{"doi":"10.1093/sleep/zsae288","title":"Insomnia in pregnancy and obstetric outcomes","abstract":"In the nonpregnant population, insomnia is the most prevalent sleep disorder [1]. The frequency of insomnia is high in pregnancy as well. A recent meta-analysis found that 38% of pregnant individuals experience insomnia. The prevalence of insomnia, furthermore, increases with advancing trimester [2]. Nevertheless, sleep disorders during pregnancy, including insomnia, are commonly underdiagnosed even though they adversely affect quality of life. Furthermore, there is some evidence that insomnia is linked to adverse pregnancy outcomes (APOs), including hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM), and preterm birth (PTB) [3]. In a large observational study of nearly 3 million pregnant people that evaluated the association of sleep disorders and PTB, pregnant individuals with insomnia had a 30% increased risk of PTB, although the study was limited by its retrospective nature [4]. Another study demonstrated that concurrent insomnia and habitual snoring were associated with HDP, but this was performed in only a single site, and the generalizability of the findings are unclear [5]. Moreover, studies of sleep disorders in pregnancy have not used objective diagnostic criteria to identify insomnia and have not been able to reliably distinguish it from poor sleep quality or short sleep duration. Thus, we used data from a prospective, large, diverse observational cohort of nulliparous individuals conducted at eight US medical centers to evaluate the relationship between insomnia and APOs. This is a secondary analysis of data from the Nulliparous Pregnancy Outcomes Study: Monitoring New Mothers-to-be (nuMoM2b), which is a prospective study evaluating APOs in nulliparous individuals [6]. Those with self-reported sleep data were included in this analysis. Insomnia symptoms were evaluated via the “Women’s Health Initiative Insomnia Rating Scale,” which was administered in early (6–13 weeks’ gestation) and mid-pregnancy (22–29 weeks). Total scores assessed symptoms in the last 4 weeks. The five-item scale results in scores ranging from 0 to 20. Those with a score of at least 9 were identified as having clinically significant insomnia symptoms [7]. The outcomes of interest included HDP (including gestational hypertension, preeclampsia, eclampsia, and HELLP [Hemolysis, Elevated Liver enzymes and Low Platelets] syndrome), GDM, PTB, and small-for-gestational-age birth <10%ile (SGA). Each were defined using standard obstetric definitions and collected via trained medical record abstraction. For each time point, separate multivariable logistic regression analysis was performed to estimate the adjusted odds ratio (aOR) and 95% confidence interval (CI) of each outcome, after adjusting for maternal age, self-reported race/ethnicity as a social construct, insurance, being at high risk for sleep-disordered breathing (SDB) as measured from questions adapted from the Berlin Questionnaire for Sleep Apnea, body mass index, and recent (within the past 3 months) smoking. Of 7676 and 8310 participants who completed sleep questionnaires in early and mid-pregnancy, the prevalence of insomnia symptoms was 42.1% and 46.5%, respectively, with 2032 individuals reporting insomnia symptoms at both time points. Individuals with insomnia symptoms in early pregnancy were more likely to be non-Hispanic White (65.0% vs. 62.8%, p = 0.005), publicly insured (26.3% vs. 21.9%, p < 0.001), report current smoking (20.6% vs. 15.0%, p < 0.001), living with obesity (11.6% vs. 10.4%, p < 0.001), and at high risk for SDB (21.9% vs. 12.5%, p < 0.001). Insomnia symptoms in early pregnancy were associated with HDP (aOR 1.10, 95% CI 1.01–1.21), and insomnia symptoms in either early or mid-pregnancy were associated with PTB (aOR 1.17, 95% CI 1.01–1.36; aOR 1.28, 95% CI 1.10–1.49, respectively). Insomnia symptoms, regardless of when they manifested, were not associated with GDM or SGA (Table 1). Association of insomnia symptoms during pregnancy with adverse perinat","journal":"SLEEP","year":2024,"id":474767,"datarank":0.10397207708399181,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"self_citation_contribution":0.10397207708399181,"citation_network_contribution":0.0,"self_endowment_contribution":0.10397207708399181,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9648,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":911066,"name":"Xiaoning Huang","orcid":"0000-0001-5813-5993","position":1,"is_corresponding":false},{"id":1311684,"name":"Phyllis Zee","orcid":null,"position":2,"is_corresponding":false},{"id":98917,"name":"Sadiya S. Khan","orcid":"0000-0003-0643-1859","position":3,"is_corresponding":false},{"id":328232,"name":"Philip Greenland","orcid":"0000-0002-6327-2439","position":4,"is_corresponding":false},{"id":294860,"name":"Francesca Facco","orcid":"0000-0002-9135-9005","position":5,"is_corresponding":false},{"id":769588,"name":"Judith H. Chung","orcid":"0000-0002-3256-1465","position":6,"is_corresponding":false},{"id":1256803,"name":"William A Grobman","orcid":null,"position":7,"is_corresponding":false},{"id":331592,"name":"David M. Haas","orcid":"0000-0002-8379-0743","position":8,"is_corresponding":false},{"id":731372,"name":"Rebecca B. McNeil","orcid":"0000-0003-1351-1670","position":9,"is_corresponding":false},{"id":1311685,"name":"B.M. Mercer","orcid":null,"position":10,"is_corresponding":false},{"id":262907,"name":"Uma M. Reddy","orcid":"0000-0001-5519-1527","position":11,"is_corresponding":false},{"id":262903,"name":"George R. Saade","orcid":"0000-0001-7925-5302","position":12,"is_corresponding":false},{"id":257473,"name":"Robert M. Silver","orcid":"0000-0002-5794-3152","position":13,"is_corresponding":false},{"id":1311254,"name":"Laura Elizabeth Wiener","orcid":"0000-0003-0960-8322","position":14,"is_corresponding":false},{"id":428487,"name":"Lynn M. Yee","orcid":"0000-0002-6274-0544","position":15,"is_corresponding":false},{"id":1311253,"name":"Rachel Friedlander","orcid":"0000-0002-7143-8689","position":0,"is_corresponding":true}],"reference_count":11,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T02:06:13.042906Z","pmid":"39663401","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}