Iranian Society of Gynecology Oncology

Document Type : Original Research Article


1 Center for Research on Occupational Diseases (CROD), Tehran University of Medical Sciences, Tehran, Iran

2 Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran


Background and Objective: Pregnancy is an exceptionally delicate time in the lives of most women. Sleep disorders during pregnancy can substantially impact a healthy pregnancy. This study investigated the relationship between sleep quality during pregnancy and adverse maternal and fetal pregnancy outcomes.
Methods: This was a prospective cohort study on 500 pregnant women referred to the Perinatology clinic. The Pittsburgh Sleep Quality Index questionnaire was used to evaluate sleep quality, and demographic data were collected from the case files of routine prenatal checkups. The study participants were followed until delivery. The association between sleep quality and postpartum complications, such as preterm birth, infant Apgar score, and (Neonatal Intensive Care Unit) NICU admission, was investigated.
Results: This study included 500 pregnant women with a mean age of 31.12 ± 5.84 years. The number of pregnancies ranged from one to seven, with a mean of 2.55±1.30. Of the infants, 12% of infants were born prematurely and 27.8% required NICU admission. Poor sleep quality was found to be associated with preterm delivery (OR: 1.27, P = 0.039) and preeclampsia (OR: 0.543, P = 0.004). Women who experienced preeclampsia during pregnancy (P = 0.01), delivered via cesarean section (P = 0.009), and had infants weighing more than 2500 g (P = 0.07) exhibited significantly poorer sleep quality.
Conclusion: We found that poor sleep quality was associated with preterm birth, cesarean section delivery, maternal preeclampsia risk, and the 5-minute Apgar score. Considering the impact of a mother’s sleep quality on pregnancy outcomes, assessing mothers' sleep health appears essential in prenatal care.


Main Subjects

1. Nicolau M, Akaarir M, Gamundı A, González J, Rial R. Why we sleep: the evolutionary pathway to the mammalian sleep. Prog Neurobiol. 2000;62(4):379-406. [DOI:10.1016/S0301-0082(00)00013-7] [PMID]
2. Rechtschaffen A. Current perspectives on the function of sleep. Perspect Biol Med. 1998;41(3):359-90. [DOI:10.1353/pbm.1998.0051] [PMID]
3. Altevogt BM, Colten HR. Sleep disorders and sleep deprivation: an unmet public health problem. Washington (DC): National Academies Press (US); 2006.
4. Sahota PK, Jain SS, Dhand R. Sleep disorders in pregnancy. Curr Opin Pulm Med. 2003;9(6):477-83. [DOI:10.1097/00063198-200311000-00005] [PMID]
5. Mindell JA, Jacobson BJ. Sleep disturbances during pregnancy. J Obstet Gynecol Neonatal Nurs. 2000;29(6):590-7. [DOI:10.1111/j.1552-6909.2000.tb02072.x] [PMID]
6. Mindell JA, Cook RA, Nikolovski J. Sleep patterns and sleep disturbances across pregnancy. Sleep Med. 2015;16(4):483-8. [DOI:10.1016/j.sleep.2014.12.006] [PMID]
7. Shneerson JM. Sleep medicine: a guide to sleep and its disorders: John Wiley & Sons; 2009.
8. Pietikäinen JT, Polo-Kantola P, Pölkki P, Saarenpää-Heikkilä O, Paunio T, Paavonen EJ. Sleeping problems during pregnancy-a risk factor for postnatal depressiveness. Arch Womens Ment Health. 2019;22(3):327-37. [DOI:10.1007/s00737-018-0903-5] [PMID]
9. Okun ML. Sleep in pregnancy and the postpartum. Encyclopedia of sleep. 6742013. p. 2-9.
10. Sedov ID, Cameron EE, Madigan S, Tomfohr-Madsen LM. Sleep quality during pregnancy: a meta-analysis. Sleep Med Rev. 2018;38:168-76. [DOI:10.1016/j.smrv.2017.06.005] [PMID]
11. Bei B, Coo S, Baker FC, Trinder J. Sleep in women: a review. Aust Psychol. 2015;50(1):14-24. [DOI:10.1111/ap.12095]
12. Hedman C, Pohjasvaara T, Tolonen U, Suhonen-Malm A, Myllylä V. Effects of pregnancy on mothers' sleep. Sleep Med. 2002;3(1):37-42. [DOI:10.1016/S1389-9457(01)00130-7] [PMID]
13. Brunner DP, Münch M, Biedermann K, Huch R, Huch A, Borbély AA. Changes in sleep and sleep electroencephalogram during pregnancy. Sleep. 1994;17(7):576-82. [DOI:10.1093/sleep/17.7.576] [PMID]
14. Izci-Balserak B, Keenan BT, Corbitt C, Staley B, Perlis M, Pien GW. Changes in sleep characteristics and breathing parameters during sleep in early and late pregnancy. J Clin Sleep Med. 2018;14(7):1161-8. [DOI:10.5664/jcsm.7216] [PMID] [PMCID]
15. Naud K, Ouellet A, Brown C, Pasquier J-C, Moutquin J-M. Is sleep disturbed in pregnancy? J Obstet Gynaecol Can. 2010;32(1):28-34. [DOI:10.1016/S1701-2163(16)34400-0] [PMID]
16. Silvestri R, Aricò I. Sleep disorders in pregnancy. Sleep Sci. 2019;12(3):232-9. [DOI:10.5935/1984-0063.20190098] [PMID] [PMCID]
17. Pien GW, Schwab RJ. Sleep disorders during pregnancy. Sleep. 2004;27(7):1405-17. [DOI:10.1093/sleep/27.7.1405] [PMID]
18. Bourjeily G. Sleep disorders in pregnancy. Obstet Med. 2009;2(3):100-6. [DOI:10.1258/om.2009.090015] [PMID] [PMCID]
19. Santiago JR, Nolledo MS, Kinzler W, Santiago TV. Sleep and sleep disorders in pregnancy. Ann Intern Med. 2001;134(5):396-408. [DOI:10.7326/0003-4819-134-5-200103060-00012] [PMID]
20. Nodine PM, Matthews EE. Common sleep disorders: management strategies and pregnancy outcomes. J Midwifery Women's Health. 2013;58(4):368-77. [DOI:10.1111/jmwh.12004] [PMID]
21. Bin YS, Cistulli PA, Ford JB. Population-based study of sleep apnea in pregnancy and maternal and infant outcomes. J Clin Sleep Med. 2016;12(6):871-7. [DOI:10.5664/jcsm.5890] [PMID] [PMCID]
22. Chappell LC, Smith GC. Should pregnant women sleep on their left? : British Medical Journal Publishing Group; 2011.
23. Farrahi Moghaddam J, Nakhaee N, Sheibani V, Garrusi B, Amirkafi A. Reliability and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI-P). Sleep Breath. 2012;16(1):79-82. [DOI:10.1007/s11325-010-0478-5] [PMID]
24. Buysse DJ, Reynolds III 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. [DOI:10.1016/0165-1781(89)90047-4] [PMID]
25. Sharma S, Nehra A, Sinha S, Soneja M, Sunesh K, Sreenivas V, Vedita D. Sleep disorders in pregnancy and their association with pregnancy outcomes: a prospective observational study. Sleep Breath. 2016;20(1):87-93. [DOI:10.1007/s11325-015-1188-9] [PMID]
26. 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):853-9. [DOI:10.1016/j.sleep.2014.02.013] [PMID]
27. Lee KA, Gay CL. Sleep in late pregnancy predicts length of labor and type of delivery. Am J Obstet Gynecol. 2004;191(6):2041-6. [DOI:10.1016/j.ajog.2004.05.086] [PMID]
28. Zafarghandi N, Hadavand S, Davati A, Mohseni SM, Kimiaiimoghadam F, Torkestani F. The effects of sleep quality and duration in late pregnancy on labor and fetal outcome. J Matern-Fetal Neonatal Med. 2012;25(5):535-7. [DOI:10.3109/14767058.2011.600370] [PMID]
29. Li R, Zhang J, Zhou R, Liu J, Dai Z, Liu D, et al. Sleep disturbances during pregnancy are associated with cesarean delivery and preterm birth. J Matern-Fetal Neonatal Med. 2017;30(6):733-8. [DOI:10.1080/14767058.2016.1183637] [PMID]
30. Hajipour M, Soltani M, Safari-Faramani R, Khazaei S, Etemad K, Rahmani S, et al. Maternal Sleep and Related Pregnancy Outcomes: A Multicenter Cross-Sectional Study in 11 Provinces of Iran. J Family Reprod Health. 2021;15(1):53-60. [DOI:10.18502/jfrh.v15i1.6078] [PMID] [PMCID]
31. Evans ML, Dick MJ, Cark AS. Sleep during the week before labor: relationships to labor outcomes. Clin Nurs Res. 1995;4(3):238-49. [DOI:10.1177/105477389500400302] [PMID]
32. Teong ACA, Diong AX, Omar SZ, Tan PC. The impact of self-reported sleep on caesarean delivery in women undergoing induction of labour: a prospective study. Sci Rep. 2017;7(1):1-8. [DOI:10.1038/s41598-017-12410-7] [PMID] [PMCID]
33. Aliakbari A, KH S, Majd H A. Relation between sleep disorders in the last month of pregnancy and type of delivery in women referring to health centers at Saghez. Shaheed Beheshti Univ Med Sci Health Servi-Facul Nurs Midwf Quar. 2006;16(54):35-42.
34. Du M, Liu J, Han N, Zhao Z, Yang J, Xu X, et al. Maternal sleep quality during early pregnancy, risk factors and its impact on pregnancy outcomes: a prospective cohort study. Sleep Med. 2021;79:11-8. [DOI:10.1016/j.sleep.2020.12.040] [PMID]
35. Wong PF, D'Cruz R, Hare A. Sleep disorders in pregnancy. Breathe. 2022;18(2):220004. [DOI:10.1183/20734735.0004-2022] [PMID] [PMCID]