Natural History of Sleep Disturbance in Childbearing Women: A Feasibility Study

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PROJECT ABSTRACT/SUMMARY Prospective data on the sleep of women as they transition from pre-pregnancy through pregnancy and to postpartum are needed to predict maternal and infant health outcomes. Sleep disturbance among new mothers is ubiquitous and presents a profound challenge, not only to mothers' health and well-being, but also to that of their infant. While some sleep disruptions may be normative and resolve with childbirth and the adaptation to new motherhood, others may be maladaptive and confer risk for adverse pregnancy and/or poor maternal or infant health outcomes. For example, sleep disturbance, globally measured, has been associated with antenatal depression, preterm birth, longer labors, more C-section deliveries, and postpartum depression. Which sleep disorders specifically confer risk is only now being delineated. Longitudinal studies are needed to determine when, for whom, and under what conditions, sleep disturbance gives rise to pathology. Prospective studies of this nature, however, have been limited, due to challenges in recruiting large, representative samples, maintaining enrolled participants, and ensuring timely completion of study instruments. In keeping with the R21 mechanism, the present study is designed to 1) pilot the feasibility of a novel methodological approach (recruitment via a national polling agency and registry, the use of an online questionnaire system, the provision of regular feedback via email and a study website, and a lottery-based incentive system) aimed to systematically and efficiently cull longitudinal data of this kind; 2) evaluate pregnant and non-pregnant women for differences with respect to cumulative sleep disorder morbidity, and determine which specific sleep disorders account for these differences; and 3) gather pilot data on the association between sleep disturbance and maternal-infant outcomes. Nulliparous women who do not intend to conceive in the next 18 months, who intend to conceive in the next 18 months, and who are currently in their first trimester, will be recruited to participate in a 16-18 month study. Feasibility will be assessed by evaluating recruitment, retention, and compliance rates and whether these meet pre-specified threshold criteria. Both sleep continuity and sleep disorder symptoms will be systematically tracked in relation to maternal and infant outcomes (e.g., fatigue, sleepiness, mood disturbance, gestational diabetes, incidence of pregnancy loss, incidence of pre-term birth, and birth weight). Given data to support the feasibility of these strategies, the methodological package proposed can be applied to numerous longitudinal designs, including, and apart from, the proposed study. Finally, the content of the proposed study will serve to allow an estimation of the overall association between sleep disturbance and maternal and infant health (i.e., an overall association between the two sets of measures) and for the evaluation of specific associations (e.g., OSA-related symptoms and gestational diabetes). Ultimately, if successful, this program of research may help define when sleep disorder interventions are needed to promote both maternal health and good infant outcomes.