Research
Obstetrics
Maternal sleep-disordered breathing and adverse pregnancy outcomes: a systematic review and metaanalysis

Presented in part at the annual International Conference of the American Thoracic Society, Philadelphia, PA, May 17-22, 2013.
https://doi.org/10.1016/j.ajog.2013.07.033Get rights and content

Objective

Symptoms of sleep-disordered breathing (SDB) are increased in pregnancy compared to the nongravid state. Maternal SDB may be associated with adverse pregnancy outcomes, but this is still under investigation. We performed a systematic literature review, and where feasible, a metaanalysis, to evaluate whether women with SDB in pregnancy have a higher risk of specific adverse pregnancy outcomes compared with women without SDB.

Study Design

Original studies published until June 2012 evaluating the association between gestational hypertension/preeclampsia, gestational diabetes, low birthweight infants, and maternal SDB, defined either by symptoms or the reference standard polysomnography, were identified from PubMed, EMBASE, and Web of Science. Data were extracted on study design and outcome estimates. When appropriate, effect estimates from each study were pooled using a random-effects model.

Results

Of the 4386 studies identified, 31 met the defined criteria. Twenty-one studies, all observational in design, reported dichotomous outcomes; 9 of these adjusted for potential confounders. Maternal SDB was significantly associated with gestational hypertension/preeclampsia (pooled adjusted odds ratio [aOR], 2.34; 95% confidence interval [CI], 1.60–3.09; 5 studies), and gestational diabetes (pooled aOR, 1.86; 95% CI, 1.30–2.42; 5 studies).

Conclusion

Based on published observational studies to date, maternal SDB is associated with an increased risk of gestational hypertension and gestational diabetes after adjusting for potential confounders. However, large-scale, prospective cohort, and interventional studies are needed to further elucidate the relationship between maternal SDB and adverse pregnancy outcomes.

Section snippets

Objective

Our objective was to conduct a systematic review and, where feasible, metaanalysis to evaluate whether pregnant women with SDB have a higher risk of adverse pregnancy outcomes, which we defined as gestational hypertension/preeclampsia, gestational diabetes, or the delivery of low-birthweight infants, compared with pregnant women without SDB.

Methods for Review

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement7 as the template for reporting the review.

General characteristics of included studies

Using our search strategy for electronic databases and manual citation searches, we identified and screened 4386 citations. Figure 1 outlines the selection process for the final 31 studies included in the qualitative analysis. Characteristics of the 31 studies are summarized in Table 1. Twenty-nine of these studies were observational in design3, 4, 5, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42 and the remaining 243, 44 were small-scale

Summary of findings

A systematic review of the literature investigating the association between adverse pregnancy outcomes (ie, gestational hypertension/preeclampsia, gestational diabetes, and/or delivery of low-birthweight infants) and maternal SDB yielded 21 studies that presented effect estimates, all of which were observational in design. Studies that met criteria for the metaanalysis demonstrated an increased risk of gestational hypertension/preeclampsia and gestational diabetes in pregnant women with SDB

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  • Cited by (0)

    The authors report no conflict of interest.

    Cite this article as: Pamidi S, Pinto LM, Marc I, et al. Maternal sleep-disordered breathing and adverse pregnancy outcomes: a systematic review and metaanalysis. Am J Obstet Gynecol 2014;210:52.e1-14.

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