妊娠早期睡眠状况与早产的关系

Association between sleep status in the first trimester and preterm birth

目的探讨孕妇妊娠早期睡眠状况与早产的关系。方法收集2019年9月1日至2020年6月10日于北京大学第三医院规律产前检查并分娩的孕妇的临床资料,通过匹兹堡睡眠质量指数(PSQI)量表调查其妊娠8~12周的睡眠状况,随访分娩结局,根据分娩孕周和早产原因分为足月产组(204例)、早产组(13例)、自发性早产组(9例),分析妊娠早期睡眠状况与早产和自发性早产的关系。结果足月产组孕妇的中位PSQI量表评分为4.0分(3.0,6.0分),低于早产组[6.0分(4.0,8.0分)]和自发性早产组[7.0分(4.0,8.0分)],分别比较,差异均有统计学意义(P均<0.05)。妊娠早期睡眠质量差(PSQI量表评分>7分)孕妇在足月产组[14.2%(29/204)]中的占比低于早产组(5/13)和自发性早产组(4/9),分别比较,差异均有统计学意义(P均<0.05)。与足月产组孕妇[8.0 h(7.0,9.0 h)]的夜间睡眠时间比较,早产组[7.0 h(7.0,8.0 h)]和自发性早产组[7.0 h(7.0,8.0 h)]显著缩短,分别比较,差异均有统计学意义(P均<0.05)。多因素分析显示,妊娠早期PSQI量表评分是影响早产的独立危险因素(a OR=1.22,95%CI为1.02~1.45;P=0.026);辅助生殖妊娠(a OR=5.55,95%CI为1.22~25.31;P=0.027)、妊娠期糖尿病(a OR=9.27,95%CI为1.96~43.82;P=0.005)、妊娠早期PSQI量表评分(a OR=1.27,95%CI为1.01~1.58;P=0.039)是影响自发性早产的独立危险因素。结论妊娠早期睡眠质量下降可能会显著增加早产包括自发性早产的风险,应当予以关注。

Objective To investigate the relationship between sleep status in the first trimester and preterm birth.Methods Clinical data of pregnant women who received regular prenatal examination and delivered in Peking University Third Hospital from September 1,2019 to June 10,2020 were collected.The Pittsburgh sleep quality index(PSQI)was used to investigate their sleep status during 8-12 weeks of gestation,and the delivery outcomes were followed up.According to the gestational age at delivery and the cause of preterm birth,they were divided into full-term delivery group(204 cases),preterm birth group(13 cases)and spontaneous preterm birth group(9 cases).The correlation between the sleep status in the first trimester and preterm birth or spontaneous preterm birth was analyzed.Results The median PSQI score of full-term delivery group was 4.0 points(3.0,6.0 points),which was lower than those of preterm delivery group[6.0 points(4.0,8.0 points)]and spontaneous preterm delivery group[7.0 points(4.0,8.0 points)],and the differences were statistically significant(all P<0.05).The proportion of pregnant women with poor sleep quality(PSQI score>7 points)in full-term delivery group[14.2%(29/204)]was lower than those in preterm delivery group(5/13)and spontaneous preterm delivery group(4/9),and the differences were statistically significant(all P<0.05).Compared with the full-term delivery group[8.0 hours(7.0,9.0 hours)],the preterm birth group[7.0 hours(7.0,8.0 hours)]and spontaneous preterm birth group[7.0 hours(7.0,8.0 hours)]had significantly shorter sleep duration at night(all P<0.05).Multivariate analysis showed that PSQI score in the first trimester was an independent risk factor for preterm birth(a OR=1.22,95%CI:1.02-1.45;P=0.026).Pregnancy with assisted reproductive technology(a OR=5.55,95%CI:1.22-25.31;P=0.027),gestational diabetes mellitus(a OR=9.27,95%CI:1.96-43.82;P=0.005),PSQI score in the first trimester(a OR=1.27,95%CI:1.01-1.58;P=0.039)were independent risk factors for spontaneous preterm birth.Conclusion Attention should be paid to the decreased sleep quality in the first trimester,which might significantly increase the risk of preterm birth and spontaneous preterm birth.