Association between sleep disordered breathing and neonatal outcomes in nulliparous individuals.

BACKGROUND: To determine whether objectively measured Sleep-Disordered Breathing (SDB) during pregnancy is associated with an increased risk of adverse neonatal outcomes in a cohort of nulliparous individuals.

METHODS: Secondary analysis of the nuMom2b- sleep disordered breathing substudy was performed. Individuals underwent in-home sleep studies for SDB assessment in early- (6-15 weeks' gestation) and mid-pregnancy (22-31 weeks' gestation). SDB was defined as an apnea-hypopnea index ≥5 events/hour at either time point. Primary outcome was a composite outcome of respiratory distress syndrome, transient tachypnea of the newborn, or receipt of respiratory support, treated hyperbilirubinemia or hypoglycemia, large-for-gestational age (LGA), seizures treated with medications or confirmed by electroencephalography, confirmed sepsis, or neonatal death. Individuals were categorized into 1) early pregnancy SDB (6-15 weeks' gestation), 2) new onset mid-pregnancy SDB (22-31 weeks' gestation), and 3) no SDB. Log-binomial regression was used to calculate adjusted risk ratios (RR) and 95% confidence intervals (CI) representing the association. Adjustments were made for maternal age, chronic hypertension, pregestational diabetes, progesterone use and Body Mass Index (BMI), new onset mid-pregnancy SDB to establish if a relationship was still present.

RESULTS: Among 2,106 participants, 3% percent (n=75) had early pregnancy SDB and 5.7% (n=119) developed new onset mid-pregnancy SDB. The incidence of the primary outcome was higher in offspring of individuals with early- (29.3%) and new onset mid- pregnancy SDB (30.3%) compared to individuals with no SDB (17.8%). After adjustment for maternal age, chronic hypertension, pregestational diabetes, progesterone use and BMI, new onset mid-pregnancy SDB conferred increased risk (RR=1.42, 95% CI: 1.05, 1.92), where there was no longer statistically significant association between early pregnancy SDB and the primary outcome.

CONCLUSION: New Onset, Mid- pregnancy SDB is independently associated with neonatal morbidity.