Sleep Quality and BMI in Pregnancy– A Prospective Cohort Study

Background: Pregnancy associated sleep disturbance is a common pregnancy-related complication which can lead to significant maternal distress and adverse pregnancy outcomes. Sleep quality can be affected by multiple factors and high BMI or obesity has been recognized as one of them. Various previous studies have demonstrated poorer sleep quality during pregnancy. However, most studies included assessment at only one point of pregnancy. This prospective cohort study aimed to better evaluate the effect of pregnancy on the quality of sleep throughout the antenatal period and how BMI affects antenatal sleep.Methods: A total of 926 women were recruited before 14 weeks of gestation and followed throughout pregnancy. The Pittsburgh Sleep Quality Index questionnaire was employed to assess sleep quality in 4 antenatal visits throughout pregnancy. Their weight was also recorded at each visit.Results: The PSQI global score was higher towards the later part of pregnancy (6.4 to 8.0, p<0.001) and highest at the 4th visit. Sleep latency was longer as pregnancy progressed (18.5 mins to 23.2 mins, p=0.001). Sleep duration became shorter over time and was the shortest at the 4th visit (7.1 hours to 6.5 hours, p<0.001). Sleep efficiency was the lowest at the 4th visit (85.2% to 81.6%, p<0.001). The same trend was observed for subjects in different BMI groups throughput pregnancy. PSQI score increased and sleep duration decreased as BMI increased. The effect of increasing BMI on PSQI and sleep duration was only observed in the higher BMI groups (>25kg/m2).Conclusions: Our study showed that sleep quality gradually declined throughout pregnancy for all BMI groups. Higher BMI was associated with poorer sleep as represented by PSQI score and sleep duration, particularly in the high BMI subgroups.