title: Poor sleep during the periconceptional period increases risk for neural tube defects in offspring.
abstract: BACKGROUND
  Poor sleep has been studied in relation to various diseases. Few studies have investigated the effect of poor sleep on birth defects.
  
  
  METHODS
  We examined the association of maternal poor sleep during periconceptional period and the risk of neural tube defects (NTDs) in offspring based on a large case-control study in northern China. The subjects included 629 NTD cases and 858 normal controls investigated between 2002 and 2007. Maternal sleep status was collected by health workers within first week after delivery. Logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) of NTDs in association with poor sleep.
  
  
  RESULTS
  The proportion of mothers with frequent poor sleep (≥4 days/week on average) was markedly higher in NTDs group (5.9%) than in control group (1.2%). In the multivariate analysis, frequent poor sleep was significantly associated with an increased risk of total NTDs (adjusted OR, 4.1; 95% CI, 1.9-8.8) and spina bifida subtype (adjusted OR, 6.4; 95% CI, 2.8-14.5). Frequent poor sleep showed a significant interaction with body mass index (BMI). Relative to women who reported poor sleep <4 days/week and with BMI < 24, frequent poor sleep showed a markedly higher increased risk of NTDs among overweight or obese women (adjusted OR, 11.8; 95% CI, 1.4-97.6) than women with BMI < 24 (adjusted OR, 2.5; 95% CI,1.1-5.9).
  
  
  CONCLUSIONS
  Maternal frequent poor sleep during the periconceptional period may increase the risk for all NTDs and spina bifida. The association appears to be independent of some lifestyle factors that are closely associated with sleep quality.
authors.affiliation: Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health/Department of Epidemiology and Biostatistics, School of Public Health, Peking University, China.
authors.forename: Zhiwen
authors.initials: Z
authors.lastname: Li
authors.affiliation: Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health/Department of Epidemiology and Biostatistics, School of Public Health, Peking University, China.
authors.forename: Le
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health/Department of Epidemiology and Biostatistics, School of Public Health, Peking University, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Jin
authors.affiliation: Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health/Department of Epidemiology and Biostatistics, School of Public Health, Peking University, China.
authors.forename: Rongwei
authors.initials: R
authors.lastname: Ye
authors.affiliation: Sydney School of Public Health, Sydney Medical School, The University of Sydney, Australia.
authors.forename: Camille
authors.initials: C
authors.lastname: Raynes-Greenow
authors.affiliation: Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health/Department of Epidemiology and Biostatistics, School of Public Health, Peking University, China.
authors.forename: Aiguo
authors.initials: A
authors.lastname: Ren
mesh_terms: D000328:Adult; D015992:Body Mass Index; D016022:Case-Control Studies; D002681:China; D005260:Female; D006801:Humans; D008019:Life Style; D016015:Logistic Models; D009035:Mothers; D009765:Obesity / Q000503:physiopathology; D050177:Overweight / Q000503:physiopathology; D012307:Risk Factors; D012890:Sleep / Q000502:physiology*; D016135:Spinal Dysraphism / Q000209:etiology* / Q000503:physiopathology*; D055815:Young Adult
keywords: case-control study; neural tube defects; poor sleep; spina bifida