A lack of sleep during pregnancy doesn’t just make the mom-to-be tired — it can make labor and delivery tougher, too.
Two different studies found that women who slept poorly during late pregnancy increased their chances of long labors, cesarean section births, lower birth weights and other complications.
Longer labors & increased chance of cesarean births
A similar study reported in the December 2004 issue of the American Journal of Obstetrics and Gynecology also found that women who have less sleep or severely disrupted sleep in late pregnancy were significantly more likely to have longer labors and are more likely to have cesarean births.
Controlling for birth weight of the newborn, the researchers at the UCSF School of Nursing found that women who averaged less than six hours of sleep per night had significantly longer labors, and were 4.5 times more likely to have cesarean deliveries than women who averaged seven or more hours of sleep. Women who averaged between six and seven hours of sleep per night were 3.7 times more likely to have a cesarean delivery.
“It is well known that sleep disturbance and fatigue are associated with adverse physical and psychological outcomes, but this is the first study of its kind to associate sleep disturbance in pregnant women with adverse perinatal outcomes,” said lead author Kathryn Lee, RN, PhD, FAAN, professor and the James and Marjorie Livingston Chair in the UCSF School of Nursing.
According to Lee, women often complain to healthcare providers about sleep problems during pregnancy, yet little is known about how sleep affects the lives of childbearing women. It is generally accepted that seven to eight hours of sleep per night is the average needed for healthy adults, while six hours of sleep or less per night is considered severe sleep restriction, she said.
The study assessed sleep of 131 women in their ninth month of pregnancy. Study findings showed that women who slept less than six hours per night had an average labor of 29 hours compared to 17.7 hours for women who received seven or more hours of sleep per night.
“We also learned that women who averaged less than six hours of sleep per night also went to bed later and spent less time in bed, thereby limiting their opportunity for sleep,” said Lee. “Women who suffer severe sleep disruption may therefore need to increase the amount of time spent in bed to assure a sufficient amount of sleep.”
When examining sleep quality, the researchers found that women who reported having poor sleep three to four days per week about three weeks prior to delivery were 4.2 times more likely to then have a cesarean delivery than women who reported having poor sleep two or fewer days per week. Women who reported having poor sleep five or more days per week were 5.3 times more likely to have a cesarean delivery.
Poor sleep in pregnancy can cause birth-related complications
Poor sleep quality and quantity during pregnancy can disrupt normal immune processes and lead to lower birth weights and other complications, finds a University of Pittsburgh School of Medicine study published in the journal Psychosomatic Medicine in July 2013.
Women with depression also are more likely than non-depressed women to suffer from disturbed sleep and to experience immune system disruption and adverse pregnancy outcomes.
“Our results highlight the importance of identifying sleep problems in early pregnancy, especially in women experiencing depression, since sleep is a modifiable behavior,” said Michele Okun, PhD, assistant professor of psychiatry at Pitt’s School of Medicine and lead author of the report. “The earlier that sleep problems are identified, the sooner physicians can work with pregnant women to implement solutions.”
Adequate and high-quality sleep, both in pregnant and non-pregnant women as well as men, is essential for a healthy immune system. Pregnancy is often associated with changes in sleep patterns, including shortened sleep, insomnia symptoms and poor sleep quality. These disturbances can exacerbate the body’s inflammatory responses and cause an overproduction of cytokines, which act as signal molecules that communicate among immune cells.
“There is a dynamic relationship between sleep and immunity, and this study is the first to examine this relationship during pregnancy as opposed to postpartum,” added Dr. Okun.
While cytokines are important for numerous pregnancy-related processes, excess cytokines can attack and destroy healthy cells and cause destruction of tissue in pregnant women, thereby inhibiting the ability to ward off disease. For expectant mothers, excess cytokines also can disrupt spinal arteries leading to the placenta, cause vascular disease, lead to depression and cause preterm birth.
Previous studies conducted postpartum have shown higher inflammatory cytokine concentrations among women who experienced adverse pregnancy outcomes such as preeclampsia and pre-term birth. While infection accounts for half of these adverse outcomes, researchers discovered that behavioral processes such as disturbed sleep also may play a role, given the relationship between sleep disturbance and immune function. Furthermore, higher concentrations of inflammatory cytokines also are found in depressed individuals.
The study is the first to evaluate all factors — inflammatory cytokines, depression and insomnia — and their possible combined effect on pregnant women. The study examined nearly 170 women, both depressed and not depressed, at 20 weeks of pregnancy and analyzed their sleep patterns and cytokine production levels over the course of 10 weeks (pregnancy-related physiological adaptations are in flux prior to 20 weeks).
The findings reveal:
- Women with depression and poor sleep are at greatest risk for adverse birth-related outcomes. Cytokine levels may be one biological pathway through which this is accomplished, particularly with regard to preterm birth.
- Any shift in immunity, such as poor sleep and/or depression, could set the stage for increased risk for adverse outcomes.
- At 20 weeks, depressed pregnant women have higher levels of inflammatory cytokines compared to non-depressed women.
- At 30 weeks of pregnancy, differences in cytokines among depressed and non-depressed women were negligible, likely because as pregnancy progresses, levels of cytokines normally increase.