Do sleep problems during pregnancy affect your unborn child? (Cassie Gibbs)

The importance of a good night's sleep

Most of us know that a good night's sleep is essential for our overall health. According to Dr. Dana Wyner at the Emory Student Counseling Center, "Sleep allows us to repair and maintain good physiological functioning in a variety of systems in our bodies...if we do not get sufficient sleep, our bodies are susceptible to break down in those domains, perhaps leading to illness, mood swings, inability to attend to daily tasks, and an overall lower tolerance to stressors."

Getting a good night's sleep during pregnancy can be even more difficult, due to the many hormonal and physiological changes in the body (1). But does sleep deprivation during the third trimester of pregnancy affect the unborn infant? This was a question addressed by a recent study conducted in Greece (1). The authors looked at how sleep deprivation (defined as ≤5 hours sleep per night) or snoring during the third trimester of pregnancy are associated with several infant outcomes. Snoring may seem like a strange exposure to examine, but snoring and sleep apnea result in less oxygen being delivered to the body, and this could affect fetal growth. 

Infant outcomes: The authors looked at low birth weight (a birth weight less than 5 pounds, 8 ounces), preterm birth (when an infant is born before 37 weeks of gestation), and fetal growth restriction (when an infant's birth weight is small compared to others of the same sex and gestational age). 

Findings: The authors found that women who were "severe snorers" during pregnancy were over 2.5 times as likely to deliver a low birth weight infant and twice as likely to deliver an infant that was "growth restricted." Women with ≤5 hours sleep per night were over 1.5 times as likely to deliver a preterm infant; they were almost 2.5 times as likely to have a preterm infant that was delivered through a planned C-section or induced delivery.

Why do these findings matter?

An infant born low birth weight, preterm, or growth restricted is at risk of many poor outcomes. Low birth weight infants are more likely to have serious health problems as a newborn (and to require treatment in the newborn ICU), more likely to die as a newborn, and are at higher risk of other lasting disabilities. As adults, they may be more likely to develop diabetes, heart disease, and high blood pressure (2). Sleep problems also affect the mother. Lack of sleep places a pregnant woman at higher risk of becoming ill or depressed (6). Researchers have found that sleep deprivation may place a pregnant woman at higher risk of diabetes and high blood pressure during pregnancy (1).

By addressing sleep problems during pregnancy, we may be able to improve the health of both the infant and the mother. Doctors should screen pregnant women for sleep disorders so that they can refer the woman to the appropriate resources. Pregnant women should also seek out their doctor's advice and educate themselves about ways to improve sleep quality.

How can we improve sleep quality during pregnancy?

• Figure out if you have a sleep disorder. Keep a sleep diary, and record how many hours of sleep you get per night. If you wake up feeling exhausted every day, it may be time to seek help. If you snore during the night and wake up tired, you could suffer from sleep apnea.                                 

• If you have a sleep disorder (whether you are pregnant or not), it would be helpful to see your primary care physician and discuss this issue. Your physician can refer you to the appropriate resources or specialists.

• Look for nonmedical interventions to help with sleep disorders (see the following bullet points for more detail). For pregnant women, it is especially important to combat sleep disorders without medication or supplements, since these may harm the developing fetus. If you snore, there are mouthguards (such as the Snore Guard [3]) you can wear that help promote deeper breathing during sleep.

• Manage stress: Practice yoga, meditation, or other activities that help you relax and de-stress at night. The more relaxed you are, the easier it should be for you to fall asleep.

• Establish good sleep habits: Establishing a consistent routine helps your body know when it is time to go to sleep and can help you fall asleep naturally. Good sleep hygiene refers to habits that will help you fall asleep, such as turning off computers/ cell phones at least an hour before sleep (since the glow from these devices keeps you awake) and avoiding caffeine before bed. Additional resources on general sleep hygiene are available here (4) and here (5).

• Also educate yourself about sleeping tips for pregnant women, such as how to sleep comfortably. For instance, you should sleep on your left side during pregnancy. This and other tips can be found here (6).

Is it ethical to recommend that women address sleep disorders during pregnancy?  
I believe so, although some minor issues could arise. Women could choose to take medications/herbal supplements (against doctors' recommendations), which could harm the fetus. Furthermore, some women might spend considerable amounts of time and money trying to address their sleep disorder without finding a (non-drug) solution. Still, many good sleep habits can be adopted easily and without spending money, and there are large potential benefits to both mother and child from improved sleep.

References:

1.  Micheli K, Komninos I, Bagkeris E, Roumeliotaki T, Koutis A, Kogevinas M, Chatzia L. Sleep Patterns in Late Pregnancy and Risk of Preterm Birth and Fetal Growth Restriction. Epidemiology 2011; 22: 738–744.

2. March of Dimes: Low birthweight

3. Snore Guard anti-snoring device
4. University of Maryland Medical Center: Sleep Hygiene
5. Harvard Med: How to get better sleep 
6. Sleep tips for pregnant women 
Images are taken from Wikimedia Commons (a media file repository making available public domain and freely-licensed educational media content).
 

Cassie Gibbs, MPH is a PhD student who is studying maternal and child health. She is a nerd at heart who enjoys using statistics to study patterns of disease in different populations. In her free time, she enjoys watching movies, riding horses, and attending graduate school events that provide free food.