Study On The Effect Of Pre-pregnancy Day Nap And Sleep Duration In The Second And Third Trimester Of Pregnancy On Fatigue

Objective:This study explores whether sleep duration and pre-pregnancy day nap have an impact on fatigue in pregnant women,and whether the impact begins in the late or middle trimester,and then explores the pathophysiological basis and molecular genetic mechanism of its occurrence and development,so as to detect and intervene fatigue in pregnant women as early as possible,providing new ideas for prenatal and postnatal care.Methods:This study was divided into two parts:（1）490 Cases of normal late pregnancy（28 weeks to prenatal）pregnant women treated in the Second Affiliated Hospital of Xiamen medical college from January to December 2020 were collected,collect general demographic information and clinical data,record the current effective sleep duration and whether to take a nap before pregnancy,3 cases of missing sleep duration samples were excluded,and 487 Cases were effective samples.The age of pregnant women ranged from 20 to 43 years old,with an average age of（29.1±4.1）years old and 28⁺¹to 40⁺⁶weeks of gestation.It can be divided into four groupsaccording to whether nap before pregnancy and sleep duration（according to the recommendations of the National Sleep Foundation,take 7 hours as the dividing point）:no nap before pregnancy and the current effective sleep time≤7 hours（n=43）;pre-pregnancy day nap and the current effective sleep time≤7 hours（n=129）;no nap before pregnancy and the current effective sleep time>7 hours（n=101）;and pre-pregnancy day nap and the current effective sleep time>7 hours（n=214）.The general data of each group of samples were investigated,and the fatigue degree of women in the third trimester of pregnancy was quantified by the FS-14 scale.The scores were divided into three items:total score,physical fatigue score,and mental fatigue score,the interaction of nap and night sleep duration effect,the difference of different main effects,and the correlation pre-pregnancy day nap and night sleep duration with the FS-14 score were analyzed.（2）198 mid pregnant women in the Second Affiliated Hospital of Xiamen medical college from August 2020 to September 2021 were collected,collect general demographic information and clinical data,record the current effective sleep duration and whether to take a nap before pregnancy.The age of pregnant women ranged from 20 to 41 years old,with an average age of（29.3±4.0）years old and 22⁺⁵～26⁺⁴weeks of gestation.Application of ANCOVA to interactively analyze pre-pregnancy day nap and night sleep duration,which showed no statistical significance（P>0.05）.Therefore,the main effect,night sleep duration,was selected for grouping and divided into night sleep duration≤7h group（n=69）and night sleep duration>7h group（n=129）.To gather statistics the general data of each group,using Fatigue Severity Scale（FSS）and Pittsburgh Sleep Quality Index（PSQI）quantitative pregnancy fatigue,calculation of FSS and PSQI total score.At the same time,the peripheral blood of the subjects was collected,and the levels of tumor necrosis nactor-ɑ（TNF-ɑ）,orosomucoid1（ORM1）,glutathione（GSH）and thiobarbituric acid reactive substance（TBARS）in serum were measured,and the single nucleotide polymorphisms（SNP）of TNF-α（rs1800629）,ORM1(rs17650,GSH（rs713041）,TBARS（rs12946397,rs17222691）were detected.The differences of sleep duration and related factors including total score of FSS,total score of PSQI and biomarkers between the two groups in the second trimester of pregnancy were analyzed,the correlation between the total scores of FSS and PSQI with biological markers such as TNF-α,ORM1,GSH and TBARS in the second trimester of pregnancy was analyzed.The genotypic distribution,allelic frequency,genotype frequency and h-W balance of biomarkers including TNF-α,ORM1,GSH and TBARS in the second trimester were analyzed.Results:（1）The difference of FS-14total score and physical fatigue score between the two groups was statistically significant（P=0.005,P=0.001）,while the difference of FS-14 mental fatigue score between the two groups was not statistically significant（P>0.05）.Regardless of whether there is a nap before pregnancy,the total fatigue score and physical fatigue score of those who sleep more than 7h are lower.FS-14 total score,FS-14 physical fatigue score,and FS-14 mental fatigue score were negatively correlated with the actual length of night sleep（P=0.001,P=0.001,P=0.030）.（2）There was no significant difference in FSS and PSQI scores between the group with sleep duration≤7h and the group with sleep duration>7h in the middle of pregnancy（P>0.05）;The level of TNF-αin the group with sleep duration>7h was significantly higher than that in the group with sleep duration≤7h（P=0.047）;There was no correlation between the total scores of FSS,PSQI and TNF-ɑ,GSH,ORM1 and TBARS in the second trimester（P>0.05）.SNPs analysis showed that there was no significant difference in genotype and allele frequency at each site（P>0.05）.rs12946397×rs17650,rs17222691×rs17650 and rs17650×rs713041 had statistical significance in the group with sleep duration≤7h（P=0.006,P=0.017,P<0.001）;However,there was no significant correlation between the interaction of gene loci and FSS total score in the group with sleep duration>7h（P>0.05）.Conclusions:（1）The current length of night sleep and a pre-pregnancy nap will affect the fatigue of pregnant women in the third trimester,mainly physical fatigue;Taking a nap before pregnancy,especially in the third trimester of pregnancy,can help reduce the fatigue of pregnant women.（2）The pathophysiological basis of fatigue in different periods is not completely consistent.High level TNF-ɑit may be the pathophysiological basis affecting the fatigue of pregnant women who sleep longer than 7 hours in the second trimester.Genetic polymorphisms of inflammation and oxidative stress response play a role in the fatigue of pregnant women who sleep less than 7 hours,and prepregnancy nap had no effect on fatigue in the second trimester of pregnancy.