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Sleep apnea may increase pregnancy complications

Women with obstructive sleep apnea are at greater risk for serious pregnancy complications, longer hospital stays and even admission to the Intensive Care Unit more often than mothers without apnea, as presented in a paper before the American Thoracic Society 2017 International Conference of more than 1.5 million pregnancies.


Researchers analyzed medical records of 1,577,636 pregnant women in the United States National Perinatal Information Center database from 2010 and 2014. Of those women, 0.12 percent had been formally diagnosed with OSA. Those with that diagnosis were typically older and more likely to be African American and smokers. They were also more likely to have pre-pregnancy hypertension, diabetes and coronary artery disease.

After adjusting for obesity and many other potential influences, researchers found the risk of ICU admission was 174 percent higher in pregnant women with OSA compared to those without OSA. Their total hospital length of stay was also significantly higher (5 days in women with OSA compared to 3 days in women without OSA). They also had an increased risk of rare but severe complications such as hysterectomy (126 percent), cardiomyopathy (259 percent), congestive heart failure (263 percent) and pulmonary edema (406 percent) associated with a diagnosis of OSA.

OSA in pregnancy resulted in an increased pregnancy-related complications, including preeclampsia (122 percent) and eclampsia (195 percent) a more severe form of preeclampsia that can lead to seizures. OSA also resulted in an increased risk of gestational diabetes (52 percent).


""Given that pregnancy is a 'window' into future cardiovascular and metabolic health, OSA is a diagnosis worthy of investigation in pregnancy. Early intervention in these women, as well as in their children, may represent a great opportunity to offer treatment strategies which may provide long-term health benefits.""

Ghada Bourjeily MD, Associate Professor of Medicine,and Attending Physician, Pulmonary Services, the Women's Medicine Collaborative, Brown University, Providence, Rhode Island, USA, and lead author.



Becaue of the hugh sample size, the study represents the great diversity in the U.S. population. "This allowed us to demonstrate associations with rare medical outcomes, including hysterectomy and ICU admission, pulmonary edema, cardiomyopathy and congestive heart failure that would have been more difficult to prove with prospective studies," explained Dr. Bourjeily. To their knowledge, no other study has reported the association between OSA in pregnancy as it relates to the increase in hysterectomy (126 percent), or ICU admissions.

The study unfortunately was too short in duration to find out how or whether OSA was being treated. Without this information, and with the general under-diagnosis of OSA, the possibility exists the researcj underestimated the association between OSA and other health problems, Dr. Bourjeily added.

The authors are now analyzing if there are associations between OSA and negative birth outcomes as well as the impact of maternal OAS on neonatal health. Examining biological mechanisms underlying OSA in pregnancy and any possible adverse birth outcomes, researchers hope to be able to identify physiologic mechanisms possibly leading to OSA in pregnancy.

Abstract 5163
Obstructive Sleep Apnea in Pregnancy Is Associated with Adverse Maternal Outcomes: A National Cohort

Introduction: Pregnancy appears to be predispose to the development of obstructive sleep apnea (OSA) due to dynamic physiologic changes. OSA has also been associated with adverse outcomes in pregnancy such as preeclampsia and gestational diabetes, both causes of short-term and long-term maternal cardiovascular and metabolic complications and adverse outcomes in the offspring.

Objective: The goal of this study was to examine the association of a diagnosis of OSA with adverse maternal outcomes.

Methods: The National Perinatal Information Center data -an organization with a charter membership from major perinatal centers in the United States- was used to identify women who had a pregnancy diagnosis between 2010 and 2014. Among these women, we used the international classification of Diseases, ninth revision for OSA diagnosis and other outcomes. Descriptive statistics were used to analyze demographic data. Multivariable logistic regression analysis was used to calculate adjusted odds ratios (aOR) and confidence intervals (CI). Results: The sample consisted of 1,577,632 pregnant women with an overall rate of OSA of 0.1%. Mothers with OSA were older (32.3 + 6.9 vs. 29.6 + 6 years, p<0.001), more likely to be Black (aOR 1.90; 95% CI 1.72-2.11, p<0.001) or smokers (aOR 1.72; 1.51-2.06 p<0.001). There was a significant association between OSA and pre-pregnancy hypertension (aOR 5.20; 4.69-5.77), diabetes (aOR 4.37; 3.81-5.01), coronary artery disease (aOR 7.74; 4.18-14.3) and chronic renal disease (aOR 2.49; 1.67-3.71), after adjusting for maternal obesity. There was also a significant association between OSA and gestational hypertensive disease and its complications after adjusting for maternal obesity: Preeclampsia (aOR 2.07; 95% CI 1.09-1.50), gestational hypertension (aOR 1.28; 1.09-1.50), ecclampsia (aOR 2.50; 1.75-3.56), acute renal failure (aOR 5.24, 3.33-8.33), pulmonary edema (aOR 9.92, 4.56-21.6) and stroke (aOR 8.25, 1.10-62.0). The risk of gestational diabetes was also significantly elevated (aOR 1.78, 1.59-2.00). Length of stay was significantly longer in women with OSA (5.1 + 5.6 vs. 3.0 + 3.0, p<0.001) and odds of an admission to the intensive care unit were higher (aOR 4.64, 4.03-5.35).

Conclusion: Pregnant women with OSA are older, more likely to be African American and have a significantly higher risk of having morbid pre-pregnancy conditions and pregnancy-specific complications such as gestational hypertensive conditions and gestational diabetes. Pregnant women with OSA also have a longer length of stay and higher odds of an admission to the intensive care unit.

Keywords: Hematopoietic stem cell; bioengineering; niche; organ on a chip; organoid.

Authors: G. Bourjeily1, V. Danilack2, D. Caldwell3, J. Muri3; 1The Miriam Hospital / Brown University - Providence, RI/US,2Brown University - Providence, RI/US, 3National Perinatal Information Center - Providence, RI/US


The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (R24DK092760), the National Institute of Allergy and Infectious Diseases (R37AI039394), the National Heart, Lung, Blood Institute Progenitor Cell Biology Consortium (UO1-HL100001), Alex's Lemonade Stand, the Doris Duke Medical Foundation, the American Society of Hematology Scholar Fellowship and the Howard Hughes Medical Institute.

Boston Children's Hospital is home to the world's largest research enterprise based at a pediatric medical center, where its discoveries have benefited both children and adults since 1869. More than 1,100 scientists, including seven members of the National Academy of Sciences, 11 members of the Institute of Medicine and 10 members of the Howard Hughes Medical Institute comprise Boston Children's research community. Founded as a 20-bed hospital for children, Boston Children's today is a 415-bed comprehensive center for pediatric and adolescent health care. Boston Children's is also the primary pediatric teaching affiliate of Harvard Medical School. For more, visit our Vector and Thriving blogs and follow us on our social media channels: @BostonChildrens, @BCH_Innovation, Facebook and YouTube
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May 23, 2017   Fetal Timeline   Maternal Timeline   News   News Archive   



The majority of women with OAS whose health records were analyzed were black.
Image Credit: womenshealth.com

 


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