A GUIDE TO HEALTHY PREGNANCY MANAGING AILMENTS AND FINDING SOLUTIONS

A_Guide_to_Healthy_Pregnancy

SLEEP CHANGES AND EXPECTATIONS DURING PREGNANCY

Nihal Türk Çelik

İstanbul Sultanbeylı̇ State Hospital, Department of Gynecology and Obstetrics , İstanbul, Türkiye

Türk Çelik N. Sleep Changes And Expectations During Pregnancy. Çetin A, ed. A Guide to Healthy Pregnancy: Managing Ailments And Finding Solutions. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.149-155.

ABSTRACT

Sleep patterns and sleep quality also change with the changing physiology during pregnancy. The trimester of pregnancy, parity status, maternal age, whether the expectant mother is overweight or not, anxiety level, diet, physical activities are the conditions that affect the sleep quality and sleep patterns of pregnant women. While increasing progesterone levels increase daytime sleep especially in the first trimester, it has been observed that sleep duration and quality decrease in the 2nd and 3rd trimesters. Poor sleep quality during pregnancy has many negative maternal and fetal consequences. Poor sleep quality in the expectant mother leads to various undesirable maternal and perinatal outcomes such as restless legs syndrome, obstructive sleep apnea, depression, gestational diabetes, preeclampsia, preterm labor, SGA. Sleep quality in pregnant women was assessed with the Pittsburg sleep quality index. The result of the test, the following findings were made that pregnant women with a score above 5 points had poor sleep quality and unfortunately, this rate in pregnant women is considerably high. Although various rates are given in the studies, the average rate is around 45-50% and the rate of pregnant women with poor sleep quality reaches up to 69% in the 3rd trimester. Sleep problems that reduce the quality of life of the expectant mother and have negative consequences should be identified by talking to the pregnant woman during pregnancy follow-up and examinations, and suggestions for the problem should be shared with the expectant mother to ensure that the problems are solved before they deepen. For example, mild exercise and massage recommendations should be explained to the pregnant woman who has sleep problems due to low back pain, and the expectant mother should be prevented from gaining excess weight by ensuring weight control. As another example, a pregnant woman with poor sleep quality due to frequent urination should be advised to restrict fluid in the 2 hours before going to sleep, and the patient must be closely observed for gestational diabetes. In summary, solutions to the problem of the pregnant woman should be determined and implemented in mutual consultation. Although solutions to these problems in pregnancy are generally tried to be found with behavioral and non-pharmacological methods, in cases where these methods are not sufficient, the pregnant woman can also be supported with pharmacological methods, taking into account the information about teratogenicity.

Keywords: Sleep; Pregnancy; Sleep quality; PSQI; Insomnia; Parity; Trimester

Referanslar

  1. LLamberg L. Sleeping poorly while pregnant may not be "normal". JAMA. 2006;295(12):1357-1361. [Crossref]  [PubMed]
  2. Mindell JA, Jacobson BJ. Sleep disturbances during pregnancy. J Obstet Gynecol Neonatal Nurs. 2000;29(6):590-597. [Crossref]  [PubMed]
  3. Facco FL, Kramer J, Ho KH, Zee PC, Grobman WA. Sleep disturbances in pregnancy. Obstet Gynecol. 2010;115(1):77-83. [Crossref]  [PubMed]
  4. Lee KA, Zaffke ME, McEnany G. Parity and sleep patterns during and after pregnancy. Obstet Gynecol. 2000;95(1):14-18. [Crossref]  [PubMed]
  5. Lee KA. Alterations in sleep during pregnancy and postpartum: a review of 30 years of research. Sleep Med Rev.1998;2(4):231-242. [Crossref]  [PubMed]
  6. Lancel M, Faulhaber J, Holsboer F, Rupprecht R. Progesterone induces changes in sleep comparable to those of agonistic GABAA receptor modulators. American Journal of Physiology-Endocrinology and Metabolism.1996;271(4):E763-E772. [Crossref]  [PubMed]
  7. Christian LM, Carroll JE, Porter K, Hall MH. Sleep quality across pregnancy and postpartum: effects ofparity and race. Sleep Health. 2019;5(4):327-334. [Crossref]  [PubMed]  [PMC]
  8. Chen SJ, Shi L, Bao YP, et al. Prevalence of restless legs syndrome during pregnancy: A systematic review and meta-analysis. Sleep Med Rev. 2018;40:43-54. [Crossref]  [PubMed]
  9. 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 and Breathing.2019;23(2):399-412. [Crossref]  [PubMed]
  10. Yang Z, Zhu Z, Wang C, Zhang F, Zeng H. Association between adverse perinatal outcomes and sleep disturbances during pregnancy: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2022;35(1):166-174. [Crossref]  [PubMed]
  11. Harskamp-van Ginkel MW, Ierodiakonou D, Margetaki K, et al. Gestational sleep deprivation is associated with higher offspring body mass index and blood pressure. Sleep.2020;43(12). [Crossref]  [PubMed]  [PMC]
  12. Blair LM, Porter K, Leblebicioglu B, Christian LM. Poor Sleep Quality and Associated Inflammation Predict Preterm Birth: Heightened Risk among African Americans. Sleep.2015;38(8):1259-1267. [Crossref]  [PubMed]  [PMC]
  13. 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):853-859. [Crossref]  [PubMed]
  14. Okun ML, Hall M, Coussons-Read ME. Sleep Disturbances Increase Interleukin-6 Production During Pregnancy: Implications for Pregnancy Complications. Reproductive Sciences.2007;14(6):560-567. [Crossref]  [PubMed]
  15. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res.1989;28(2):193-213. [Crossref]  [PubMed]
  16. Sedov ID, Cameron EE, Madigan S, Tomfohr-Madsen LM. Sleep quality during pregnancy: A meta-analysis. Sleep MedRev.2018;38:168-176. [Crossref]  [PubMed]
  17. Kızılırmak A, Timur S, Kartal B. Insomnia in Pregnancy and Factors Related to Insomnia. The Scientific World Journal.2012;2012:1-8. [Crossref]  [PubMed]  [PMC]
  18. Okun ML, Kline CE, Roberts JM, Wettlaufer B, Glover K, Hall M. Prevalence of Sleep Deficiency in Early Gestation and its Associations with Stress and Depressive Symptoms. J Womens Health.2013;22(12):1028-1037. [Crossref]  [PubMed]  [PMC]
  19. Du M, Liu J, Han N, et al. Maternal sleep quality during early pregnancy, risk factors and its impact on pregnancy outcomes: a prospective cohort study. Sleep Med. 2021;79:11-18. [Crossref]  [PubMed]
  20. Reid KJ, Facco FL, Grobman WA, et al. Sleep During Pregnancy: The nuMoM2b Pregnancy and Sleep Duration and Continuity Study. Sleep. 2017;40(5). [Crossref]  [PubMed]  [PMC]
  21. Hsu WY, Chiu NY, Chang CC, Chang TG, Lane HY. The association between cigarette smoking and obstructive sleep apnea. Tob Induc Dis. 2019;17(April). [Crossref]  [PubMed]  [PMC]
  22. Ahluwalia N, Andreeva VA, Kesse-Guyot E, Hercberg S. Dietary patterns, inflammation and the metabolic syndrome. Diabetes Metab. 2013;39(2):99-110. [Crossref]  [PubMed]
  23. Slavish DC, Graham-Engeland JE, Engeland CG, Taylor DJ, Buxton OM. Insomnia symptoms are associated with elevated C-reactive protein in young adults. Psychol Health.2018;33(11):1396-1415. [Crossref]  [PubMed]
  24. Casas I, Nakaki A, Pascal R, et al. Effects of a Mediterranean Diet Intervention on Maternal Stress,Well-Being, and Sleep Quality throughout Gestation-The IMPACT-BCN Trial. Nutrients. 2023;15(10):2362. [Crossref]  [PubMed]  [PMC]
  25. Christian LM, Carroll JE, Porter K, Hall MH. Sleep quality across pregnancy and postpartum: effects ofparity and race. Sleep Health.2019;5(4):327-334. [Crossref]  [PubMed]  [PMC]
  26. Hagen EW, Mirer AG, Palta M, Peppard PE. The Sleep-Time Cost of Parenting: Sleep Duration and Sleepiness Among Employed Parents in the Wisconsin Sleep Cohort Study. Am J Epidemiol. 2013;177(5):394-401. [Crossref]  [PubMed]  [PMC]
  27. Meltzer LJ, Mindell JA. Relationship between child sleedisturbances and maternal sleep, mood, andparenting stress: A pilot study. Journal of Family Psychology. 2007;21(1):67-73. [Crossref]  [PubMed]
  28. Mindell JA, Sadeh A, Kwon R, Goh DYT. Relationship Between Child and Maternal Sleep: ADevelopmental and Cross-Cultural Comparison. J Pediatr Psychol. 2015;40(7):689-696. [Crossref]  [PubMed]
  29. McDonald SD, Han Z, Mulla S, Beyene J. Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses. BMJ.2010;341(jul20 1):c3428-c3428. [Crossref]  [PubMed]  [PMC]
  30. Li R, Zhang J, Gao Y, et al. Duration and quality of sleep during pregnancy are associated with preterm birth and small for gestational age: A prospective study. International Journal of Gynecology & Obstetrics. 2021;155(3):505-511. [Crossref]  [PubMed]
  31. Dominguez JE, Habib AS, Krystal AD. A review of the associations between obstructive sleep apnea and hypertensive disorders of pregnancy and possible mechanisms of disease. Sleep Med Rev. 2018;42:37-46. [Crossref]  [PubMed]  [PMC]
  32. Robertson NT, Turner JM, Kumar S. Pathophysiological changes associated with sleep disordered breathing and supine sleep position in pregnancy. Sleep Med Rev. 2019;46:1-8. [Crossref]  [PubMed]
  33. Cai S, Tan S, Gluckman PD, et al. Sleep Quality and Nocturnal Sleep Duration in Pregnancy and Risk of Gestational Diabetes Mellitus. Sleep. 2017;40(2). [Crossref]  [PubMed]  [PMC]
  34. Wulff K, Gatti S, Wettstein JG, Foster RG. Sleep and circadian rhythm disruption in psychiatric and neurodegenerative disease. Nat Rev Neurosci. 2010;11(8):589-599. [Crossref]  [PubMed]
  35. Stacey T, Thompson JMD, Mitchell EA, Ekeroma AJ, Zuccollo JM, McCowan LME. Association between maternal sleep practices and risk of late stillbirth: a case-control study. BMJ.2011;342(jun141):d3403-d3403. [Crossref]  [PubMed]  [PMC]
  36. Rubio E, Levey EJ, Rondon MB, et al. Poor sleep Quality and Obstructive Sleep Apnea are Associated with Maternal Mood, and Anxiety Disorders in Pregnancy. Matern Child Health J. 2022;26(7):1540-1548. [Crossref]  [PubMed]  [PMC]
  37. Santiago JR, Nolledo MS, Kinzler W, Santiago T V. Sleep and Sleep Disorders in Pregnancy. Ann InternMed2001;134(5):396. [Crossref]  [PubMed]
  38. Davis FC. Melatonin: Role in Development. J Biol Rhythms. 1997;12(6):498-508. [Crossref]  [PubMed]
  39. Moretti ME, Caprara D, Coutinho CJ, et al. Fetal safety of loratadine use in the first trimester ofpregnancy: A multicenter study. Journal of Allergy and Clinical Immunology. 2003;111(3):479-483. [Crossref]  [PubMed]
  40. US Food and Drug Administration. Ramelteon. Accessed May 10, 2019. [Link]
  41. Takzare N, Hosseini M jamal, Bakhtiarian A, Takzare A, Habibi P. The Teratogenic Effects ofFlurazepam Intake during Organogenesis of the Rat Fetus. Toxicol Mech Methods. 2008;18(9):711-716. [Crossref]  [PubMed]
  42. Paulino DSM, Borrelli CB, Faria-Schützer DB, Brito LGO, Surita FG. Non-pharmacological Interventions for Improving Sleep Quality During Pregnancy: A Systematic Review and Meta-Analysis. Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics. 2022;44(08):776-784. [Crossref]  [PubMed]  [PMC]