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Sleep Trajectories Among Pregnant Women and the Impact on Outcomes: A Population-Based Cohort Study

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Abstract

Objectives Sleep problems and deprivation are common during pregnancy, particularly in the third trimester. Previous studies are mostly descriptive or focused on specific clinical groups and late pregnancy. We aimed to identify sleep duration trajectories during the pregnancy period, their associated factors, and impact on pregnancy and birth outcomes. Methods We studied 200 women from a mother–child cohort recruited in 2009–2011 from the French general population. We used semi-parametric models to analyze data collected through questionnaires. Results We detected three sleep duration trajectories during pregnancy: short-decreasing (<6.5h/night, 10.8% of the sample), medium-decreasing (6.5-8h/night, 57.6%), and long-increasing (>8h/night, 31.6%) trajectories. Factors associated with the short-decreasing trajectory relative to the medium-decreasing trajectory were older age (odds-ratio/year = 1.13 [95%Confidence-Interval 1.00-1.29]) and working > 28 weeks of gestational age (odds-ratio = 0.30 [0.10–0.90]). Sleep duration during pregnancy in this trajectory group was modified by insomniac symptoms (regression coefficient/trimester = −0.74 [Standard-Error 0.12]) and naps (regression coefficient/trimester = 0.58 [0.25]). Restless legs syndrome was the only factor associated with the long-increasing trajectory and decreased sleep duration (regression coefficient/trimester = −0.88 [0.25]). Assisted delivery (i.e. cesarean section and/or instrumental delivery) and post-partum depression were more frequent among women with the short-decreasing and long-increasing trajectories whereas cesarean section alone was more prevalent among those with the short-decreasing trajectory. Proportion of premature births was higher in the short-decreasing trajectory group. Birth-weight-z-score was lower in the long-increasing trajectory group. Conclusion We identified sleep trajectories among pregnant women with specific risk factors that could affect both pregnancy and birth outcomes. Taking these into consideration could improve both maternal and child health.

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Acknowledgements

The AuBE study was allowed through consecutive grants from the French Ministry of Health: Programmes Hospitaliers de Recherche Clinique—PHRC interrégional, 2009 and AOL 2010. We especially acknowledge Mrs. Sophie Foucat and all the parents of the association SA VIE (http://www.sa-vie.fr; Nantes-France), Dr Elisabeth Briand-Huchet and Mrs. Myriam Morinay, president of the French national association NAITRE et VIVRE (naitre-et-vivre.org) for supporting the development and funding of research about the Sudden Infant Death Syndrome. We acknowledge the staff of the University Hospital of Saint-Etienne (Director: F. Boiron) for their support. The study was designed with the help of the Direction Régionale de la Recherche Clinique (DRRC, University Hospital, Saint-Etienne—France) and especially with the help of Dr Andrea Buchmuller, Arnauld Garcin and Emilie Presles. We are indebted to several research teams for their determinant implication in the study design: Prof. Patrick Pladys and Prof. Alain Beuchée, INSERM, U642; Université de Rennes 1, LTSI ; Département de médecine de l’enfant et de l’adolescent, néonatologie, CHU Rennes (35000, France), Prof. Georges Teyssier and Dr Gilles Damon, Pôle Mère Enfant, Réanimation néonatale, CHU de Saint-Étienne (42055, France). We acknowledge all psychologists (Mrs. Camille Stagnara and Mélodie Hardy) and technicians who participated in the data collection, particularly Mrs. Maryse Victoire for the availability and kindness. We also acknowledge Mrs. Jacqueline Vallon and Valerie Faure (DAMR—University Hospital, Saint-Etienne—France) for their administrative support. Of course, we finally thank the parents and children of the AuBE cohort who trust us, who help us to keep the study moving and without whom we could not continue this great adventure.

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Authors and Affiliations

  1. Epidemiology and Statistics Sorbonne Paris Cité Research Center (CRESS), INSERM, UMR1153, early ORigins of Child Health And Development Team (ORCHAD), 16 Av Paul Vaillant Couturier, Villejuif Cedex, 94807, France

    Sabine Plancoulaine

  2. UMRS 1153, Univ Paris-Descartes, Paris, France

    Sabine Plancoulaine

  3. Pediatric and neonatal reanimation unit, Pôle Mère et Enfant, Hôpital Nord, Saint-Etienne, France

    Sophie Flori & Hugues Patural

  4. EA SNA-EPIS 4607, University Jean Monnet de Saint-Etienne, Saint-Etienne, France

    Sophie Flori & Hugues Patural

  5. Child and Adolescent Psychopathology Unit, Salvator Hospital, Public Assistance-Marseille Hospitals, University Aix-Marseille II, Marseille, France

    Flora Bat-Pitault

  6. Institut de Neurosciences de la Timone, CNRS, Aix-Marseille University, Marseille, France

    Flora Bat-Pitault

  7. Sleep Pediatric Unit, Hôpital Femme Mère Enfant, University Lyon1, Lyon, France

    Jian-Sheng Lin & Patricia Franco

  8. Integrative Physiology of Brain Arousal System, CRNL, INSERM-U1028, CNRS UMR5292, University Lyon1, Lyon, France

    Jian-Sheng Lin & Patricia Franco

Authors
  1. Sabine Plancoulaine
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  2. Sophie Flori
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  3. Flora Bat-Pitault
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  4. Hugues Patural
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  5. Jian-Sheng Lin
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  6. Patricia Franco
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Correspondence to Sabine Plancoulaine.

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Plancoulaine, S., Flori, S., Bat-Pitault, F. et al. Sleep Trajectories Among Pregnant Women and the Impact on Outcomes: A Population-Based Cohort Study. Matern Child Health J 21, 1139–1146 (2017). https://doi.org/10.1007/s10995-016-2212-9

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  • DOI: https://doi.org/10.1007/s10995-016-2212-9

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