(453) Association of Insomnia in Pregnancy with Maternal and Neonatal Outcomes

In the non-pregnant population, insomnia is the most prevalent sleep disorder and is associated with an increased risk of cardiovascular and metabolic disease. Despite the frequency of insomnia during pregnancy, little is known about its association with adverse perinatal outcomes.

Study Design: In this secondary analysis of data from a large, diverse observational cohort of nulliparous individuals conducted at eight US medical centers, those with self-reported sleep data were included. Insomnia symptoms were evaluated via a sleep questionnaire adapted from the 'Women's Health Initiative Insomnia Rating Scale' in early (6-13 weeks’) and mid pregnancy (22-29 weeks’). Having clinically significant insomnia symptoms was defined as a score of 9 or greater. The outcomes of interest included hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM), preterm birth (PTB), and small-for-gestational-age birth < 10%ile (SGA). For each time point, separate multivariable logistic regression analysis was performed adjusting for maternal age, race/ethnicity as a social construct, insurance, high risk for sleep-disordered breathing, body mass index, and smoking.

Results: Of 7,676 and 8,310 participants who completed sleep questionnaires in early and mid pregnancy, the prevalence of insomnia symptoms was 42.1% and 46.5% respectively. Individuals with insomnia symptoms in early pregnancy were more likely to be non-Hispanic White, publicly insured, older, a current smoker, living with obesity, and at high risk for sleep-disordered breathing. Insomnia symptoms in early pregnancy were associated with HDP (aOR 1.10, 95% CI 1.01-1.21), and insomnia symptoms in early and mid pregnancy were associated with PTB (aOR 1.17, 95% CI 1.01-1.36; aOR 1.28, 95% CI 1.10-1.49, respectively). Insomnia symptoms were not associated with GDM or SGA.

Conclusion:

Insomnia symptoms are common in pregnancy. Even after controlling for sleep-disordered breathing, insomnia symptoms in early pregnancy are associated with an increased risk of HDP and symptoms in early and mid pregnancy are associated with an increased risk of PTB.