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Monday, April 25, 2016

Mom's Day Monday: Better Sleep Helps Prevent Gestational Diabetes and Stillbirth In Pregnancy

Mom's toss and turn at night, and often just can't get comfortable. Gynos are quick to point out that proper blood flow to the baby cannot occur when mom's are flat on their back, and mom's are horrified if they awake to find that they were happily snoozing on their back (not thought to be harmful in the context of shifting sleep positions). Poor sleep for those who are not pregnant can be an important contributing cause of both heart and endocrine disease, and it's likely no different in pregnancy. But the facts are not completely clear either! Two new studies look at overall sleep quality and what that does to the placenta, and in turn, what it does for developing babies. In a study from Obstetrics and Gycology Dr. Roxanna Twedt found that the worse a mom's sleep was in pregnancy the more likely she was to have poor blood sugar control if she was a gestational diabetic. A British Medical Journal study just published about causes of late pregnancy still birth looked at how you sleep, and how often you run to the bathroom and the lowering of the risk of stillbirth. Although intuitively pregnant women feel like too much running to the bathroom increases their pregnancy fatigue, the interesting twist is that it's good for them! The good news is that snoring, daytime sleepiness (measured with the Epworth sleepiness scale), and sleep position at the time of going to sleep and on waking (left side, right side, back, and other) showed no connection to what is one of the worst outcomes in pregnancy which is the baby not surviving in the uterus late in pregnancy. The risk of stillbirth in the group study was about 3/1000 overall. We’ve always have said there has to be a reason that women get up often to pee during the night in late pregnancy and now there is an interesting theory. Maybe it’s not just getting you ready to do late night feedings, but in fact it is a boost to placental circulation, and this study found that women who got up to go to the toilet once or less on the last night were more likely to experience a late stillbirth compared with women who got up more frequently. Interestingly daytime napping wasn’t as healthy as not napping late in pregnancy. This was a prospective study which is considered the most reliable form of research, but not done in a sleep lab or with any technology to confirm these sleep characteristics. Other ways of testing the placental health involve ultrasound. It therefore isn’t something we can really change pregnancy recommendations on, but it will give us something to gab about with our gyno.

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