Raichel M. Alex, Dwayne L. Mann, Ali Azarbarzin, Daniel Vena, Laura K Gell, Andrew Wellman, Susan Redline, Scott A. Sands
Scott A. Sands
Research Category: Women's Health, Sex-Differences and Gender Biology
RATIONALE: We assessed the association between objective measurement of inspiratory airflow limitation severity and increased incidence of adverse pregnancy outcomes in a large community study (Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-be, nuMoM2b). Pregnancy outcomes included preeclampsia, hypertensive disorders of pregnancy (HTDP), gestational diabetes mellitus (GDM), preterm delivery and low infant birthweight.
METHODS: Overnight polysomnography was completed at early (6–15weeks, N=3009) and mid (22–31weeks, N=2330) pregnancy. Flow limitation severity (“flow:drive ratio”, 0%=fully obstructed, 100%=open airway) was non-invasively quantified using breath-by-breath airflow shape features. Associations were assessed by multivariable regression analysis adjusting for maternal age, BMI and chronic hypertension.
RESULTS: Flow limitation severity was associated with incident preeclampsia (odds ratio [95CI]: 2.52 [1.71–3.71]), HTDP (1.66 [1.23–2.24]) and lower birthweight (by 95.07g [39.61–150.54]), but not GDM or preterm delivery. These associations were observed at both early and mid-pregnancy. Sleep apnea (apnea-hypopnea index, AHI≥5) was significant only during mid-pregnancy and was not associated with hypertensive outcomes after adjusting for flow limitation.
CONCLUSIONS: Airflow limitation is independently associated with preeclampsia, HTDP and lower birth weight. Hypertensive outcomes are more closely associated with airflow limitation than AHI. Earlier assessment of airflow limitation may lead to better management of adverse pregnancy outcomes.