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Am J Perinatol 2024; 41(S 01): e2418-e2426
DOI: 10.1055/a-2115-0147
Original Article

Association between Sleep Disordered Breathing and Neonatal Outcomes in Nulliparous Individuals

Arlin Delgado
1   Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida
,
Anthony M. Kendle 
1   Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida
,
Tara Randis 
2   Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa Florida
,
Keyur Donda
2   Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa Florida
,
Jason L. Salemi
3   College of Public Health, University of South Florida, Tampa, Florida
,
Francesca L. Facco
4   Department of Obstetrics and Gynecology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Corette B. Parker
5   RTI International, Research Triangle Park, North Carolina
,
Uma M. Reddy
6   Department of Obstetrics and Gynecology, Columbia University, New York City, New York
,
Robert M. Silver
7   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
,
Robert C. Basner
6   Department of Obstetrics and Gynecology, Columbia University, New York City, New York
,
Judith H. Chung
8   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Irvine, School of Medicine, Irvine, California
,
Frank P. Schubert
9   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
,
Grace W. Pien
10   Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Susan Redline
11   Departments of Medicine and Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Samuel Parry
12   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
,
William A. Grobman
13   Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
,
Phyllis C. Zee
14   Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Judette M. Louis
1   Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida
3   College of Public Health, University of South Florida, Tampa, Florida
› Author Affiliations Funding This study is supported by grant funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Heart Lung and Blood Institute: U10 HD063036, Research Triangle Institute; U10 HD063072, Case Western Reserve University; U10 HD063047, Columbia University; U10 HD063037, Indiana University; U10 HD063041, Magee-Women's Hospital; U10 HD063020, Northwestern University; U10 HD063046, University of California Irvine; U10 HD063048, University of Pennsylvania; and U10 HD063053, University of Utah.
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Abstract

Objective Our objective was to determine whether objectively measured sleep-disordered breathing (SDB) during pregnancy is associated with an increased risk of adverse neonatal outcomes in a cohort of nulliparous individuals.

Study Design Secondary analysis of the nuMom2b sleep disordered breathing substudy was performed. Individuals underwent in-home sleep studies for SDB assessment in early (6–15 weeks' gestation) and mid-pregnancy (22–31 weeks' gestation). SDB was defined as an apnea-hypopnea index ≥5 events/h at either time point. The primary outcome was a composite outcome of respiratory distress syndrome, transient tachypnea of the newborn, or receipt of respiratory support, treated hyperbilirubinemia or hypoglycemia, large-for-gestational age, seizures treated with medications or confirmed by electroencephalography, confirmed sepsis, or neonatal death. Individuals were categorized into (1) early pregnancy SDB (6–15 weeks' gestation), (2) new onset mid-pregnancy SDB (22–31 weeks' gestation), and (3) no SDB. Log-binomial regression was used to calculate adjusted risk ratios (RR) and 95% confidence intervals (CIs) representing the association.

Results Among 2,106 participants, 3% (n = 75) had early pregnancy SDB and 5.7% (n = 119) developed new-onset mid-pregnancy SDB. The incidence of the primary outcome was higher in the offspring of individuals with early (29.3%) and new onset mid-pregnancy SDB (30.3%) compared with individuals with no SDB (17.8%). After adjustment for maternal age, chronic hypertension, pregestational diabetes, and body mass index, new onset mid-pregnancy SDB conferred increased risk (RR = 1.43, 95% CI: 1.05, 1.94), where there was no longer statistically significant association between early pregnancy SDB and the primary outcome.

Conclusion New onset, mid-pregnancy SDB is independently associated with neonatal morbidity.

Key Points

  • SDB is a common condition impacting pregnancy with known maternal risks.

  • Objectively defined SDB in pregnancy was associated with a composite of adverse neonatal outcomes.

  • New onset SDB in mid pregnancy conferred statistically significant increased risk.

Keywords

neonatology - obstetrics - sleep disordered breathing

Supplementary Material



Publication History

Received: 03 September 2022

Accepted: 15 March 2023

Accepted Manuscript online:
28 June 2023

Article published online:
29 July 2023

© 2023. Thieme. All rights reserved.

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