Allostatic load in early pregnancy is associated with poor sleep quality

BackgroundAllostatic load (AL) measures the cumulative impact of chronic stress and is associated with adverse health outcomes. A novel scoring system has previously been developed for AL in early pregnancy that is associated with pre-eclampsia. It was hypothesized that AL, as identified by the present model, is associated with psychosocial stressors and, specifically, poor sleep quality.MethodsWomen were selected from a low-risk, community-dwelling study population who enrolled at <15 weeks gestation. Nine physiologic components were divided among the domains of cardiovascular, metabolic, and inflammatory function. Spearman's rank correlations were used to examine the association of AL with age, income, the Revised Prenatal Distress Questionnaire (NuPDQ), Inventory of Depressive Symptoms (IDS), and Pittsburgh Sleep Quality Index (PSQI). The Wilcoxon rank-sum test was used to compare AL by race and educational attainment.ResultsA total of 103 women were identified, with: a mean age of 29.8 ± 5.0 years, 17.5% black, and mean gestational age 12.2 ± 1.1 weeks. Allostatic load was positively correlated with the PSQI (ρ = 0.23, p = 0.018). There were no associations with age, income, prenatal distress, race, or depression scores. College-educated women had lower AL compared with those with less education (0.57 ± 0.43 vs 0.81 ± 0.55, p = 0.045).ConclusionHigher AL, measured by the pregnancy-specific model, was associated with poorer sleep quality and lower educational attainment, both of which were considered to be chronic stressors. These relationships were consistent with previous findings in non-pregnant populations, and suggest that AL may be useful for capturing the physiologic impact of chronic stress in early pregnancy.     

Maternal and paternal sleep during pregnancy in the Child-sleep birth cohort

Study objectivesMaternal and paternal sleep insufficiency during pregnancy appears to be a risk factor for health and wellbeing in young families. Here, we evaluated the prevalence of sleep insufficiency and symptoms of insomnia during pregnancy (at 32nd pregnancy week) and their relationship to depression, anxiety and environmental stress.MethodsThe study is based on a population based sample from Finland consisting of 1667 mothers and 1498 fathers from the Child-sleep birth cohort. We evaluated both the core symptoms of insomnia (sleep onset problems, nocturnal awakenings, too-early awakenings, and poor sleep quality) and the presence of insufficient sleep. Insufficient sleep was defined as a two-hour difference between self-assessed sleep need and reported sleep duration, or sleep duration shorter than six hours per night.ResultsWe found that symptoms of insomnia were more prevalent among women than among men (9.8% vs. 6.2%), whereas sleep debt was less prevalent among women than among men (4.5% vs. 9.6%). Overall, 11.8% of the women and 14.9% of the men reported either significant insomnia or short sleep. Symptoms of insomnia were related to symptoms of depression both among women and men (AOR 3.8, 95% CI 2.6–5.6 vs. AOR 1.9, 95% CI 1.1–3.2), while short sleep was related to depression among women (AOR 3.3, 95% CI 1.8–5.8), and to low education, poor health and a larger number of children among men.ConclusionsThe study showed that insomnia and sleep insufficiency are prevalent among women and men during pregnancy. The findings underline the impact of insomnia to both maternal and paternal health during pregnancy as well as to the implementation of effective interventions to prevent negative consequences of sleep disturbances.     

Chronic sleep loss during pregnancy as a determinant of stress: impact on pregnancy outcome

Short sleep duration, poor sleep quality, and insomnia frequently characterize sleep in pregnancy during all three trimesters. We aimed: (i) to review the clinical evidence of the association between conditions of sleep loss during pregnancy and adverse pregnancy outcomes; and (ii) to discuss the potential pathophysiological mechanisms that may be involved. A systematic search of cross-sectional, longitudinal studies using Medline, Embase, and PsychINFO, and MeSH headings and key words for conditions of sleep loss such as ‘insomnia’, ‘poor sleep quality’, ‘short sleep duration’, and ‘pregnancy outcome’ was made for papers published between January 1, 1960 and July 2013. Twenty studies met inclusion criteria for sleep loss and pregnancy outcome: seven studies on prenatal depression, three on gestational diabetes, three on hypertension, pre-eclampsia/eclampsia, six on length of labor/type of delivery, eight on preterm birth, and three on birth grow/birth weight. Two main results emerged: (i) conditions of chronic sleep loss are related to adverse pregnancy outcomes; and (ii) chronic sleep loss yields a stress-related hypothalamic–pituitary–adrenal axis and abnormal immune/inflammatory, reaction, which, in turn, influences pregnancy outcome negatively. Chronic sleep loss frequently characterizes sleep throughout the course of pregnancy and may contribute to adverse pregnancy outcomes. Common pathophysiological mechanisms emerged as being related to stress system activation. We propose that in accordance to the allostatic load hypothesis, chronic sleep loss during pregnancy may also be regarded as both a result of stress and a physiological stressor per se, leading to stress ‘overload’. It may account for adverse pregnancy outcomes and somatic and mental disorders in pregnancy.     

Poor sleep during early pregnancy increases subsequent risk of gestational diabetes mellitus

ObjectivesTo examine the relationship between poor sleep quality during pregnancy and the risk of gestational diabetes mellitus (GDM).MethodsA total of 4066 singleton pregnant women from the Tongji Maternal and Child Health Cohort (TMCHC) without overt diabetes before pregnancy were analyzed. Sleep quality and duration during early pregnancy were self-reported by enrolled women at their first antenatal care visit before 16 weeks of gestation. Gestational diabetes mellitus (GDM) was assessed with a 75-g, 2-h oral glucose tolerance test at 24–28 weeks of gestation. Information about self-reported sleep quality and duration in mid-pregnancy were also collected at this time. Odds ratios (OR) and 95% CIs were calculated by multivariable logistic regression models, and adjusted for potential confounders to estimate the effect of poor sleep quality and the interaction between sleep quality and duration on the development of GDM. Stratified analyses were performed according to age, parity, family history of diabetes and napping.ResultsA total of 335 (8.2%) participants were diagnosed with GDM. Poor sleep quality was reported in 259 (6.4%) women during early pregnancy and 248 (6.1%) in mid-pregnancy. The risk of GDM was increased in women with poor sleep quality during early pregnancy (OR 1.77, 95% CI 1.20–2.61). No association was found between poor sleep quality during mid-pregnancy and the risk of GDM. The risk of GDM was highest in women with poor sleep and longer nighttime sleep duration during early pregnancy (OR 2.27, 95% CI 1.20–4.29) when compared with those who reported good sleep and 7.0–8.5 h of sleep duration per night. Stratified analysis found that the association between poor sleep quality in early pregnancy and the risk of GDM was stronger among women aged ≥30 years (OR 2.35, 95% CI 1.35–4.09) and those with a family history of diabetes (OR 4.02, 95% CI 1.54–10.48).ConclusionsPoor sleep quality during early pregnancy was associated with an increased risk of GDM. Screening for and treating sleep problems in early pregnancy could potentially reduce the risk of GDM.     

Sleep disturbance and cardiometabolic risk factors in early pregnancy: a preliminary study

BackgroundCardiometabolic (CM) risk factors are linked to increased morbidity. Disturbed sleep is associated with CM risk factors in late pregnancy, but little is known about sleep in early pregnancy and CM risk factors.MethodsDiary and actigraphy-assessed sleep information, as well as CM outcomes (blood pressure (BP) and body mass index (BMI)), were collected thrice from pregnant women (N = 161) in early pregnancy: T1 (10–12 weeks), T2 (14–16 weeks) and T3 (18–20 weeks). The sleep variables evaluated included sleep onset latency (SOL), wake after sleep onset (WASO) and total sleep time (TST). Sleep variables were dichotomised using established clinical cut-offs.ResultsBMI and BP significantly changed across time. Women with persistent SOL ⩾ 20 min had greater BMI than women without persistent SOL ⩾ 20 min prior to covariate adjustment at T1 and T2, but at T3 the BMI values converged. Similar results were observed for persistent WASO ⩾ 30 min. Persistently long WASO, as measured by actigraphy, was associated with elevated SBP, after controlling for covariates.ConclusionsConsistent with anecdotal evidence, it appears as if a subset of women report substantial difficulty initiating and maintaining sleep during early pregnancy and this may augment the risk of higher BP and BMI. Understanding these relationships is important as CM risk factors are linked to maternal and infant morbidity. Assessing sleep in early pregnancy may bestow time necessary for appropriate intervention.     

某部2013年新兵睡眠质量及相关因素分析

目的了解某部2013年新兵的睡眠质量状况。方法采用自制的新兵心理卫生调查问卷及匹兹堡睡眠质量指数量表（PSQI）对某部200名2013年新兵进行调查测试。结果2013年新兵的睡眠质量异常检出率为17．01％,高于正常男性群体和2010年新兵（P=0．001）;2013年新兵的主观睡眠质量（SSQ）、入睡潜伏时间（sL）、睡眠干扰因素（Sdi）、应用催眠药物（USM）、白天功能障碍（DD）分值及PSQI总分均高于正常男性群体（P〈0．05,P〈0．01）;睡眠效率（HSE）低于正常男性群体（P〈0．05）,2013年新兵的SL、HSE、Sdi．及PSQI总分高于2010年新兵（P〈0．01）,睡眠时间（Sdu）分值低于2010年新兵（P〈0．05）。Logistic回归分析显示：非自愿入伍（P〈0．001,OR=8．782。95％CI=3．860～19．979）、认为不适应部队生活（P〈0．001,OR=6．731,95％CI=2．943—15．392）为2013年新兵睡眠质量异常的显著危险因子。结论2013年新兵的睡眠质量状况不容乐观,应当给予持续关注;乐观向上的心态有助于良好的睡眠质量。     

Associations of sleep duration and quality with incident cardiovascular disease,cancer, and mortality: a prospective cohort study of 407,500 UK biobank participants

ObjectiveFew studies have investigated the associations of sleep duration and sleep quality with incident cardiovascular diseases (CVDs), cancer, and mortality in the same large population. This study aimed at estimating the independent risk factors of long or short sleep durations and several typical characteristics of poor sleep quality for incident CVDs, cancer, and mortality.MethodsIn this prospective cohort study, 407 500 individuals were enrolled. Cox proportional hazards models were used to calculate the adjusted hazard ratios and 95% confidence intervals (HR, 95%CI) of associations of sleep duration and quality with incident CVDs, cancer, and mortality.ResultsCompared with the sleep duration of 7 h, sleep duration of ≤5 h and ≥9 h were both associated with higher risk of all-cause mortality (HR = 1.25, 95% CI: 1.16–1.34 and HR = 1.30, 95% CI: 1.22–1.38, respectively), CVD mortality (HR = 1.27, 95% CI: 1.09–1.49 and HR = 1.32, 95% CI: 1.16–1.50, respectively), and CVD incidence (HR = 1.23, 95% CI: 1.16–1.31 and HR = 1.08, 95% CI: 1.02–1.15, respectively). Additionally, long sleep duration (≥9 h) was associated with a higher risk of cancer mortality (HR = 1.19, 95% CI: 1.10–1.30) and cancer incidence (HR = 1.08, 95% CI: 1.04–1.12). Moreover, CVD incidence was significantly associated with snoring, insomnia and narcolepsy, increasing the risk by 7%, 26%, and 20%, respectively.ConclusionLong sleep durations may substantially increase the risk of mortality and morbidity. Snoring, insomnia, and narcolepsy were independent risk factors for incident CVD.     

三甲医院护士睡眠质量及其影响因素研究

目的了解三甲医院护士的睡眠质量,并分析相关的影响因素。方法采用随机整群抽样法,抽取北京、上海、广州、重庆四座城市8所三甲医院的护士共1508例作为研究对象。采用自编的《一般情况调查表》,以及匹兹堡睡眠质量指数、自测健康评定量表、简易应对方式问巷进行测评。结果三甲医院护士的睡眠质量主要表现在日间功能障碍、入睡时间和主观睡眠质量方面,主要的睡眠问题为入睡困难、夜间易醒或早醒,轮值夜班及聘任制护士的睡眠质量较差;睡眠质量与年龄、文化程度、职称等因素无关;睡眠质量与自测健康、应对方式显著相关。结论三甲医院护士的睡眠质量不容乐观,应采取综合因素进行干预,以提高他们的身心健康水平。     

慢性乙型肝炎患者睡眠质量与心理健康水平的相关研究

目的 了解慢性乙肝患者的睡眠质量和心理健康水平状况以及两者之间的关系,为改善慢性乙肝患者的睡眠质量和心理健康水平提供参考和依据.方法 随机抽取76例慢性乙肝患者采用匹兹堡睡眠质量指数量表（PSQI）和症状自评量表（SCL-90）进行问卷调查.结果 （1）53例（69.74％）慢性乙肝患者存在睡眠质量问题,睡眠质量不佳主要体现在日间功能障碍（75％）,入睡时间（68.42％）,睡眠质量（68.42％）,睡眠障碍（57.89％）.（2）26例34.21％的慢性乙肝患者存在心理问题,主要表现在强迫症状（14.47％）、抑郁（13.1％）、人际关系敏感（13.1％）、躯体化（13.1％）.（3）睡眠质量良和差的慢性乙肝患者在SCL-90总分及各因子得分上差异有统计学意义（P＜0.01）.（4）慢性乙肝患者PSQI总分及大多数因子分与SCL-90总分及各因子呈正相关（P＜0.05）.结论 慢性乙肝患者的睡眠质量与心理健康水平高度相关,因此要积极关注慢性乙肝患者的睡眠质量.     

The association between sleep quality and quality of life: a population-based study

ObjectivesThis study aimed to evaluate the association between sleep quality and quality of life (QoL).MethodsThis cross-sectional study included 225,541 adults (101,133 men, 124,408 women) who participated in the 2018 Korean Community Health Survey. Multiple sociodemographic and psychosocial variables were evaluated and compared between participants with poor (n = 67,619) and good sleep quality (n = 157,922); sleep quality was subjectively determined using the Pittsburgh Sleep Quality Index (PSQI). The EuroQol five-dimension (EQ-5D) index scores were adjusted for multiple confounding factors and compared between the good and poor sleep quality groups. A logistic regression analysis was used to identify determinants of the lowest quartile of QoL.ResultsThe mean EQ-5D index scores were significantly lower in the poor sleep quality group (score 0.85) than in the good sleep quality group (score 0.92; p < 0.001). The multivariate odds ratio (OR) for the lowest quartile of the EQ-5D index scores in the poor sleep quality group versus that in the good sleep quality group was 1.95 (95% confidence interval [CI], 1.89–2.00). Participants with poor sleep quality were more likely than those with good sleep quality to have some or severe problems with physical activity (OR, 1.46; 95% CI, 1.41–1.51), self-control (OR, 1.35; 95% CI, 1.29–1.42), daily activity (OR, 1.44; 95% CI, 1.39–1.50), pain (OR, 1.81; 95% CI, 1.77–1.86), and anxiety/depression (OR, 2.24; 95% CI, 2.17–2.31).ConclusionPoor sleep quality is associated with impaired QoL, particularly if some or severe problems with anxiety/depression are present.     

Partial sleep deprivation: impact on the architecture and quality of sleep

Objective: The study was aimed at the examination of the acute and cumulative impact of partial sleep deprivation (PSD) on architecture and quality of sleep, on circadian rhythm and on daytime fatigue.Methods: Time in bed for 16 healthy male volunteers was reduced from 8 to 5 h during four consecutive nights, followed by two recovery nights. This scheme matches the terms of service and sleep rhythms of rescue helicopter pilots in Germany. Polysomnography was recorded during each night, and motor activity and body core temperature were recorded continuously. Subjective sleep quality and alertness were acquired by questionnaires.Results: In the course of PSD, electroencephalography (EEG) showed a reduction of S1 and S2 (p = 0.039), whereas S3, S4 (0.024) and rapid eye movement (REM; p = 0.030) sleep increased. Subjective sleep quality improved, while sleep need (p < 0.001) and fatigue (p < 0.001) deepened. These effects declined rapidly after one recovery night.Conclusions: PSD alters sleep and daytime alertness. The results indicate that not only slow wave sleep (SWS) but also REM is important for sleep. Sleep became more effective when wake periods and sleep latencies decreased, thereby improving subjective sleep quality. Sleepiness, sleep need and fatigue increased immediately and accumulated throughout the restricting procedure.     

Association between sleep duration during pregnancy and gestational diabetes mellitus: a meta-analysis

ObjectiveSleep is critical for glucose metabolism. Pregnant women often have sleep disturbances and extreme sleep duration. Investigations of the relationship between sleep duration during pregnancy and gestational diabetes mellitus (GDM) have reported inconsistent results. The present study aimed to meta-analyze the relationship between sleep duration during pregnancy and GDM risk.MethodsWe performed a systematic search of the PubMed, ISI Web of Science, and PsycINFO databases for studies that were published up to October 2017, that reported associations between sleep duration during pregnancy and GDM risk. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated as the effect sizes for all studies. Heterogeneity and potential publication biases were assessed.ResultsA total of 4366 papers were retrieved, among which seven studies assessed the relationship between sleep duration during pregnancy and GDM development. The seven articles included 18,203 subjects at baseline and 1294 GDM cases during follow-up. Compared to normal sleep duration, extreme sleep duration during early and middle pregnant stages had a close relationship with GDM based upon pooled data from prospective and cross-sectional studies. Prospective results showed that long sleep duration during pregnancy was a risk factor for GDM, but not short sleep duration. Publication biases were found when analyzing the relationship between extreme sleep duration and GDM.ConclusionsExtreme sleep duration during pregnancy is closely associated with GDM. Moreover, long but not short sleep duration can predict the risk of developing GDM. These findings remind us of the importance of sleep duration control during pregnancy and help optimize early strategies for the prevention of GDM.     

Effects of pregnancy on eating attitudes and disorders: a prospective study

The aim of this prospective study was to investigate the effects of pregnancy on eating disorders (ED), dietary habits and body image perception. One hundred and fifty pregnant women were interviewed between the period January 2001 and May 2003. Ninety-seven women completed the study and were divided in three subgroups: pregnant women with a positive history of dieting (n=37), pregnant women with a positive history of dieting with a complete diagnosis of a current ED (n=11) and pregnant women with a negative history either of dieting or ED (control group; n=49). Age, education and parity were equally distributed in all three groups. To verify if pregnancy exerts a specific protective effect, a battery of psychometric tests was administered to women at 12 degrees (T0), 22 degrees (T1), and 34 degrees pregnancy weeks (T2), and 2 days (T3) and 4 months (T4) after delivery, respectively. The study showed a quadratic trend for ED, subthreshold ED and body satisfaction, with a general improvement in the middle of pregnancy and a return to previous levels after delivery. Some interesting significant differences came out among the groups.     

No increased risk of adverse pregnancy outcomes for women with myasthenia gravis: a nationwide population-based study

Background:  This study aims to examine the risk of adverse pregnancy outcomes [low birthweight (LBW), preterm birth, cesarean sections (CS) and babies born small for gestational age (SGA)] in pregnant women with myasthenia gravis (MG), using a 3-year population-based database, taking characteristics of infant and mother into consideration.
Methods:  This study used two nationwide population-based datasets: the Taiwan National Health Insurance Research Dataset and the Taiwan birth certificate registry. We identified 163 pregnant women with MG during 2001–2003 as the study cohort and 815 randomly selected pregnant women as a comparison cohort. Conditional logistic regression analyses were performed.
Results:  The results showed that, although these patterns did not reach a statistically significant level, mothers with MG had higher percentages of LBW (6.8%, vs. 5.6%), SGA (17.8%, vs. 14.1%) and cesarean deliveries (44.8%, vs. 37.4%), except for preterm births (8.1%, vs. 8.1%). After adjusting for highest maternal education level, marital status, family monthly income and infant gender and parity, the odds ratios (OR) of LBW, preterm birth, SGA infants, and cesarean delivery for mothers with MG were 1.19 (95% CI = 0.60–2.38), 1.00 (95% CI = 0.54–1.87), 1.30 (95% CI = 0.83–2.04), and 1.33 (95% CI = 0.94–1.88), respectively, as compared to unaffected mothers.
Conclusions:  We conclude that there were no statistically significant differences in the risk of having preterm, LBW, SGA infants and cesarean deliveries between women with and without MG.     

The association of nighttime sleep duration and quality with chronic kidney disease in middle-aged and older Chinese: a cohort study

ObjectiveThis cohort study aimed to assess the associations between sleep duration and quality with the risk of incident chronic kidney disease (CKD) in middle-aged and older Chinese.MethodsWe used the 2011 and 2015 surveys of the China Health and Retirement Longitudinal Study (CHARLS). Nighttime sleep duration was categorized into five groups: ≤4, (4–6], (6–8], (8–10], and >10 h/night. Sleep quality was assessed by restless days in the past week (<1, 1–2, 3–4, and 5–7 days/week). Multivariate logistic regression was used to assess the association between sleep duration and quality with incident CKD.ResultsA total of 11,339 participants free of CKD at baseline were included in this study. After four years follow-up, the incidence of CKD was 7.8%. There was a “U-shaped” association between sleep duration and risk of CKD. Compared to 6–8 h of nighttime sleep duration, those who slept ≤4 h/night (RR: 1.639, 95% CI: 1.287–2.087) or >10 h/night (RR: 2.342, 95% CI: 1.007–5.451) had increased risk of developing CKD after adjustment for confounders. Participants with 5–7 restless days per week had significantly increased risk of CKD (adjusted RR: 1.686, 95% CI: 1.352–2.102), compared to those who rarely or never had a restless sleep.ConclusionsExtreme nighttime sleep duration and poor sleep quality were associated with increased risk of CKD in middle-aged and older Chinese. Obtaining an optimal nighttime sleep duration and better sleep quality might reduce the risk of CKD.     

Associations between sleep bruxism,sleep quality,and exposure to secondhand smoke in Japanese young adults: a cross-sectional study

ObjectiveSleep bruxism, a major sleep disorder that causes serious harm to oral health, is considered a multifactorial disease. Sleep bruxism can be induced by smoking, which also adversely affects sleep quality. The objective of present study was to clarify the associations between sleep bruxism, sleep quality, and exposure to secondhand smoke (SHS).MethodsTo assess the prevalence of sleep bruxism, sleep quality, and SHS exposure, we conducted oral examinations and self-report questionnaires on university students in Japan. Sleep bruxism and quality were screened using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI) and the third edition of the International Classification of Sleep Disorders (ICSD-3). The inclusion criteria were adults aged between 18 and 19 years, non-smokers and non-alcohol drinkers. The exclusion criteria was failing to complete the questionnaire in full.ResultsWe analyzed a total of 1781 Japanese young adults. Young adult females who had been exposed to SHS had worse sleep quality (p = 0.019) than those who had not. Young adult female with worse sleep quality showed a higher prevalence of sleep bruxism (p = 0.034) than those with better sleep quality. Using structural equation modeling, direct associations were identified between SHS exposure and poor sleep quality (standardized coefficients, 0.153; p = 0.008) and between sleep bruxism and poor sleep quality (standardized coefficients, 0.187; p = 0.022) in young adult females. However, no association was found among young adult males.ConclusionSHS exposure is indirectly associated with sleep bruxism through poor sleep quality in Japanese young adult females.     

影响急性脑梗死患者睡眠质量的相关因素

目的 评价急性脑梗死患者睡眠质量,探讨影响急性脑梗死患者睡眠质量的危险因素,为临床诊断和防治提供依据.方法 以华北煤炭医学院附属医院神经内科2006年10月至2008年3月住院有睡眠障碍的急性脑梗死患者96例为病例组,病程在2周以内,且均为首发脑梗死.采用匹兹堡睡眠质量指数(PSQI)量表进行调查.对照组为同期住院无睡眠障碍的急性脑梗死患者145例.对影响急性脑梗死患者睡眠质量的危险因素进行分析.结果 急性脑梗死患者的睡眠障碍与病变部位有关,以皮质下组发生睡眠障碍的危险性高.患者的睡眠障碍与病情也有关,睡眠障碍随病情加重而加重(中、重度与轻度比较,OR值分别为2.22、7.25,χ~2=21.35,P=0.0000);日常生活能力越差,发生睡眠障碍的危险性越高;文化程度越高,发生睡眠障碍的危险性越高(小学、中学、大专及以上文化程度与文盲比较,OR值分别为1.08、1.98、6.50,χ~2=19.61,P=0.0002);随着抑郁程度的加重,睡眠障碍逐渐加重;体力劳动者睡眠障碍发病风险低于脑力劳动者(OR 0.31,χ~2=17.83,P=0.0000).结论 高文化程度、发生在皮质下部位的脑梗死、病情重、抑郁是急性腩梗死患者睡眠障碍的危险因素,体力劳动者睡眠障碍的发病危险性低.     

Maternal smoking, obesity, and risk of venous thromboembolism during pregnancy and the puerperium: a population-based nested case-control study

BACKGROUND: Smoking and obesity are associated with adverse pregnancy outcomes. The aim of the present study was to examine the association between smoking, obesity (BMI>30), and risk for venous thromboembolism (VTE) during pregnancy and the puerperium. MATERIALS AND METHODS: In a population-based case-control study nested within a Danish cohort of 71,729 women, we identified 129 cases with VTE in pregnancy or the puerperium, and 258 pregnant non-VTE controls. We obtained data from medical records regarding current smoking status, BMI, and other covariates, and computed the odds ratios (OR) for VTE as a measure of relative risk. RESULTS: Smoking and obesity were associated with increased risk of VTE during pregnancy and the puerperium (adjusted OR 2.7 (95% CI: 1.5, 4.9) and 5.3 (95% CI: 2.1, 13.5), respectively). Obesity appeared to be associated with a higher risk of pulmonary embolism (adjusted OR: 14.9 (95% CI: 3.0, 74.8) than of deep venous thrombosis (adjusted OR: 4.4, 95% CI: 1.6, 11.9). CONCLUSION: Smoking and obesity are risk factors for VTE in pregnancy and the puerperium.