The presence of coexisting sleep-disordered breathing among women with hypertensive disorders of pregnancy does not worsen perinatal outcome

Danielle L. Wilson; Mark E. Howard; Alison M. Fung; Fergal J. O'Donoghue; Maree Barnes; Martha Lappas; Susan P. Walker

doi:10.1371/journal.pone.0229568

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The presence of coexisting sleep-disordered breathing among women with hypertensive disorders of pregnancy does not worsen perinatal outcome

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The presence of coexisting sleep-disordered breathing among women with hypertensive disorders of pregnancy does not worsen perinatal outcome

Danielle L. Wilson, Mark E. Howard, Alison M. Fung, Fergal J. O'Donoghue, Maree Barnes, Martha Lappas and Susan P. Walker

PLoS One, Vol.15(2), pp.1-15

2020

DOI: https://doi.org/10.1371/journal.pone.0229568

PMID: 32101584

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Abstract

Objective To determine whether the presence of co-existing sleep-disordered breathing (SDB) is associated with worse perinatal outcomes among women diagnosed with a hypertensive disorder of pregnancy (HDP), compared with normotensive controls. Study design Women diagnosed with HDP (gestational hypertension or preeclampsia) and BMI- and gestation-matched controls underwent polysomnography in late pregnancy to determine if they had coexisting SDB. Fetal heart rate (FHR) monitoring accompanied the sleep study, and third trimester fetal growth velocity was assessed using ultrasound. Cord blood was taken at delivery to measure key regulators of fetal growth. Results SDB was diagnosed in 52.5% of the HDP group (n = 40) and 38.1% of the control group (n = 42); p =.19. FHR decelerations were commonly observed during sleep, but the presence of SDB did not increase this risk in either the HDP or control group (HDP group-SDB = 35.3% vs. No SDB = 40.0%, p = 1.0; control group-SDB = 41.7% vs. No SDB = 25.0%, p =.44), nor did SDB affect the total number of decelerations overnight (HDP group-SDB = 2.7 +/- 1.0 vs. No SDB = 2.8 +/- 2.1, p =.94; control group-SDB = 2.0 +/- 0.8 vs. No SDB = 2.0 +/- 0.7, p = 1.0). Fetal growth restriction was the strongest predictor of fetal heart rate events during sleep (aOR 5.31 (95% CI 1.26-22.26), p =.02). The presence of SDB also did not adversely affect fetal growth; in fact among women with HDP, SDB was associated with significantly larger customised birthweight centiles (43.2% +/- 38.3 vs. 16.2% +/- 27.0, p =.015) and fewer growth restricted babies at birth (30% vs. 68.4%, p =.026) compared to HDP women without SDB. There was no impact of SDB on measures of fetal growth for the control group. Cord blood measures of fetal growth did not show any adverse effect among women with SDB, either in the HDP or control group. Conclusion We did not find that the presence of mild SDB worsened fetal acute or longitudinal outcomes, either among women with HDP or BMI-matched normotensive controls. Unexpectedly, we found the presence of SDB conferred a better prognosis in HDP in terms of fetal growth. The fetus has considerable adaptive capacity to withstand in utero hypoxia, which may explain our mostly negative findings. In addition, SDB in this cohort was mostly mild. It may be that fetal sequelae will only be unmasked in the setting of more severe degrees of SDB and/or underlying placental disease.

Details

Title: The presence of coexisting sleep-disordered breathing among women with hypertensive disorders of pregnancy does not worsen perinatal outcome
Authors: Danielle L. Wilson (Corresponding Author) - The University of Melbourne
Mark E. Howard - Institute for Breathing and Sleep
Alison M. Fung - Mercy Hospital for Women
Fergal J. O'Donoghue - Institute for Breathing and Sleep
Maree Barnes - Institute for Breathing and Sleep
Martha Lappas - The University of Melbourne
Susan P. Walker - Mercy Hospital for Women
Publication details: PLoS One, Vol.15(2), pp.1-15
Publisher: Public Library Science
Date published: 2020
DOI: 10.1371/journal.pone.0229568
ISSN: 1932-6203
PMID: 32101584
Copyright note: © 2020 Wilson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: The data file for this study is available from the figshare database (https://figshare.com/, DOI: 10.6084/m9.figshare.11720199)
Grants: Sleep-disordered breathing in pregnancy-induced hypertension and preeclampsia: Maternal and fetal outcomes, 1038747, National Health and Medical Research Council (Australia, Canberra) - NHMRC
Grant note: This research was supported by the following - Institute for Breathing and Sleep (DW, MH, SW, FO, MB, AF) - https://ibas.org.au/ Austin Medical Research Foundation (MB, MH, DW) - http://www.austinmrf.org.au/ Medical Research Foundation for Women and Babies (now named Norman Beischer Medical Research Foundation) (DW, SW, AF) - http://www.nbmrf.org.au/ Research Fellowship from the Department of Obstetrics and Gynaecology (University of Melbourne) (ML).
Organisation Unit: Thompson Institute
Language: English
Record Identifier: 991219791002621
Output Type: Journal article

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