Sleeping for two: a cross-sectional study on associations between objectively measured sleep during early to mid-pregnancy and maternal and fetal outcomes and inflammatory biomarker profiles

Abstract Background Pregnant women often experience subjective sleep disturbances shown to be associated with maternal and fetal outcomes. However, subjectively experienced sleep often deviates from objective measurements. Therefore, the aim of this study was to explore the relationship between obje...

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Main Authors: Caitlin Macdonald, Tryfonas Pitsillos, Anna-Karin Wikström, Alkistis Skalkidou, Peter Meerlo, Jocelien Olivier, Jelmer Prins, Inger Sundström Poromaa, Theodora Kunovac Kallak
Format: Article
Language:English
Published: BMC 2025-05-01
Series:BMC Pregnancy and Childbirth
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Online Access:https://doi.org/10.1186/s12884-025-07634-9
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author Caitlin Macdonald
Tryfonas Pitsillos
Anna-Karin Wikström
Alkistis Skalkidou
Peter Meerlo
Jocelien Olivier
Jelmer Prins
Inger Sundström Poromaa
Theodora Kunovac Kallak
author_facet Caitlin Macdonald
Tryfonas Pitsillos
Anna-Karin Wikström
Alkistis Skalkidou
Peter Meerlo
Jocelien Olivier
Jelmer Prins
Inger Sundström Poromaa
Theodora Kunovac Kallak
author_sort Caitlin Macdonald
collection DOAJ
description Abstract Background Pregnant women often experience subjective sleep disturbances shown to be associated with maternal and fetal outcomes. However, subjectively experienced sleep often deviates from objective measurements. Therefore, the aim of this study was to explore the relationship between objectively measured sleep in early to mid-pregnancy and maternal and fetal outcomes and inflammatory biomarkers. Methodology A total of 1,610 pregnant women aged 18 or older from the Safe Physical Activity in Pregnancy (SPAP) study were recruited during early (week 10–14) to mid-pregnancy (week 16–19). Blood samples were taken and sleep was monitored using an Actiwatch, tracking total sleep time, sleep efficiency, wake after sleep onset, and sleep onset latency for 7 days in early to mid-pregnancy. A combined sleep categorisation was created using total sleep time and sleep efficiency to categorise participants into three sleep quality groups: Good, Intermediate, and Poor. Maternal and fetal outcomes were collected via questionnaires, medical records, and plasma samples were analysed using the Olink cardiovascular paneI Il (n = 407). Results A total of 1,444 participants were included. The women were categorized as good sleepers (50.4%), intermediate (32.6%), or poor sleepers (17.0%) based on the distribution of the participant’s sleep parameters. Poor sleep was more common in women born outside Europe, those with higher pre-gestational BMI, and those with pre-pregnancy diabetes. Sleep groups did not differ in metabolic factors. Poor sleep was associated with an increased likelihood of requiring an emergency caesarean section (AOR = 1.86, 95% CI 1.13–3.05). No significant associations were found for other outcomes such as pre-eclampsia, premature birth, small for gestational age etc. Nine inflammatory biomarkers were significantly lower in poor sleepers, while one marker was higher. Conclusion Poor sleep in early to mid-pregnancy was more common in pregnant women with pre-pregnancy diabetes, obesity, and those born outside of Europe. Poor sleep was associated with a higher likelihood of emergency caesarean section, but no other maternal or fetal outcomes. An overall trend was observed towards lower levels of inflammatory markers in women that slept poorly; however, additional studies are needed to better understand the immune system’s role in the relationship between sleep, maternal health, and maternal and fetal outcomes. Possible mechanisms underlying these associations warrant further research.
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spelling doaj-art-eb493dbe8ba949a9b1529b79f5d96d9d2025-08-20T03:42:02ZengBMCBMC Pregnancy and Childbirth1471-23932025-05-0125111210.1186/s12884-025-07634-9Sleeping for two: a cross-sectional study on associations between objectively measured sleep during early to mid-pregnancy and maternal and fetal outcomes and inflammatory biomarker profilesCaitlin Macdonald0Tryfonas Pitsillos1Anna-Karin Wikström2Alkistis Skalkidou3Peter Meerlo4Jocelien Olivier5Jelmer Prins6Inger Sundström Poromaa7Theodora Kunovac Kallak8Department of Women’s and Children’s Health, Uppsala UniversityDepartment of Women’s and Children’s Health, Uppsala UniversityDepartment of Women’s and Children’s Health, Uppsala UniversityDepartment of Women’s and Children’s Health, Uppsala UniversityNeurobiology Expertise Group, Groningen Institute for Evolutionary Life Sciences, University of GroningenNeurobiology Expertise Group, Groningen Institute for Evolutionary Life Sciences, University of GroningenDepartment of Obstetrics and Gynaecology, University of Groningen, University Medical Center GroningenDepartment of Women’s and Children’s Health, Uppsala UniversityDepartment of Women’s and Children’s Health, Uppsala UniversityAbstract Background Pregnant women often experience subjective sleep disturbances shown to be associated with maternal and fetal outcomes. However, subjectively experienced sleep often deviates from objective measurements. Therefore, the aim of this study was to explore the relationship between objectively measured sleep in early to mid-pregnancy and maternal and fetal outcomes and inflammatory biomarkers. Methodology A total of 1,610 pregnant women aged 18 or older from the Safe Physical Activity in Pregnancy (SPAP) study were recruited during early (week 10–14) to mid-pregnancy (week 16–19). Blood samples were taken and sleep was monitored using an Actiwatch, tracking total sleep time, sleep efficiency, wake after sleep onset, and sleep onset latency for 7 days in early to mid-pregnancy. A combined sleep categorisation was created using total sleep time and sleep efficiency to categorise participants into three sleep quality groups: Good, Intermediate, and Poor. Maternal and fetal outcomes were collected via questionnaires, medical records, and plasma samples were analysed using the Olink cardiovascular paneI Il (n = 407). Results A total of 1,444 participants were included. The women were categorized as good sleepers (50.4%), intermediate (32.6%), or poor sleepers (17.0%) based on the distribution of the participant’s sleep parameters. Poor sleep was more common in women born outside Europe, those with higher pre-gestational BMI, and those with pre-pregnancy diabetes. Sleep groups did not differ in metabolic factors. Poor sleep was associated with an increased likelihood of requiring an emergency caesarean section (AOR = 1.86, 95% CI 1.13–3.05). No significant associations were found for other outcomes such as pre-eclampsia, premature birth, small for gestational age etc. Nine inflammatory biomarkers were significantly lower in poor sleepers, while one marker was higher. Conclusion Poor sleep in early to mid-pregnancy was more common in pregnant women with pre-pregnancy diabetes, obesity, and those born outside of Europe. Poor sleep was associated with a higher likelihood of emergency caesarean section, but no other maternal or fetal outcomes. An overall trend was observed towards lower levels of inflammatory markers in women that slept poorly; however, additional studies are needed to better understand the immune system’s role in the relationship between sleep, maternal health, and maternal and fetal outcomes. Possible mechanisms underlying these associations warrant further research.https://doi.org/10.1186/s12884-025-07634-9Sleep qualityActigraphyEarly pregnancyMaternal outcomesFetal outcomesInflammatory biomarkers
spellingShingle Caitlin Macdonald
Tryfonas Pitsillos
Anna-Karin Wikström
Alkistis Skalkidou
Peter Meerlo
Jocelien Olivier
Jelmer Prins
Inger Sundström Poromaa
Theodora Kunovac Kallak
Sleeping for two: a cross-sectional study on associations between objectively measured sleep during early to mid-pregnancy and maternal and fetal outcomes and inflammatory biomarker profiles
BMC Pregnancy and Childbirth
Sleep quality
Actigraphy
Early pregnancy
Maternal outcomes
Fetal outcomes
Inflammatory biomarkers
title Sleeping for two: a cross-sectional study on associations between objectively measured sleep during early to mid-pregnancy and maternal and fetal outcomes and inflammatory biomarker profiles
title_full Sleeping for two: a cross-sectional study on associations between objectively measured sleep during early to mid-pregnancy and maternal and fetal outcomes and inflammatory biomarker profiles
title_fullStr Sleeping for two: a cross-sectional study on associations between objectively measured sleep during early to mid-pregnancy and maternal and fetal outcomes and inflammatory biomarker profiles
title_full_unstemmed Sleeping for two: a cross-sectional study on associations between objectively measured sleep during early to mid-pregnancy and maternal and fetal outcomes and inflammatory biomarker profiles
title_short Sleeping for two: a cross-sectional study on associations between objectively measured sleep during early to mid-pregnancy and maternal and fetal outcomes and inflammatory biomarker profiles
title_sort sleeping for two a cross sectional study on associations between objectively measured sleep during early to mid pregnancy and maternal and fetal outcomes and inflammatory biomarker profiles
topic Sleep quality
Actigraphy
Early pregnancy
Maternal outcomes
Fetal outcomes
Inflammatory biomarkers
url https://doi.org/10.1186/s12884-025-07634-9
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