title: Maternal sleep-disordered breathing and adverse pregnancy outcomes: a systematic review and metaanalysis.
abstract: 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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Respiratory Division and Sleep Laboratory, McGill University Health Center, Montreal, QC, Canada. Electronic address: sushmita.pamidi@mail.mcgill.ca.
authors.forename: Sushmita
authors.initials: S
authors.lastname: Pamidi
authors.affiliation: Respiratory Division and Sleep Laboratory, McGill University Health Center, Montreal, QC, Canada.
authors.forename: Lancelot M
authors.initials: LM
authors.lastname: Pinto
authors.affiliation: Department of Pediatrics, Centre Hospitalier de l'Université Laval, Quebec City, QC, Canada.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Marc
authors.affiliation: Respiratory Epidemiology and Clinical Research Unit and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Health Center, Montreal, QC, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Benedetti
authors.affiliation: Respiratory Division and Sleep Laboratory, McGill University Health Center, Montreal, QC, Canada; Respiratory Epidemiology and Clinical Research Unit and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Health Center, Montreal, QC, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Schwartzman
authors.affiliation: Respiratory Division and Sleep Laboratory, McGill University Health Center, Montreal, QC, Canada.
authors.forename: R John
authors.initials: RJ
authors.lastname: Kimoff
mesh_terms: D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000209:etiology*; D011256:Pregnancy Outcome; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000150:complications*
keywords: adverse pregnancy outcomes; gestational diabetes; gestational hypertension; low birthweight infants; sleep apnea