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Volume 14 No. 12
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Accepted Papers

Scientific Investigations

Association of Adverse Pregnancy Outcomes With Self-Reported Measures of Sleep Duration and Timing in Women Who Are Nulliparous

Francesca L. Facco, MD1; Corette B. Parker, PhD2; Shannon Hunter, MS2; Kathryn J. Reid, PhD3; Phyllis C. Zee, MD, PhD3; Robert M. Silver, MD4; David M. Haas, MD5; Judith H. Chung, MD6; Grace W. Pien, MD7; Chia-Ling Nhan-Chang, MD, PhD8; Hyagriv N. Simhan, MD1; Samuel Parry, MD9; Ronald J. Wapner, MD8; George R. Saade, MD10; Brian M. Mercer, MD11; Caroline Torres, MD8; Jordan Knight, DO5; Uma M. Reddy, MD12; William A. Grobman, MD13
1Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; 2RTI International, Research Triangle Park, North Carolina; 3Department of Neurology, Northwestern University, Chicago, Illinois; 4Department of Obstetrics and Gynecology, University of Utah and Intermountain Healthcare, Salt Lake City, Utah; 5Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, Indiana; 6Department of Obstetrics and Gynecology, University of California, Irvine, Orange, California; 7Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; 8Department of Obstetrics and Gynecology, Columbia University, New York, New York; 9Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania; 10Department of Obstetrics and Gynecology, University of Texas Medical Branch, University of Texas, Galveston, Texas; 11Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, Ohio; 12Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; 13Department of Obstetrics and Gynecology Medicine, Northwestern University, Chicago, Illinois

Study Objectives:

To examine the relationship of self-reported sleep during pregnancy with adverse pregnancy outcomes. A secondary objective was to describe the concordance between self-reported and objectively assessed sleep during pregnancy.


In this prospective cohort, women completed a survey of sleep patterns at 6 to 13 weeks' gestation (visit 1) and again at 22 to 29 weeks' gestation (visit 3). Additionally, at 16 to 21 weeks (visit 2), a subgroup completed a week-long sleep diary coincident with an actigraphy recording. Weekly averages of self-reported sleep duration and sleep midpoint were calculated. A priori, sleep duration < 7 hours was defined as “short,” and sleep midpoint after 5:00 AM was defined as “late.” The relationship of these sleep abnormalities with hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) was determined.


Of the 10,038 women enrolled, sleep survey data were available for 7,524 women at visit 1 and 7,668 women at visit 3. A total of 752 women also provided ≥ 5 days of sleep diary data coincident with actigraphy at visit 2. We did not observe any consistent relationship between self-reported short sleep and HDP or GDM. There was an association between self-reported late sleep midpoint and GDM (visit 1 adjusted odds ratio 1.67, 95% confidence interval 1.17, 2.38; visit 2 adjusted odds ratio 1.73, 95% confidence interval 1.23, 2.43). At visit 2, 77.1% of participants had concordance between their diary and actigraphy for short sleep duration, whereas 94.3% were concordant for sleep midpoint.


Self-reported sleep midpoint, which is more accurate than self-reported sleep duration, is associated with the risk of GDM.

Clinical Trial Registration:

Registry:, Title: Pregnancy as a Window to Future Cardiovascular Health: Adverse Pregnancy Outcomes as Predictors of Increased Risk Factors for Cardiovascular Disease, Identifier: NCT02231398, URL:


Facco FL, Parker CB, Hunter S, Reid KJ, Zee PC, Silver RM, Haas DM, Chung JH, Pien GW, Nhan-Chang CL, Simhan HN, Parry S, Wapner RJ, Saade GR, Mercer BM, Torres C, Knight J, Reddy UM, Grobman WA. Association of adverse pregnancy outcomes with self-reported measures of sleep duration and timing in women who are nulliparous. J Clin Sleep Med. 2018;14(12):2047–2056.

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