chervin RD. Validation of Watch-PAT-200 against polysomnography during pregnancy. J Clin Sleep Med. 2012;8(3):287–94. Scholar
  67. 67.
    Ge X, Tao F, Huang K, Mao L, Huang S, Niu Y, et al. Maternal snoring may predict adverse pregnancy outcomes: a cohort study in China. PLoS One. 2016;11(2):e0148732. Scholar
  68. 68.
    Qiu C, Lawrence W, Gelaye B, Stoner L, Frederick IO, Enquobahrie DA, et al. Risk of glucose intolerance and gestational diabetes mellitus in relation to maternal habitual snoring during early pregnancy. PLoS One. 2017;12(9):e0184966. Scholar
  69. 69.
    Sharma SK, Nehra A, Sinha S, Soneja M, Sunesh K, Sreenivas V, et al. Sleep disorders in pregnancy and their association with pregnancy outcomes: a prospective observational study. Sleep Breath. 2016;20(1):87–93. Scholar
  70. 70.
    Izci B, Martin SE, Dundas KC, Liston WA, Calder AA, Douglas NJ. Sleep complaints: snoring and daytime sleepiness in pregnant and pre-eclamptic women. Sleep Med. 2005;6(2):163–9. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Nur Khairani Farihin Abdul Jafar
    • 1
  • Derric Zenghong Eng
    • 1
  • Shirong Cai
    • 1
    • 2
    Email author
  1. 1.Singapore Institute for Clinical SciencesAgency for Science, Technology and Research (A*STAR)SingaporeSingapore
  2. 2.Department of Obstetrics & Gynaecology, Yong Loo Lin School of MedicineNational University of Singapore, National University Health SystemSingaporeSingapore

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