Elsevier

Sleep Medicine Reviews

Volume 14, Issue 2, April 2010, Pages 107-114
Sleep Medicine Reviews

Clinical Review
Sleep deprivation during pregnancy and maternal and fetal outcomes: Is there a relationship?

https://doi.org/10.1016/j.smrv.2009.05.001Get rights and content

Summary

Sleep duration in the population has been declining. Women occupy an increasingly prominent place in the work force without reducing most of their responsibilities at home. Consequently, sleep needs are often pushed to the bottom of women's daily priority list. Prior research has indicated that sleep deprivation is associated with higher levels of pro-inflammatory serum cytokines. This is important because higher plasma concentrations of pro-inflammatory serum cytokine levels are associated with postpartum depression and adverse birth outcomes such as preterm delivery. However, little research has directly examined how sleep deprivation may affect maternal and fetal outcomes. This review summarizes the existing data on the effect of sleep deprivation during pregnancy on maternal and fetal outcomes.

We review supporting evidence for the hypotheses that sleep deprivation during pregnancy increases the risk of preterm delivery and postpartum depression, and that systemic inflammation is the causal mechanism in the association. Prior research on sleep in pregnancy has been limited by varying data collection methods, subjective self-reported sleep measures, small and non-representative samples, cross-sectional designs; descriptive or non-hypothesis driven studies. Future research with longitudinal study designs is needed to allow examination of the effect of sleep deprivation on adverse maternal and fetal outcomes.

Introduction

Sleep deprivation has become a major public health concern in the United States because of its detrimental effects on cognitive functioning over time, accidents and errors in the workplace, and alterations in metabolic and endocrine function of individuals.1 Increasing evidence also suggests that sleep deprivation may increase mortality.1, 2 To date, despite the multiple competing demands women face in modern society,3 75% of sleep research has been conducted in men,4 although there is increased interest in sleep research in women. To meet the demands and opportunities of our modern society, having adequate sleep is often at the bottom of the priority list for American women who try to balance work and family life.3

During pregnancy and the postpartum period, women are at particular risk for sleep restriction because of the physical changes of pregnancy and the need to provide frequent infant care. Pregnancy and the postpartum period are also times when women are at a heightened risk of depression.5 Maternal depression has been well documented to adversely impact maternal–child relationships, parenting practices, family functioning, and children's development and general well-being.5 Several authors have hypothesized that sleep deprivation may increase the risk of adverse maternal and fetal outcomes. Limited evidence also suggests an association between sleep problems and maternal depression. This article reviews what is currently known about the relationship between sleep duration during pregnancy and maternal and fetal outcomes, with a special emphasis on preterm delivery and postpartum depression.

Section snippets

The prevalence of sleep deprivation

Although sleep needs may vary by age and gender, the National Sleep Foundation has recommended 7–8 h of sleep per 24 h for adults.6 Research has shown that sleep duration in healthy young adults stabilized at approximately 8.2 h after elimination of prior sleep debt.7 However, studies have indicated that the self-reported sleep duration of Americans has decreased by 1.5–2 h over the past 40 years, to a mean of 7–7.9 h.8, 9, 10 Average nightly sleep duration has declined even more over the past

Effect of sleep deprivation

In 2004, the U.S. Surgeon General observed that sleep disorders, sleep deprivation, and sleepiness affect as many as 70 million Americans and result in $16 billion in annual health-care expenses and $50 billion in lost productivity.17 The effects of sleep deprivation are cumulative, such that a mild reduction in sleep duration each night could, over time, result in significant functional deficits.18 Chronic sleep deprivation has detrimental effects on fat and glucose metabolism, inflammatory

Sleep duration during pregnancy

Sleep in women is affected by physiologic changes in neuroendocrine hormones, body temperature, mood, and emotional state during puberty, the menstrual cycle, pregnancy and menopause.24 In the past decade, sleep patterns and problems in women in the childbearing years have received increased research interest. However, few studies have focused on pregnancy. Using subjective sleep data, Hedman and coworkers surveyed 325 pregnant Finnish women and found that the mean hours of total self-reported

Effect of sleep deprivation on maternal and fetal health

Despite the potential adverse effect of sleep deprivation on maternal and fetal outcomes, little research has investigated the prevalence of and risk factors for sleep deprivation during pregnancy and the postpartum period, or the relationship between sleep and pregnancy outcomes. Limited research has indicated that poor sleep may be detrimental to the labor and delivery process. In a prospective observational study of 131 healthy primiparous women in their ninth month of pregnancy, Lee and Gay

Conclusion

Lack of sleep affects our physical and mental health. Although the average sleep duration in the American population has declined for both sexes, research has shown that more women than men report not getting the sleep they need.11 Pregnant women particularly need sufficient sleep to nourish the development of their infants and the energy they need for the labor and delivery process. Sleep deprivation during pregnancy has been associated with longer labor, elevated perception of pain and

Acknowledgements

This study was supported by KL2 Multidisciplinary Clinical Research Career Development Program Scholar (KL2RR024994) award from NIH.

References* (68)

  • P.A. Coble et al.

    Childbearing in women with and without a history of affective disorder. II. Electroencephalographic sleep

    Compr Psychiatr

    (1994)
  • R.L. Goldenberg et al.

    Epidemiology and causes of preterm birth

    Lancet

    (2008)
  • N. Breslau et al.

    Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults

    Biol Psychiatry

    (1996)
  • E.T. Kahn-Greene et al.

    The effects of sleep deprivation on symptoms of psychopathology in healthy adults

    Sleep Med

    (2007)
  • A. Wolfson et al.

    Pregnancy and the postpartum period

  • H. Giedke et al.

    Therapeutic use of sleep deprivation in depression

    Sleep Med Rev

    (2002)
  • A.M. Swain et al.

    A prospective study of sleep, mood, and cognitive function in postpartum and nonpostpartum women

    Obstet Gynecol

    (1997)
  • A. Sluzewska et al.

    Indicators of immune activation in major depression

    Psychiatry Res

    (1996)
  • M. Maes et al.

    Immune activation in the early puerperium is related to postpartum anxiety and depressive symptoms

    Psychoneuroendocrinology

    (2000)
  • M. Maes et al.

    In humans, serum polyunsaturated fatty acid levels predict the response of proinflammatory cytokines to psychologic stress

    Biol Psychiatry

    (2000)
  • S. Banks et al.

    Behavioral and physiological consequences of sleep restriction

    J Clin Sleep Med

    (2007)
  • C. Hublin et al.

    Sleep and mortality: a population-based 22-year follow-up study

    Sleep

    (2007)
  • N.G. Swanson

    Working women and stress

    J Am Med Womens Assoc

    (2000)
  • National Heart Lung and Blood Institute

    National sleep disorders research plan

    Sleep and Health

    (2007)
  • C. Mazure et al.

    Summit on women and depression. Proceedings and recommendations

    (Apr 2002)
  • National Sleep Foundation. Let sleep work for you. Available from:...
  • T.A. Wehr et al.

    Conservation of photoperiod-responsive mechanisms in humans

    Am J Physiol

    (1993)
  • National Center for Health Statistics

    QuickStats: percentage of adults who reported an average of less than 6 hours of sleep per 24 hour period, by sex and age group – United States, 1985 and 2004

    Morb Mortal Wkly Rep

    (2005)
  • E. Lindberg et al.

    Sleep disturbances in a young adult population: can gender differences be explained by differences in psychological status?

    Sleep

    (1997)
  • N. Goel et al.

    Gender differences in polysomnographic sleep in young healthy sleepers

    Chronobiol Int

    (2005)
  • W.B. Webb

    Partial and differential sleep deprivation

  • C. Hublin et al.

    Insufficient sleep – a population-based study in adults

    Sleep

    (2001)
  • National Sleep Foundation

    “Sleep in America” poll

    (2007)
  • K.A. Lee et al.

    Toward optimal health: the experts respond to sleep deprivation. Interview by Jodi Godfrey Meisler

    J Wom Health

    (1998)
  • Cited by (244)

    View all citing articles on Scopus
    e

    Tel.: +1 215 615 4875; fax: +1 215 615 4874.

    f

    Tel.: +1 314 362 4342; fax: +1 314 747 3813.

    g

    Tel.: +1 314 362 7139; fax: +1 314 362 0041.

    *

    The most important references are denoted by an asterisk.

    View full text