Association between maternal sleep duration and quality and the risk of preterm birth: a systematic review and meta-analysis of observational studies
Abstract Abstract Background: The association between sleep duration and quality and the risk of preterm birth remains controversial. Methods: Relevant studies were retrieved from the PubMed and Web of Science databases up to the end of September 2018 and the reference lists of the retrieved articles were reviewed. Random effects models were applied to estimate summarized relative risks (RRs) and 95% confidence intervals (CIs). Results: Ten identified studies (nine cohort studies and one case-controlled study) examined the associations between sleep duration and quality and the risk of preterm birth. Compared with women with the shortest sleep duration, the summary RRs were 0.76 (95% CI = 0.64–0.89) for women with the longest sleep duration, without between-study heterogeneity (I2 = 0%). Additionally, as compared with women with good sleep quality, the summary RRs were 1.54 (95% CI = 1.18–2.01) for women with poor sleep quality (Pittsburgh Sleep Quality Index > 5), with high between-study heterogeneity (I2 = 76.7%). The results of stratified analysis by trimester, geographical location, study design, type of preterm birth, and adjustment for potential confounders were comparable to those of the main meta-analysis. Funnel plots as well as the Egger’s and Begg’s tests showed no evidence of publication bias. Conclusions: This systematic review and meta-analysis revealed that short sleep duration and poor sleep quality may be associated with an increased risk of preterm birth.