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How Does Sleep Duration Affect Gestational Diabetes Risk? 

Aug 7, 2021
 
Editor: Steve Freed, R.PH., CDE

Author: Macrina Ghali, PharmD Candidate 2021, Florida A&M University, College of Pharmacy and Pharmaceutical Sciences

The prevalence of gestational diabetes may be related to the duration of sleep among pregnant women.   

Gestational diabetes mellitus (GDM) has been associated with poor neonatal outcomes, not limited to increased birth weight, macrosomia, neonatal hypoglycemia, and the mother’s inability to carry to term. Furthermore, the management of GDM is essential to preventing type 2 diabetes and obesity in infants. Previous studies have shown that poor sleep may increase the risk of cesarean section deliveries, premature birth, and low Apgar scores. The pathophysiology may be related to higher interleukin-6 (IL-6) levels or hypothalamic-pituitary-adrenal axis dysregulation, both of which can increase the risk of insulin resistance. However, studies assessing the impact of sleep duration in pregnancy are lacking and have shown inconsistent results. Therefore, researchers in China sought to determine the association between sleep duration during the first trimester and the risk of developing GDM.  

 

A prospective cohort study was conducted in China, evaluating the impact of sleep duration on 3,692 pregnant women. Short, average, and long sleep duration were classified as less than seven hours, between seven to nine hours, and more than nine hours per night. GDM diagnosis was made using the oral glucose tolerance test (OGTT), the standard diagnostic tool, between 24-28 weeks of gestation. Statistical analysis was conducted using Chi-square tests, and multiple studies were completed to determine the covariates’ impact. At baseline, the median age was 29 years, and the median gestational age was 10.2 weeks. In addition, 166 patients were included in the short sleep duration group and 505 patients in the extended sleep duration group. Patients in the short sleep duration group were more likely to have not taken folic acid supplements, aged at least 35 years and multiparous, and engaged in alcohol intake. In contrast, patients in the more extended sleep duration group were younger, had no pregnancy history, and reported folic acid supplementation use.   

Among all women included in the study, 29% of patients developed GDM. 31%, 29%, and 38% of patients in the long, normal, and short sleep duration group, respectively. Patients with short sleep duration had a 32% higher risk of GDM development (aRR 1.32, 95% CI 1.06 – 1.63, P = 0.013). No differences were observed when normal sleep duration was compared to the long sleep duration group (31%, P = 0.224). Similarly, no differences were observed in GDM prevalence when comparing poor and normal sleep quality (aRR 1.01, 95% CI 0.90 – 1.12, P = 0.936), regardless of duration. Subgroup analysis found that women with poor sleep and those who were either overweight or had a GDM history were at a higher risk of GDM.  

Women with less than seven hours of sleep were at an increased risk for GDM development. The results of this study emphasize the need for clinicians to direct more attention to this patient population. Lifestyle and medication measures should be encouraged in women with shorter sleep duration to prevent and reduce the incidence of GDM. Healthcare providers can also educate patients on alcohol intake, physical activity, and folic acid supplementation to decrease short sleep duration prevalence. Furthermore, clinicians should give more aggressive care to control GDM to women with a higher BMI and those with a prior history of GDM. This study’s strength was the higher percentage of women in the shorter sleep duration group, increasing power compared to previous studies. 

In contrast, a weakness of this study was the self-reported nature of sleep duration. Furthermore, there was no mention of frequent sleep duration assessment to detect changes in duration during the first trimester. Another limitation was the study population, which was primarily composed of Han descent patients, decreasing generalizability. However, overall, this study emphasized the need for adequate sleep duration to reduce the prevalence of GDM and highlighted the potential impact of lifestyle modifications.  

Practice Pearls: 

  • Shorter sleep duration during pregnancy is associated with a higher risk of developing gestational diabetes.  
  • Early detection and prevention strategies for gestational diabetes should be provided for pregnant females with less than seven hours of sleep nightly. 
  • More extensive studies with more diverse patient populations should be conducted to determine the impact of the association. 

 

Du, Min et al. “Association between sleep duration in early pregnancy and risk of gestational diabetes mellitus: a prospective cohort study.” Diabetes & metabolism, vol. 47,5 101217. December 16, 2020 

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;15:853–9.  

Okun ML, Hall M, Coussons-Read ME. Sleep disturbances increase interleukin- 6 production during pregnancy: implications for pregnancy complications. Reprod Sci 2007;14:560–7.  

 

Macrina Ghali, PharmD Candidate 2021, Florida A&M University, College of Pharmacy and Pharmaceutical Sciences