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. 2024 Dec 2;7(12):e2452204.
doi: 10.1001/jamanetworkopen.2024.52204.

Persistent Short Sleep Duration From Pregnancy to 2 to 7 Years After Delivery and Metabolic Health

Minjee Kim  1   2   3 , Laura Elizabeth Wiener  4 , Jace Gilbert  4 , Rebecca B McNeil  4 , Kathryn J Reid  1   2 , William A Grobman  5 , Francesca Facco  6 , David M Haas  7 , Robert M Silver  8 , Philip Greenland  9 , Lynn M Yee  10 , Phyllis C Zee  1   2 ; Eunice Kennedy Shriver National Institute of Child Health and Human Development NuMoM2b and National Heart, Lung, and Blood Institute NuMoM2b Heart Health Study Network
Collaborators, Affiliations

Persistent Short Sleep Duration From Pregnancy to 2 to 7 Years After Delivery and Metabolic Health

Minjee Kim et al. JAMA Netw Open. .

Abstract

Importance: Short sleep duration during pregnancy and the perimenopausal period has been associated with adverse cardiometabolic outcomes. However, it remains unclear how sleep duration changes after delivery and whether such changes are associated with the cardiometabolic health of birthing people.

Objective: To investigate whether persistently short sleep during pregnancy and after delivery is associated with incident hypertension and metabolic syndrome.

Design, setting, and participants: This secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be Heart Health Study (NuMoM2b-HHS), an ongoing prospective cohort study, was conducted between September 5, 2023, and March 1, 2024, in 8 US academic medical centers. Participants were aged 18 years or older at NuMoM2b enrollment; recruited during their first pregnancy between October 1, 2010, and September 30, 2013; and followed up for a mean (SD) of 3.1 (0.9) years after delivery.

Exposures: Self-reported short sleep duration (<7 hours) during pregnancy and 2 to 7 years after delivery was defined as persistent short sleep.

Main outcomes and measures: Incident hypertension and metabolic syndrome (MetS) at follow-up. Regression models were used to estimate relative risks of incident hypertension and MetS by sleep duration pattern. Hypertension analyses excluded participants with hypertension at baseline, and MetS analyses excluded participants with MetS at baseline. Multivariable models included a priori covariates of baseline age and time from delivery to follow-up. Incident hypertension analyses included an additional covariate of body mass index at baseline.

Results: Among 3922 participants (mean [SD] age, 27.3 [5.4] years; 598 Hispanic [15.2%], 485 non-Hispanic Black [12.4%], and 2542 non-Hispanic White [64.8%]), 565 individuals (14.4%) experienced persistent short sleep. Non-Hispanic Black (adjusted odds ratio [aOR], 2.17; 95% CI, 1.59-2.97) and unmarried (aOR, 1.68, 95% CI, 1.29-2.19) participants were significantly more likely to experience persistent short sleep compared with non-Hispanic White and married participants, respectively. Persistent short sleep was associated with higher odds of incident MetS (aOR, 1.60; 95% CI, 1.21-2.11) but not incident hypertension (aOR, 0.91; 95% CI, 0.69-1.19).

Conclusions and relevance: In this study, short sleep duration that persisted from pregnancy to 2 to 7 years after delivery was associated with a greater risk for adverse cardiometabolic outcomes. Future studies should explore whether sleep-targeted interventions during and after pregnancy are associated with improved cardiometabolic health outcomes, particularly among populations at increased risk.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr. Kim reported receiving grants from Genentech, Inc on behalf of Northwestern University outside the submitted work. Dr. Haas reported receiving grants from the National Institutes of Health and Heartland Health Research Alliance outside the submitted work.

Figures

Figure 1.
Figure 1.. Study Flowchart
Enrollment and inclusion of participants in the study are summarized in the flowchart. HTN indicates hypertension; MetS, metabolic syndrome; NuMoM2b, Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be; nuMoM2b-HHS, nuMoM2b-Heart Health Study.
Figure 2.
Figure 2.. Association of Sociodemographic Characteristics With Short Sleep (SS) Duration Patterns
Associations between early pregnancy sociodemographic characteristics in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be and SS duration patterns are summarized as adjusted odds ratios (aORs) with 95% CIs after adjustment for baseline age and time from delivery to follow-up study visit. GED indicates general education development certificate.
Figure 3.
Figure 3.. Association of Sleep Duration Patterns With Incident Hypertension (HTB) and Metabolic Syndrome (MetS)
Associations of sleep duration patterns (reference group: never short sleep) with incident HTN (A) or MetS (B) 2 to 7 years after index pregnancy are summarized as unadjusted and adjusted odds ratios (ORs) with 95% CIs. Adjustment covariates included age and body mass index (calculated as weight in kilograms divided by height in meters squared) in early index pregnancy and time from delivery to follow-up study visit for HTN (A) and age in early index pregnancy and time from delivery to follow-up study visit for MetS (B).
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