| PART 1 SLEEP AND SLEEP-RELATED FACTORS IN WOMEN DURING LATE PREGNANCYOBJECTIVE: To explore sleep and sleep-related factors in women during late pregnancy by establishing a birth cohort.METHODS: 260 late-pregnancy women who met the entering criteria were recruited in the prospective cohort study from Renji Hospital in Shanghai from Aug2012 to Jul 2013.Actigraph was used to measure sleep parameters in women during late pregnancy.A high performance liquid chromatography-mass spectrometry method was used to measure the cortisol concentration in hair which objectively reflecting chronic stress level of late pregnancy women.General survey questionnaire was used to collect basic information of women and her family.Infant birth information was extracting from the baby’s birth records from hospital.T test,ANOVA,pearson correlation analysis and multivariable linear regression analysis were used to explore sleep-related factors in women during late pregnancy.RESULTS: Women during late pregnancy had 7.02±1.02 hours of sleep time,with 49.7% of the prevalence of sleep time less than 7 hours;88.13±35.76 minutes of wake time after sleep onset;72.29%±9.55% of sleep efficiency,with 93.8% of the prevalence of sleep efficiency less than 85%;and 40.87 ± 13.63 of sleep fragmentation index at night.Multivariable analysis showed that the family income,the chronic stress and carrying a boy were significantly associated with sleep quality of late pregnancy women.Specifically,compared with pregnant women whose annual family income is more than 170,000 yuan,the pregnant women whose annual family income is less than 110,000 yuan have longer wake time after sleep onset(β=0.373,p<0.001),lower sleep efficiency(β=-0.199,p=0.016)and higher degree of sleep fragmentation(β=0.277,p=0.001).Women who had the higher level of stress in late pregnancy,had shorter sleep time(β=-0.194,p=0.010)and higher degree of sleep fragmentation(β =0.157,p=0.028).Compared with women who carrying a girl,women carrying a boy had shorter sleep time(β=-0.201,p=0.009),longer wake time after sleep onset(β=0.178,p=0.015),lower sleep efficiency(β=-0.214,p=0.004)and higher degree of sleep fragmentation(β=0.264,p<0.001).CONCLUSIONS: The sleep quality of women in the third trimester of pregnancy is generally poor,and the family income,maternal stress level and fetal sex are closely related to maternal sleep quality.Health care providers should pay attention to the sleep status of pregnant women,especially those women with high psychological stress in late pregnancy,and provide positive and effective measures to improve the sleep quality of pregnant women.So as to improve pregnancy outcomes and promote the healthy growth of the offspring.PART 2 THE EFFECTS OF SLEEP IN LATE PREGNANCY ON GROWTH AND METABOLISM IN OFFSPRINGOBJECTIVE: To explore the effect of maternal sleep in late pregnancy on growth and metabolism in offspring by establishing a birth cohort.METHODS: 255 pairs of healthy mothers and infants who met the entering criteria were recruited in the prospective cohort study from Renji Hospital in Shanghai from Aug 2012 to Jul 2013.There are 132 boys(51.8%)and 123girls(48.2%).Actigraph was used to measure sleep parameters in women during late pregnancy.A high performance liquid chromatography-mass spectrometry method was used to measure the cortisol concentration in hair.General survey questionnaire was used to collect basic information of women and her family.Infant birth information was extracting from the baby’s birth records from hospital.Children were followed up immediately after birth(whitin 3 days),42d、3m、6m、9m、12m、18m and 24 m postpartum,and their body weight and body length were measured,and BMI was calculated.The umbilical vein blood was collected at birth,and the concentration of leptin,adiponetin,triglyceride,total cholesterol,high density lipoprotein and low density lipoprotein in the cord blood were measured.Random venous blood of vena jugularis externa was collected at 24 months follow-up,and glucose and insulin levels were measured.Insulin resistance was assessed using HOMA-IR(homeostasis model assessment for insulin resistance).RESULTS: Infants’ weight,length and BMI at birth were 3.37(95%CI :3.32,3.42)kg,49.92(49.70,50.15)cm and 13.54(13.38,13.69)kg/m2,respectively;their weight for age z score,length for age z score and BMI for age z score at birth were 0.15(0.05,0.25)、0.21(0.09,0.32)and 0.09(-0.03,0.20),respectively.Children’s weight,length and BMI at 2 years of age were 12.69(12.50,12.89)kg,89.07(88.68,89.48)cm and 15.95(15.78,16.13)kg/m2,respectively;their weight for age z score,length for age z score and BMI for age z score at 2 years of age were 0.59(0.48,0.71),0.74(0.60,0.87)and 0.26(0.13,0.38),respectively.The average concentration of leptin,adiponectin,triglyceride,total cholesterol,high density lipoprotein and low density lipoprotein in the cord blood were 5.50(5.10,5.90)ng/ml,108.27(101.28,115.56)ug/ml,0.42(0.37,0.50)mmol/l,1.89(1.82,1.98)mmol/l,1.00(0.96,1.04)mmol/l and 0.72(0.67,0.77)mmol/l,respectively.The average concentration of glucose,insulin and insulin resistance in the venous blood at 2 years age of children were 4.64(4.55,4.73)mmol/l,4.74(4.19,5.30)u IU/ml and 1.02(0.89,1.16),respectively.There was no relationship neither between maternal sleep time,sleep efficiency,wake time after sleep onset and sleep fragmentation index in late pregnancy and weight,body length and BMI at birth,nor between maternal sleep time,sleep efficiency,wake time after sleep onset and sleep fragmentation index in late pregnancy and weight,body length and BMI at 2 years of age.However,maternal sleep in the third trimester of pregnancy was significantly associated with metabolism in offspring.Specifically,the shorter sleep time of mothers in the third trimester of pregnancy,the lower leptin level in the umbilical cord blood of offspring(β=0.212,p=0.011).The lower sleep efficiency of mothers,the higher triglyceride level in umbilical cord blood of offspring(β=-0.216,p=0.012).The longer wake time after sleep onset of mothers,the higher insulin level(β=0.285,p=0.005)and higher insulin resistance(β=0.293,p=0.004)in venous blood at 2 years age of children.CONCLUSIONS: There was no relationship between maternal sleep in late pregnancy and growth in offspring at birth and at 2 years of age.However,maternal sleep in the third trimester of pregnancy was significantly associated with the metabolism in offspring at birth and 2 years of age.It is suggested that maternal poor sleep during late pregnancy may be a high risk factor for metabolic disorders in offspring,which needs to be further verified in larger populations. |
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