Ghada Bourjeily, MD: Research Gaps on Sleep Issues During Pregnancy

The most common sleep issues during pregnancy include insomnia and restless leg syndrome—and are most common during the first but especially the third trimester. Factors that may disrupt sleep during pregnancy include fetal movement, contractions, heartburn at night, nasal congestion, and body discomfort from ligamental stretching. Some factors may stay consistent throughout the pregnancy and others may change.

Pregnant women tend to wake up a lot more than they did pre-pregnancy and have more frequent naps in the first and third semester. Ultimately pregnant women have a reduced sleep efficiency.

At SLEEP 2024, the 38th annual meeting of the Associated Professional Sleep Societies, Ghada Bourjeily, MD, from Brown University, presented on sleep and circadian rhythms during pregnancy and how these impacts fetal and neonatal outcomes. In an interview with HCPLive, Bourjeily spoke about the common sleep disorders pregnant women experience and gaps in research on this topic.

About a quarter of pregnant women describe symptoms of insomnia, and the insomnia prevalence rises as the pregnancy progresses. Research had found up to 50% to 60% of pregnant women report insomnia symptoms.

About a quarter of pregnant women also have restless legs syndrome, which is more common in the third trimester than the first trimester. Furthermore, about 5% to 60% of pregnant women have sleep disorder related to breathing, the percentage depending on what population of pregnant women are screened.

“Complicated pregnancies have a higher prevalence of sleep disorder breathing than low risk normal pregnancies, especially in women that have a normal body habitus,” Bourjeily told HCPLive.

Pregnant women experience circadian rhythm shifts during the first trimester, falling asleep earlier in the night. By the third trimester, a circadian rhythm shift occurs again, and they return to their pre-pregnancy levels.

Research has shown several associations between sleep disturbances during pregnancy and fetal and neonatal outcomes. For instance, congenital anomalies are linked to sleep disordered breathing and neurodevelopmental outcomes—such as low test and reading scores on standardized testing—is linked to being exposed to sleep apnea during pregnancy.

Gaps in research include understanding how a mother’s sleep impacts the health of the fetus in the womb and longer term, such as regarding cardiovascular health, metabolic health, neurodevelopmental outcomes, and milestones.

Bourjeily emphasized the importance of addressing possible long term fetal or neonatal outcomes related to sleep.

“Many things that happen in the course of pregnancy might, in fact, get better after pregnancy ends; however, it doesn't mean that we should ignore them until pregnancy is terminated or ends with a baby to address because of their associations with adverse outcomes,” she said. “When pregnant women have disturbances such as sleep, for instance, and it is not thought to be related to just some physiological factors or hormonal factors that might impact sleep but some true disturbance or some sleep disorder, we should take it seriously and address it because of these associations with both maternal health, but also possible long term fetal or neonatal outcomes.”

References

^{Baker, T, Bourjeily, G, England, S. Sleep and Circadian Rhythms in Pregnancy: Fetal and Neonatal Outcomes. Session presented at SLEEP 2024. Houston, TX. June 2, 2024.}