| ObjectiveThis study investigated the relationship among maternal sleep pattern,cardiovascular health during pregnancy and birth weight of offspring,to verify whether healthy sleep pattern during pregnancy can improve the poor birth weight of offspring caused by poor cardiovascular health,and to provide scientific basis for guiding sleep during pregnancy and promoting maternal and child health.MethodsBased on the Hefei Maternal and Child health cohort,9 013 pregnant women were recruited from three hospitals in Hefei who had regular check-ups and were followed up from baseline（16-23 weeks）to delivery.The basic information and sleep information of pregnant women were collected by questionnaire at baseline.The sleep pattern included five sleep characteristics: sleep chronotype,sleep duration,snoring,insomnia and daytime sleepiness.Each sleep characteristic was grouped and the score of poor sleep was calculated.In the second trimester of pregnancy（24-27 weeks）,maternal basic information was collected through the hospital information system and related indicators of venous blood were collected.Cardiovascular health included five related indicators: body mass index,blood pressure,blood sugar,blood lipids and smoking status.Each indicator was grouped and the cardiovascular health score was calculated.At the time of delivery,basic health data of the offspring were collected through the hospital information system,including gestational age,sex,birth weight,and indicators related of birth weight（macrosomia,low birth weight,large for gestational age,small for gestational age）were calculated.A total of 7 286 maternal and infant pairs were collected,and the blood samples of 2 976 pregnant women were randomly selected for venous blood test in the middle of pregnancy.Multiple linear and logistic regression models were used to analyze the relationship between maternal sleep characteristics,cardiovascular health scores in the second trimester,and offspring birth weight-related indicators.A mediation model was used to assess the relationship between maternal cardiovascular health in sleep characteristics and offspring birth weight.Linear and logistic regression models were used to analyze the relationship between maternal CVH in the second trimester and offspring birth weight-related indicators under different sleep characteristics.Potential adjusted confounders included maternal age,education level,monthly family income,physical activity,fruit intake,dessert intake,cod liver oil supplementation,folic acid supplementation,parity,family history of hypertension and diabetes,gestational gender and age.ResultsAmong 2 976 participants,46.2% of the CVH was all ideal group,29.5% was ≥1intermediate（no poor）group,and 24.3% had ≥1 poor group.The proportion of poor sleep score was 0-1（28.4%）,2-3（65.3%）and 4-5（6.3%）.The birth weight of offspring was 3420.91 ± 422.36 g.Late chronotype,snoring,and excessive daytime sleepiness were associated with an increased risk of developing CVH in the second trimester compared with healthy sleep patterns.In the late sleep chronotype group,the RR（95% CI）was 0.834（0.720,0.966）for the all ideal level group（vs.non-ideal group）and 1.275（1.060,1.534）for the≥1 worse level group（vs.all ideal level group）.In the snoring group,the RR（95% CI）was 0.713（0.609,0.834）for the all ideal level group（vs.the non-ideal group）,1.362（1.134,1.637）for the ≥1 intermediate level group（vs.the all ideal level group）,and≥ 1 worse level group（vs.the all ideal level group）1.440（1.185,1.751）.In the excessive daytime sleepiness group,the RR（95% CI）was 1.311（1.036,1.659）for the≥1 worse level group（vs.all ideal level groups）.For each additional point of poor sleep score,the RR（95% CI）was 0.880（0.816,0.949）for the all ideal level group（vs.the non-ideal group）,1.108（1.015,1.210）for the ≥1 intermediate group（vs.the all ideal level group）,and ≥1 poor group（vs.the all ideal level group）,the RR（95% CI）was 1.177（1.070,1.294）.Compared with healthy sleep patterns,pregnant women were in late chronotype（β=33.652,95%CI: 5.875,61.429;P=0.018）,snoring（β=38.780,95%CI: 9.780,68.128;P=0.010）,insomnia（β=32.970,95%CI: 3.442,62.075;P=0.029）,the birth weight of the offspring was significantly higher.The birth weight of offspring increased with maternal poor sleep score（β=28.954,95%CI: 14.833,43.075;P<0.001）.The birth weight of offspring decreased with the increase of CVH scores in the second trimester of pregnancy（β=-28.073,95%CI:-39.868,-16.279;P<0.001）.Compared with pregnant women who were grouped into all ideal groups by CVH,pregnant women in ≥1 poor group had a 73.313 g increase in offspring birth weight（β=73.313,95% CI: 38.975,107.652;P<0.001）.The results of multivariate logistic analysis showed that the higher the CVH score of pregnant women,the lower the risk of macrosomia（RR=0.810,95%CI:0.729,0.899）and LGA（RR=0.802,95%CI:0.735,0.875）in offspring.The higher the poor sleep score,the higher the risk of macrosomia（RR=1.264,95%CI:1.103,1.449）and LGA（RR=1.255,95%CI: 1.120,1.406）in offspring.The three correlations of pregnancy sleep pattern,CVH at second trimester,and offspring birth weight（P<0.01）,and the presence of total effects,qualified for the mediation analysis.This study explored the mediating effect of CVH score in the second trimester between maternal sleep score and offspring birth weight.The results showed that the indirect effect of CVH between sleep score and offspring birth weight was 2.7477（1.2305,4.6467）,and the percentage of indirect effect was 9.49%（6.57%-18.75%）.A stratified analysis of poor sleep patterns found that pregnant women with poor sleep patterns and poor CVH groupings had a higher risk of offspring macrosomia and LGA.The poor sleep score was analyzed by stratification.The sleep score of 2-5 points with CVH was divided into ≥1 poor group as the reference group,and the sleep score of pregnant women with 2-5 points and CVH was divided into all ideal groups（RR=0.557,95%CI: 0.391,0.794）,sleep score of 0-1 with CVH grouped into ≥1 intermediate index（no poor）group（RR=0.417,95%CI: 0.229,0.759）,grouping with CVH into all ideal index groups（RR=0.270,95%CI: 0.156,0.469）was associated with a lower risk of macrosomia in offspring;and the sleep score of pregnant women with 2-5 points and CVH was divided into all ideal groups（RR=0.527,95%CI: 0.391,0.711）,sleep score of0-1 with CVH grouped into ≥1 intermediate（no poor）group（RR=0.506,95%CI: 0.317,0.807）,grouping with CVH into all ideal index groups（RR=0.361,95%CI: 0.236,0.807）was associated with a lower risk of LGA in offspring.ConclusionsThe findings suggest that poor sleep patterns during pregnancy can exacerbate poor maternal cardiovascular health,which in turn leads to increased birth weight in offspring,increased risk of LGA and macrosomia,and healthy sleep patterns reduce this risk. |
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