Share this article on:

Association Between Sleep-Disordered Breathing and Hypertensive Disorders of Pregnancy and Gestational Diabetes Mellitus

Facco, Francesca L. MD, MSCI; Parker, Corette B. DrPH; Reddy, Uma M. MD, MPH; Silver, Robert M. MD; Koch, Matthew A. MD, PhD; Louis, Judette M. MD, MPH; Basner, Robert C. MD; Chung, Judith H. MD, PhD; Nhan-Chang, Chia-Ling MD; Pien, Grace W. MD, MSCE; Redline, Susan MD, MPH; Grobman, William A. MD, MBA; Wing, Deborah A. MD, MBA; Simhan, Hyagriv N. MD; Haas, David M. MD, MS; Mercer, Brian M. MD; Parry, Samuel MD; Mobley, Daniel RPSGT; Hunter, Shannon MS; Saade, George R. MD; Schubert, Frank P. MD, MS; Zee, Phyllis C. MD, PhD

doi: 10.1097/AOG.0000000000001805
Contents: Original Research

OBJECTIVE: To estimate whether sleep-disordered breathing during pregnancy is a risk factor for the development of hypertensive disorders of pregnancy and gestational diabetes mellitus (GDM).

METHODS: In this prospective cohort study, nulliparous women underwent in-home sleep-disordered breathing assessments in early (6–15 weeks of gestation) and midpregnancy (22–31 weeks of gestation). Participants and health care providers were blinded to the sleep test results. An apnea–hypopnea index of 5 or greater was used to define sleep-disordered breathing. Exposure–response relationships were examined, grouping participants into four apnea–hypopnea index groups: 0, greater than 0 to less than 5, 5 to less than 15, and 15 or greater. The study was powered to test the primary hypothesis that sleep-disordered breathing occurring in pregnancy is associated with an increased incidence of preeclampsia. Secondary outcomes were rates of hypertensive disorders of pregnancy, defined as preeclampsia and antepartum gestational hypertension, and GDM. Crude and adjusted odds ratios and 95% confidence intervals (CIs) were calculated from univariate and multivariate logistic regression models.

RESULTS: Three thousand seven hundred five women were enrolled. Apnea–hypopnea index data were available for 3,132 (84.5%) and 2,474 (66.8%) women in early and midpregnancy, respectively. The corresponding prevalence of sleep-disordered breathing was 3.6% and 8.3%. The prevalence of preeclampsia was 6.0%, hypertensive disorders of pregnancy 13.1%, and GDM 4.1%. In early and midpregnancy the adjusted odds ratios for preeclampsia when sleep-disordered breathing was present were 1.94 (95% CI 1.07–3.51) and 1.95 (95% CI 1.18–3.23), respectively; hypertensive disorders of pregnancy 1.46 (95% CI 0.91–2.32) and 1.73 (95% CI 1.19–2.52); and GDM 3.47 (95% CI 1.95–6.19) and 2.79 (95% CI 1.63–4.77). Increasing exposure–response relationships were observed between apnea–hypopnea index and both hypertensive disorders and GDM.

CONCLUSION: There is an independent association between sleep-disordered breathing and preeclampsia, hypertensive disorders of pregnancy, and GDM.

There is an independent association between sleep-disordered breathing during pregnancy and preeclampsia and gestational diabetes mellitus.Supplemental Digital Content is Available in the Text.

University of Pittsburgh, Pittsburgh, and the University of Pennsylvania, Philadelphia, Pennsylvania; RTI International, Washington, DC; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the University of Utah, Salt Lake City, Utah; Case Western Reserve University, Cleveland, Ohio; Columbia University, New York, New York; the University of California–Irvine, Irvine, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts; Northwestern University, Chicago, Illinois; Indiana University, Bloomington, Indiana; and the University of Texas Medical Branch, Galveston, Galveston, Texas.

Corresponding author: Francesca L. Facco, MD, MSCI, Magee-Womens Hospital, 300 Halket Street, Room 2233, Pittsburgh, PA 15213; email:

Supported by grant funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Heart Lung and Blood Institute: U10 HD063036, Research Triangle Institute; U10 HD063072, Case Western Reserve University; U10 HD063047, Columbia University; U10 HD063037, Indiana University; U10 HD063041, Magee-Women's Hospital; U10 HD063020, Northwestern University; U10 HD063046, University of California–Irvine; U10 HD063048, University of Pennsylvania; and U10 HD063053, University of Utah.

Financial Disclosure Dr. Zee has served as a consultant for Aptalis, Merck, EISAI, Philips, Vanda, and Pernix. She has received research support (grants to Northwestern University) from Jazz, Eisai, Philips, and Technogel. She also owns stock in Teva. The other authors did not report any potential conflicts of interest.

Presented at the Society for Maternal-Fetal Medicine’s 2015 annual meeting, February 2–7, 2015, San Diego, California.

Comments and views of the author(s) do not necessarily represent the views of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

For a list of the participating institutions and researchers in the Sleep Disordered Breathing Study within the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b) Network, please see Appendix 1, available online at

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.