title: Sleep disturbances during pregnancy are associated with cesarean delivery and preterm birth.
abstract: OBJECTIVE
  The purpose of this study was to examine the associations of sleep disturbances during pregnancy with cesarean delivery and preterm birth.
  
  
  METHODS
  In this prospective study, 688 healthy women with singleton pregnancy were selected from three hospitals in Chengdu, China 2013-2014. Self-report questionnaires, including the sleep quantity and quality as well as exercise habits in a recent month were administered at 12-16, 24-28, and 32-36 weeks' gestation. Data on type of delivery, gestational age, and the neonates' weight were recorded after delivery. After controlling the potential confounders, a serial of multi-factor logistic regression models were performed to evaluate whether sleep quality and quantity were associated with cesarean delivery and preterm birth.
  
  
  RESULTS
  There were 382 (55.5%) women who had cesarean deliveries and 32 (4.7%) who delivered preterm. Women with poor sleep quality during the first (OR: 1.87, 95% CI [1.02-3.43]), second (5.19 [2.25-11.97]), and third trimester (1.82 [1.18-2.80]) were at high risk of cesarean delivery. Women with poor sleep quality during the second (5.35 [2.10-13.63]) and third trimester (3.01 [1.26-7.19]) as well as short sleep time (<7 h) during the third trimester (4.67 [1.24-17.50]) were at high risk of preterm birth.
  
  
  CONCLUSIONS
  Sleep disturbances are associated with an increased risk of cesarean delivery and preterm birth throughout pregnancy. Obstetric care providers should advise women with childbearing age to practice healthy sleep hygiene measures.
authors.affiliation: a Department of Nutrition , Food Safety and Toxicology, West China School of Public Health, Sichuan University , Chengdu , China.
authors.forename: Run
authors.initials: R
authors.lastname: Li
authors.affiliation: b Sichuan Provincial Maternal and Child Health Hospital , Chengdu , China.
authors.forename: Ju
authors.initials: J
authors.lastname: Zhang
authors.affiliation: c West China Second University Hospital, Sichuan University , Chengdu , China.
authors.forename: Rong
authors.initials: R
authors.lastname: Zhou
authors.affiliation: d Chengdu Women's & Children's Central Hospital , Chengdu , China , and.
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.affiliation: e Department of Clinical Nutrition , First Affiliated Hospital of Kunming Medical University , Kunming , China.
authors.forename: Zhengyan
authors.initials: Z
authors.lastname: Dai
authors.affiliation: a Department of Nutrition , Food Safety and Toxicology, West China School of Public Health, Sichuan University , Chengdu , China.
authors.forename: Dan
authors.initials: D
authors.lastname: Liu
authors.affiliation: a Department of Nutrition , Food Safety and Toxicology, West China School of Public Health, Sichuan University , Chengdu , China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Wang
authors.affiliation: a Department of Nutrition , Food Safety and Toxicology, West China School of Public Health, Sichuan University , Chengdu , China.
authors.forename: Huijuan
authors.initials: H
authors.lastname: Zhang
authors.affiliation: a Department of Nutrition , Food Safety and Toxicology, West China School of Public Health, Sichuan University , Chengdu , China.
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Li
authors.affiliation: a Department of Nutrition , Food Safety and Toxicology, West China School of Public Health, Sichuan University , Chengdu , China.
authors.forename: Guo
authors.initials: G
authors.lastname: Zeng
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D006801:Humans; D016015:Logistic Models; D011247:Pregnancy; D047928:Premature Birth; D011446:Prospective Studies; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Cesarean delivery; pregnancy; preterm birth; sleep