Association Of Sleep Patterns During Pregnancy With Glucose Metabolism And Birth Outcome And The Role Of Biological Clock Gene Polymorphism

Objective Healthy relationship between sleep patterns in pregnancy and glucose metabolism or birth outcomes is still scarce and inconsistent,which does not allow final conclusions yet.Based on the Hefei Maternal and child birth cohort,the present study aimed to investigate this relationship between sleep timing in pregnancy and OGTT outcomes or adverse gestational age outcomes.Subgroup analyses of SNP phenotype further verified the above results,which were designed to found sensitive populations.Methods 7 134 pregnant womens in the second trimester who met the inclusion criteria were consecutively recruited at 3 hospitals in Hefei from March 2015 to July 2020.Insight into sleep conditions in the past month is obtained by Pittsburgh sleep quality index.The fasting venous blood samples collected on the same day were investigated.Some pregnant women were sampled and the phenotypes of rs1260326 and rs1801260 loci were detected.OGTT outcomes were transcripted by Handbook of Maternal health care and be considered the basis of GDM diagnosis.Patients were followed until delivery and the data of gestational age type assessment was collectioned.Results Late sleep was associated with lower GDM rate(get up timing: OR = 0.86,95% CI: 0.81-0.91)and higher SGA rate(bedtime: OR = 1.19,95% CI: 1.05-1.34;get up: OR = 1.25,95% CI: 1.04-1.28;sleep midpoint: OR = 1.25,95% CI: 1.10-1.43).Longer sleep duration was associated with lower GDM rate(OR = 0.89,95% CI: 0.84-0.95)and lower LGA rate(OR = 0.91,95% CI: 0.84-0.99).In the association between sleep time and SGA,no mediating effect of glucose metabolism function was found(get up timing: P for indirect(AUC)= 0.90,P indirect(HOMA-IR)= 0.49;sleep midpoint: P for indirect(AUC)= 0.90,P for indirect(HOMA-IR)= 0.62).AUC(P for indirect = 0.01,accounting of indirect = 12.0%)and HOMA-IR(P for indirect = 0.01,accounting of indirect = 13.4%)of glucose metabolism indexes played a mediating role in the association between sleep duration and LGA.Rs1801260 pregnant women with C type(sleep midpoint: OR = 2.22,95% CI: 1.01-4.89)had a higher risk of SGA than those with later sleep time.Rs1260326 C / T type(bedtime: OR = 2.18,95% CI: 1.46-3.25,sleep midpoint: OR = 1.83,95% CI: 1.22-2.74)and T / T type(bedtime: OR = 1.96,95% CI: 1.22-2.74;get up: OR = 1.79,95% CI: 1.28-2.49;sleep midpoint: OR = 2.37,95% CI: 1.52-3.70)had higher risk of SGA than those with later sleep time.Conclusions The delay of sleep schedule(bedtime later than 11:00 p.m.and getting up later than 8:00 a.m.)was not only associated with lower risk of GDM,but also with higher risk of SGA(especially the sleep pattern of staying up late and getting up late).The pregnant women with rs1801260 C and rs1260326 T had higher risk of SGA than those with rs1801260 C and rs1260326 T.Longer sleep duration is associated with lower risk of GDM and lower risk of LGA.One of the mechanisms of the health protective effect of longer sleep duration on LGA may be through reducing blood glucose and insulin resistance.