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Disturbed Sleep and Inflammatory Cytokines in Depressed and Nondepressed Pregnant Women: An Exploratory Analysis of Pregnancy Outcomes

Okun, Michele L. PhD; Luther, James F. MA; Wisniewski, Stephen R. PhD; Wisner, Katherine L. MD, MS

doi: 10.1097/PSY.0b013e31829cc3e7
Original Articles

Objective Disturbed sleep and depression are potential risk factors for pregnancy complications. Both conditions are known to dysregulate biological pathways responsible for maintaining homeostatic balance and pregnancy health. Depression during pregnancy is associated with poor sleep. Thus, we explored whether disturbed sleep was associated with inflammatory cytokines and risk for adverse pregnancy outcomes, as well as whether depression augmented the sleep-cytokine relationship, thereby additively contributing to risk for adverse outcomes.

Methods Interview-assessed sleep and plasma cytokine concentrations were evaluated in a cohort of depressed and nondepressed pregnant women (n = 168) at 20 and 30 weeks’ gestation. Outcomes evaluated included preterm birth, birth weight, and peripartum events.

Results Among depressed women, short sleep duration (<7 hours) was associated with higher interleukin (IL)-8 across time (β = 0.506, p = .001), poor sleep efficiency (<85%) was associated with higher IL-6 (β = 0.205, p = .006), and daytime naps were associated with higher tumor necrosis factor α (β = 0.105, p = .024). Aspects of poor sleep were associated with having a lower weight baby (p values <.053). Among depressed women, interferon-γ increased risk for preterm birth (odds ratio = 1.175, p = .032). Trends for IL-6 and higher birth weight (β = 105.2, p = .085), interferon-γ and lower birth weight (β = −19.92, p < .069), and increased IL-8 and babies weighing less than 4000 grams (odds ratio = 0.72, p < .083) were observed.

Conclusions Although speculative, disturbed sleep may disrupt normal immune processes and contribute to adverse pregnancy outcomes. Exploratory analyses indicate that depression modifies these relationships.

Supplemental digital content is available in the text.

From the Sleep Medicine Institute and Department of Psychiatry, School of Medicine (M.L.O.), and Departments of Epidemiology (J.F.L., S.R.W., K.L.W.), OB/GYN (K.L.W.), and Psychiatry, Women’s Behavioral HealthCARE (K.L.W.), University of Pittsburgh, Pittsburgh, Pennsylvania.

Address correspondence and reprint requests to Michele L. Okun, PhD, Western Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O’Hara St Room E1124, Pittsburgh, PA 15213. E-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Received for publication June 22, 2012; revision received April 23, 2013.

Copyright © 2013 by American Psychosomatic Society
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