| Background:Gestational diabetes mellitus(GDM)refers to any glucose intolerance with onset or first recognition during pregnancy.It is ascribed to diabetes mellitus by the Word Heath Organization(WHO),which is the most common pregnancy complication.The incidence rate is around 3.1%-21.2%in Asian.Complications of both mother and their offspring,such as obesity and cardiovascular disease are associated with GDM.In recent years,with increasing social pressure and working hours,sleep disturbances have become increasingly prominent.Evidence has demonstrated that the risk of diabetes associated with sleep disorders is comparable to the traditional risk of diabetes.While during the pregnancy,because of the hormone change,body discomfort and birth-related worry,it is easier for the pregnant to have sleep disturbance,which mainly exhibits reduced sleep duration,decreased sleep quality and sleep disordered breathing.Although the symbol of the sleep disorders was confirmed to be related to the occurrence of GDM,the studies about the pre-pregnancy and different periods of the pregnancy are relatively rare,and the results are still in debate.Therefore,The purpose of this study is to explore the effect of the sleep disturbances during different pregnant periods on the occurrence of GDM,and to analyze the dynamic changes of sleep condition before and during pregnancy and the relationship with GDM.Aim:Correlate the relationship between the self-reported sleep disturbances in the prepregnancy,early pregnancy,and mid pregnancy and the risk of the subsequent GDM occurrence;Analyze the dynamic changes of sleep condition before and during pregnancy and the relationship with GDM.Methods:This study was a nested case-control analysis based on a prospective pregnancy cohort.Pregnant women who visited the prenatal clinic of Peking University Third Hospital between September 1,2019 and June 10,2020 were invited to participate the cohort.The pregnant women were asked to fill the questionnaire to collect their sleep status 1 month before pregnancy,7-llweeks of gestation and 20-24weeks of gestation,respectively.Pittsburgh sleep quality index(PSQI)and Berlin questionnaire(BQ)were used to obtain the sleep duration,sleep quality,and the risk of obstructive sleep apnea(OSA).The OGTT was completed during24-28 weeks of gestation subsequently to decide the GDM and non-GDM groups based on the experimental results.Comparing the sleep conditions of the two groups before pregnancy,early pregnancy,and mid pregnancy,and observing the relationship between sleep changes in the three stages and the occurrence of GDM.Statistical analysis was performed by Statistical.Two sides P value<0.05 was considered as statistically significant.Results:Correlate the relationship between the self-reported sleep disturbances in the prepregnancy,early pregnancy,and mid pregnancy and the risk of the subsequent GDM occurrence:This study included 358,247,and 224 pregnant women before pregnancy,early pregnancy,and second trimester,respectively.Out of 358 women during prepregnangcy,64(17.9%)were diagnosed with GDM,while the other 294(82.1%)were defined as non-GDM group.In the first trimester,there were 40(17.1%)women in the GDM group and the other 194(82.9%)pregnant women in the non-GDM group.And in the second trimester,41(18.3%)women in the GDM group and the other 183(81.7%)pregnant women in the non-GDM group.Multivariate analysis of the relationship between sleep factors and the occurrence of GDM:The high risk of OSA during prepregnancy,early pregnancy and second trimester were all related to the occurrence of GDM(prepregnancy:aOR=4.42,95%CI:1.10～17.80;early pregnancy:aOR=6.44,95%CI:1.41～29.51;second trimester:aOR=4.31,95%CI:1.07-17.35).In addition,the duration of daytime naps before pregnancy greater than 60 minutes was also an independent risk factor for the occurrence of GDM(aOR=4.08,95%CI:1.35-12.34).the daytime nap duration>60minutes is also an independent factors of the occurrence of GDM(aOR=4.08 95%CI:1.35～12.34).Multivariate analysis of the relationship between other factors and the occurrence of GDM:In prepregnancy,first trimester,and second trimester studies,the age(prepregnancy:aOR=1.11,95%CI:1.03-1.19,early trimester:aOR=1.11,95%CI:1.01～1.22;second trimester:aOR=1.11,95%CI:1.00～1.23)and family history of diabetes(pre-pregnancy:aOR=2.40,95%CI:1.34-4.29;early pregnancy:aOR=aOR=3.07,95%CI:1.45～6.52;second trimester:(aOR=2.84,95%CI:1.32～6.10)were all independent risk factors of the occurrence of GDM.The history of HBsAg positivity in the first trimester and the second trimester(early trimester:aOR=2.78,95%CI:1.10～7.03;second trimester:aOR=4.31,95%CI:1.07-17.35)significantly increased the risk of GDM.BMI was associated with GDM in the prepregnancy study(aOR=1.12,95%CI:1.01～1.24).Analyze the dynamic changes of sleep condition before and during pregnancy and the relationship with GDM:totally 193 pregnant women were involved in this study,where 36(18.7%)were attributed to the GDM group,while 158(81.3)were in the non-GDM group.The reported sleep duration is the longest in early-pregnancy,while it decreased in mid-pregnancy.The variation of the sleep duration during the pre-and early-pregnancy is statistic significant(P<0.001).The sleep quality reduced distinctively during the pregnancy,including early-and mid-pregnancy.The variation of the PSQI scores during the pre-and early-pregnancy is statistic significant(P<0.001).We define the PSQI>5 as the poor sleep quality,and found that the percentage of the pregnant with poor sleep quality are highest in early-pregnancy(36.7%).The percentages of OSA high risk are 3.1%,3.6%and 4.2%for pre-,early-,and mid-pregnancy,respectively,meaning that the prevalence rate increased with the pregnancy period.The ratios of OSA high risk in non-GDM group are all lower than the GDM group within the corresponding period.Conclusion:Tht high risk of OSA during prepregnangcy,early pregnancy,mid pregnancy is related to the occurrence of GDM.Daytime nap duration>60minutes before pregnancy will also significantly increase the risk of GDM.We found that pregnant women reported the longest nighttime sleep during the first trimester,with the highest proportion of poor sleep quality.While the prevalence rate of OSA high risk increased along with the pregnancy period,particularly during the mid-pregnancy.The dynamic variation of the pregnant with OSA high risk along with the pregnancy period is related to the occurrence of GDM.It is recommended to strengthen the sleep health education for women during prepregnancy,pay attention to the sleep status of pregnant women and the trend of sleep changes before and after pregnancy from multiple dimensions,develop good sleep habits as soon as possible,timely screen for those at high risk of OSA,pay attention to identifying OSA during pregnancy to provide necessary medical sleep guidance.These measures would have positive significance for reducing the risk of GDM. |
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