孕期睡眠與子代出生體質(zhì)量相關(guān)性的研究進展

1. 復(fù)旦大學(xué)公共衛(wèi)生學(xué)院, 上海 200032;
2. 復(fù)旦大學(xué)附屬婦產(chǎn)科醫(yī)院產(chǎn)科, 上海 200011

收稿日期：2021-06-10；接受日期：2021-06-29

基金項目：國家自然科學(xué)基金(81871183)，國家自然科學(xué)基金青年項目(81701470)，上海市科學(xué)技術(shù)委員會基金(18411963400)

摘要：目前孕期睡眠與子代出生體質(zhì)量之間關(guān)系的研究結(jié)論尚不一致，多項研究認為孕婦孕期睡眠呼吸障礙（sleep-disordered breathing，SDB）、孕期睡眠不足、睡眠質(zhì)量差與子代低出生體質(zhì)量相關(guān)。孕婦睡眠姿勢與子代出生體質(zhì)量相關(guān)性的研究較少，有研究發(fā)現(xiàn)孕婦仰臥位睡眠可導(dǎo)致子代低出生體質(zhì)量。孕期睡眠障礙和子代出生體質(zhì)量之間的關(guān)聯(lián)模式尚須進一步的縱向研究證實，同時客觀的睡眠時間和睡眠質(zhì)量測量方法有待探討。本文主要從SDB、睡眠持續(xù)時間、睡眠質(zhì)量及睡眠姿勢4個方面來闡述孕期睡眠與子代出生體質(zhì)量之間關(guān)系的研究進展。

關(guān)鍵詞：睡眠    妊娠    出生體質(zhì)量    睡眠呼吸障礙    

Research progress of correlation between sleep during pregnancy and offspring birth weight

GUI Yu-yan1 , SHI Hui-jing1 , XIAO Xi-rong2     

1. School of Public Health, Fudan University, Shanghai 200032, China;
2. Department of Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China

Foundation item: Supported by General Program of National Natural Science Foundation of China (81871183), Youth Program of National Natural Science Foundation of China (81701470), and Fund of Shanghai Science and Technology Commission (18411963400)

Abstract: At present, the correlation between maternal sleep and offspring birth weight has not be insured. More studies support the conclusion that sleep-disordered breathing (SDB), lack of sleep, poor sleep in pregnant women are related to the low birth weight of offspring. There are few studies on the correlation between sleep posture of pregnant women and birth weight, but some studies found that supine sleep of pregnant women is associated with low birth weight. Further longitudinal studies as well as objective measurements of sleep time and quality are needed to confirm the correlation between maternal sleep disorders and offspring birth weight. This paper mainly discusses the relationships between the maternal sleep and offspring birth weight from SDB, sleep duration, sleep quality, and sleep posture.

Key words: sleep    pregnancy    birth weight    sleep-disordered breathing    

近年來，睡眠與妊娠結(jié)局之間關(guān)系的研究成為熱點[1-5]。出生體質(zhì)量是胎兒生長的重要指標，影響出生后健康狀況、器官功能和疾病的發(fā)生發(fā)展[6-7]。低出生體質(zhì)量的新生兒心血管疾病、肥胖、Ⅱ型糖尿病和高血壓風(fēng)險增加之間存在相關(guān)性[8-10]。目前關(guān)于睡眠與子代出生體質(zhì)量之間關(guān)系的研究結(jié)論并不一致。本文主要從母親孕期睡眠呼吸障礙（sleep-disordered breathing，SDB）、睡眠持續(xù)時間、睡眠質(zhì)量及睡眠姿勢4個方面對睡眠與子代出生體質(zhì)量之間的關(guān)系作一綜述。

1 SDB

SDB是指一系列夜間呼吸障礙，包括原發(fā)性打鼾、上呼吸道阻力增加和阻塞性睡眠呼吸暫停（obstructive sleep apnea, OSA），其特征是在睡眠中反復(fù)出現(xiàn)完全或部分上氣道塌陷，反復(fù)出現(xiàn)通氣異常和覺醒[11]。SDB是最常見的睡眠障礙之一，影響高達32%的孕婦[12]。

目前大多數(shù)研究[5]未發(fā)現(xiàn)子代出生體質(zhì)量與打鼾的相關(guān)性。但是，一項納入1 000余名孕婦的前瞻性研究[13]顯示，頻繁或幾乎總是打鼾的婦女子代低出生體質(zhì)量的風(fēng)險增加；校正是否為早產(chǎn)兒因素后，打鼾不再與子代低出生體質(zhì)量相關(guān)。另有研究[14-17]認為，打鼾婦女子代出生體質(zhì)量較不打鼾婦女高，可能與母親肥胖有關(guān)。Olivarez等[17]通過體質(zhì)指數(shù)（body mass index, BMI）分層分析發(fā)現(xiàn)，僅BMI＞30 kg/m2的婦女打鼾與子代高出生體質(zhì)量有關(guān)。Ge等[14]則發(fā)現(xiàn)，在中國人群中，孕期打鼾者分娩巨大兒的風(fēng)險增加。其中，與BMI＜24 kg/m2的不打鼾者相比，BMI＜24 kg/m2的打鼾者和超重/肥胖（BMI≥24 kg/m2）的打鼾者分娩巨大兒的相對風(fēng)險都增加[14]。此外，Tauman等[18]在122例孕婦中進行的橫斷面研究發(fā)現(xiàn)，打鼾婦女所生嬰兒的臍帶血中核紅細胞含量較高，提示胎兒存在低氧血癥。

柏林問卷（Berlin questionnaire，BQ）包含打鼾、白天嗜睡、高血壓和BMI等內(nèi)容，陽性提示OSA高風(fēng)險[19]。Higgins等[15]報告，與BQ陰性婦女相比，BQ陽性婦女的子代出生體質(zhì)量顯著升高。而Ugur等[20]的前瞻性研究顯示，與BQ陰性婦女相比，BQ陽性婦女的子代存在低出生體質(zhì)量趨勢；Chen等[21]也認為，母親診斷OSA與子代低出生體質(zhì)量風(fēng)險增加有關(guān)；Louis等[22]則發(fā)現(xiàn)，與單純肥胖的婦女相比，伴OSA的肥胖婦女嬰兒體質(zhì)量顯著降低。此外，Sharma等[23]對273名婦女進行的一項前瞻性研究未發(fā)現(xiàn)子代出生體質(zhì)量與BQ陽性的關(guān)系，但發(fā)現(xiàn)打鼾婦女的子代存在出生體質(zhì)量降低的趨勢；Guilleminault等[24]的研究結(jié)果相似。

3個薈萃分析[1-2, 25]結(jié)果顯示，孕婦SDB與子代低出生體質(zhì)量之間存在相關(guān)性。而Li等[26]的一項納入8 749名婦女（15項研究）的薈萃分析則顯示，孕婦SDB和子代低出生體質(zhì)量無關(guān)。另外3項大型研究[13, 15, 27]（1 000名以上參與者）發(fā)現(xiàn)SDB與出生體質(zhì)量不相關(guān)。導(dǎo)致這些研究結(jié)果不一致的原因可能如下：（1）SDB測量的時期不一致，嚴重程度也未得到一致評估；（2）低出生體質(zhì)量與胎兒宮內(nèi)生長受限不同，無須進行胎齡校正，故未排除早產(chǎn)等混雜因素的影響?？傊?，研究總體結(jié)果支持孕婦SDB導(dǎo)致子代低出生體質(zhì)量[28]。但是大多數(shù)研究中潛在的混雜變量未得到控制，這可能是導(dǎo)致這種關(guān)聯(lián)不明確的原因[28]。

2 睡眠持續(xù)時間

美國國家睡眠基金會建議成年人每晚睡眠時間為7~9 h，認為每晚睡眠時間不足6 h為睡眠不足[29]。然而，懷孕期間睡眠不足尚無定論。而且，懷孕期間所需的最佳夜間睡眠時間也不確定，同時不同年齡、種族和胎次的婦女的最佳夜間睡眠時間也可能不同。

一項前瞻性研究[30]中，孕30周時臥床時間＜7 h抑郁婦女的子代出生體質(zhì)量較臥床時間＞9 h的抑郁婦女的子代低。一項納入739名孕婦的前瞻性研究[31]發(fā)現(xiàn)，母親孕期睡眠時間不足8 h與子代低出生體質(zhì)量的風(fēng)險增加有關(guān)。一項對176名孕婦進行的前瞻性隊列研究[32]發(fā)現(xiàn)，初產(chǎn)婦懷孕期間睡眠時間減少，子代出生體質(zhì)量降低。另一項對3 567名孕婦的前瞻性研究[33]發(fā)現(xiàn)，與睡眠8~9 h/d相比，孕早期睡眠7 h/d的孕婦子代出生體質(zhì)約減少42.70 g，睡眠不足7 h/d的孕婦子代低出生體質(zhì)量的風(fēng)險增加83%。Rabkin等[34]發(fā)現(xiàn)，懷孕中期和晚期每晚睡眠超過9 h的婦女，其子代平均出生體質(zhì)量略有增加，且從懷孕中期開始子代出生體質(zhì)量與母親睡眠時間正相關(guān)。

然而，一項橫斷面研究[35]表明母親短睡眠與子代低出生體質(zhì)量之間無相關(guān)性。一項橫斷面研究[36]則發(fā)現(xiàn)，母親睡眠不足8 h與子代出生體質(zhì)量大于3 500 g相關(guān)。一項前瞻性研究[37]發(fā)現(xiàn)，與睡眠6.0~7.9 h/d的孕婦相比，睡眠9.0~9.9 h/d的子代低出生體質(zhì)量與小于胎齡兒的發(fā)生率降低。另一項前瞻性研究[38]發(fā)現(xiàn)，孕婦孕前及孕期睡眠時間與新生兒出生體質(zhì)量呈倒U形關(guān)系。該研究顯示，在孕前睡眠時間不足7 h/d的婦女中，每天多睡1 h，子代出生體質(zhì)量平均增加44.7 g，但在排除其他潛在混雜因素后差異無統(tǒng)計學(xué)意義；然而，對于每天睡眠超過9 h的孕婦，每增加1 h睡眠時間會使子代出生體質(zhì)量平均減少39.2 g，調(diào)整混雜因素和母親抑郁焦慮等因素后，結(jié)果相似[38]。

總之，大部分研究認為母親睡眠不足與子代出生體質(zhì)量降低相關(guān)，少量研究認為母親睡眠不足導(dǎo)致子代出生體質(zhì)量增加或與子代出生體質(zhì)量無關(guān)。大多數(shù)研究未用一致的短睡眠時間定義，而采用主觀的、自我報告的睡眠時間，且為相對短的時間。因此，需要基于客觀測量數(shù)據(jù)進一步研究孕期睡眠時間和子代出生體質(zhì)量之間的關(guān)聯(lián)模式。

3 睡眠質(zhì)量

睡眠質(zhì)量差在妊娠婦女中很常見，其中胎次和胎齡等因素可能影響睡眠質(zhì)量。Wilson等[39]報告，孕晚期睡眠效率下降，表現(xiàn)為覺醒增加、深度睡眠減少。Signal等[40]證明，初產(chǎn)婦通常睡眠效率較低，在床時間更長，從孕中期起睡眠期間醒來的時間較經(jīng)產(chǎn)婦長。睡眠質(zhì)量差可能會對母體妊娠結(jié)局產(chǎn)生負面影響[4]，進而影響胎兒結(jié)局。然而，很少有研究探討孕期睡眠質(zhì)量差對子代出生體質(zhì)量的影響。

最常采用匹茲堡睡眠質(zhì)量指數(shù)（Pittsburgh sleep quality index，PSQI）[41]評估睡眠質(zhì)量。Rajendiran等[42]發(fā)現(xiàn)，睡眠良好和睡眠不良者子代出生體質(zhì)量之間沒有差異；但是，亞組分析顯示，孕婦睡眠越差（PSQI得分＞18分），子代出生體質(zhì)量越低。一項涉及1 466對母嬰的前瞻性研究[43]發(fā)現(xiàn)，分娩女性子代的孕婦孕期PSQI評分與子代出生體質(zhì)量負相關(guān)，但分娩男性子代母親的睡眠質(zhì)量與子代體質(zhì)量之間無相關(guān)性。此外，妊娠晚期睡眠質(zhì)量差是子代低出生體質(zhì)量的危險因素[43]。Dolatian等[44]發(fā)現(xiàn)，睡眠質(zhì)量在不同子代出生體質(zhì)量（＜2 500 g、2 600~3 000 g、3 001~4 000 g和＞4 000 g）的孕婦間差異無統(tǒng)計學(xué)意義，雖然指出睡眠障礙組子代出生體質(zhì)量較低，但未提供具體數(shù)據(jù)。一項研究[36]通過孕婦主觀描述睡眠是“清爽的”“相對清爽的”“不清爽的”來評估其睡眠質(zhì)量，發(fā)現(xiàn)與睡眠“不清爽的”或“相對清爽的”的孕婦相比，睡眠“清爽的”孕婦女性子代出生體質(zhì)量＞2 500 g的概率更高，同時發(fā)現(xiàn)孕晚期睡眠障礙可能導(dǎo)致子代出生體質(zhì)量下降[36]。

上述研究表明，母親睡眠質(zhì)量差可能導(dǎo)致子代出生體質(zhì)量降低。但是睡眠質(zhì)量評估受主觀因素影響，因此需要進行大規(guī)模的縱向研究來驗證這一關(guān)系。

4 睡眠姿勢

妊娠晚期產(chǎn)婦仰臥位與下腔靜脈壓迫有關(guān)[45]，因此為防止心臟輸出量下降和促進母體血液流向胎盤，應(yīng)避免這種體位[46]。發(fā)生急性胎兒窘迫時，孕婦左側(cè)臥位有助于胎兒復(fù)蘇[47]。產(chǎn)科手術(shù)或操作（如超聲波和腹部觸診）時，通常會將婦女置于左側(cè)傾斜位置。有研究[48]建議仰臥低血壓綜合征孕婦或體位依賴性SDB孕婦避免仰臥位。但是，孕婦睡眠體位常被忽略。有研究[49]表明，大多數(shù)孕婦存在仰臥位睡眠。這表明胎兒可能會重復(fù)地暴露在氧氣和營養(yǎng)物減少的環(huán)境中，導(dǎo)致胎兒生長受限甚至死亡。

目前關(guān)于孕婦睡眠姿勢與子代出生體質(zhì)量的研究較少，有2項研究[35, 50]發(fā)現(xiàn)孕婦仰臥位睡眠與子代低出生體質(zhì)量相關(guān)。一項納入1 804名孕婦的薈萃分析[50]發(fā)現(xiàn)，與其他入睡姿勢相比，孕晚期以仰臥位姿勢入睡的女性子代出生體質(zhì)量平均降低144 g，子代出生體質(zhì)量降低與已知出生體質(zhì)量相關(guān)的變量無關(guān)，以非仰臥位姿勢（左側(cè)臥位、右側(cè)臥位以及其他姿勢）入睡的孕婦平均子代出生體質(zhì)量相似。一項橫斷面研究[35]發(fā)現(xiàn)，懷孕期間仰臥位睡眠婦女發(fā)生子代低出生體質(zhì)量和死產(chǎn)的風(fēng)險增加，且低出生體質(zhì)量可能是仰臥位睡眠導(dǎo)致死產(chǎn)的因素。

母體仰臥位睡眠導(dǎo)致胎兒不良結(jié)局的潛在機制可能包括母體氧飽和度降低、胎盤血流灌注減少和間歇性胎兒低氧血癥[5]。臨床醫(yī)生應(yīng)加強孕婦睡眠姿勢與子代低出生體質(zhì)量之間關(guān)系的研究。

5 小結(jié)與展望

健康和疾病的發(fā)展起源（developmental origins of health and disease，DOHaD）理論認為胎兒能根據(jù)子宮內(nèi)環(huán)境信號作出適應(yīng)性調(diào)整，從而提高在不利的出生后環(huán)境下的即時存活率。如果子宮內(nèi)適應(yīng)不正確或出生后環(huán)境發(fā)生重大變化，導(dǎo)致產(chǎn)前宮內(nèi)適應(yīng)和產(chǎn)后生活環(huán)境不匹配，就可能使成年期患病風(fēng)險增加[51]。懷孕期間發(fā)生的生理變化與睡眠結(jié)構(gòu)變化有關(guān)。這些變化會在心理層面、代謝和表觀遺傳學(xué)層面影響母親及其后代的健康[52]。此外，睡眠時間和質(zhì)量可能對飲食模式有影響，而飲食模式直接影響后代的健康[53]。

低出生體質(zhì)量與新生兒發(fā)病率和死亡率相關(guān)，并與成年期慢性疾病的發(fā)展有關(guān)[54]。多數(shù)研究認為母親睡眠障礙與子代出生體質(zhì)量降低相關(guān)。需要進一步的縱向研究來證實母親睡眠障礙和子代出生體質(zhì)量之間的關(guān)聯(lián)模式。通過不同的人群樣本，納入激素和心理健康生物標志物等指標，并采用客觀的睡眠時間和睡眠質(zhì)量評估方法（如目前許多智能穿戴設(shè)備上提供的方法）有利于明確該關(guān)聯(lián)模式。

利益沖突：所有作者聲明不存在利益沖突。

參考文獻

[1]

PAMIDI S, PINTO L M, MARC I, et al. Maternal sleep-disordered breathing and adverse pregnancy outcomes: a systematic review and metaanalysis[J]. Am J Obstet Gynecol, 2014, 210(1): 52. e1-52. e14. [DOI]

[2]

DING X X, WU Y L, XU S J, et al. A systematic review and quantitative assessment of sleep-disordered breathing during pregnancy and perinatal outcomes[J]. Sleep Breath, 2014, 18(4): 703-713. [DOI]

[3]

PALAGINI L, GEMIGNANI A, BANTI S, et al. Chronic sleep loss during pregnancy as a determinant of stress: impact on pregnancy outcome[J]. Sleep Med, 2014, 15(8): 853-859. [DOI]

[4]

AUGUST E M, SALIHU H M, BIROSCAK B J, et al. Systematic review on sleep disorders and obstetric outcomes: scope of current knowledge[J]. Am J Perinatol, 2013, 30(4): 323-334.

[5]

WARLAND J, DORRIAN J, MORRISON J L, et al. Maternal sleep during pregnancy and poor fetal outcomes: a scoping review of the literature with meta-analysis[J]. Sleep Med Rev, 2018, 41: 197-219. [DOI]

[6]

RISNES K R, VATTEN L J, BAKER J L, et al. Birthweight and mortality in adulthood: a systematic review and meta-analysis[J]. Int J Epidemiol, 2011, 40(3): 647-661. [DOI]

[7]

SMITH C J, RYCKMAN K K, BARNABEI V M, et al. The impact of birth weight on cardiovascular disease risk in the Women's Health Initiative[J]. Nutr Metab Cardiovasc Dis, 2016, 26(3): 239-245. [DOI]

[8]

TARRY-ADKINS J L, OZANNE S E. Mechanisms of early life programming: current knowledge and future directions[J]. Am J Clin Nutr, 2011, 94(6 Suppl): 1765S-1771S.

[9]

LILLYCROP K A, BURDGE G C. Epigenetic mechanisms linking early nutrition to long term health[J]. Best Pract Res Clin Endocrinol Metab, 2012, 26(5): 667-676. [DOI]

[10]

WANG G, WALKER S O, HONG X, et al. Epigenetics and early life origins of chronic noncommunicable diseases[J]. J Adolesc Health, 2013, 52(2 Suppl 2): S14-S21.

[11]

DEMPSEY J A, VEASEY S C, MORGAN B J, et al. Pathophysiology of sleep apnea[J]. Physiol Rev, 2010, 90(1): 47-112. [DOI]

[12]

LOUIS J M, KOCH M A, REDDY U M, et al. Predictors of sleep-disordered breathing in pregnancy[J]. Am J Obstet Gynecol, 2018, 218(5): 521 e1-521 e12. [DOI]

[13]

MICHELI K, KOMNINOS I, BAGKERIS E, et al. Sleep patterns in late pregnancy and risk of preterm birth and fetal growth restriction[J]. Epidemiology, 2011, 22(5): 738-744. [DOI]

[14]

GE X, TAO F B, HUANG K, et al. Maternal snoring may predict adverse pregnancy outcomes: a cohort study in China[J]. PLoS One, 2016, 11(2): e0148732. [DOI]

[15]

HIGGINS N, LEONG E, PARK C S, et al. The Berlin Questionnaire for assessment of sleep disordered breathing risk in parturients and non-pregnant women[J]. Int J Obstet Anesth, 2011, 20(1): 22-25. [DOI]

[16]

KO H S, KIM M Y, KIM Y H, et al. Obstructive sleep apnea screening and perinatal outcomes in Korean pregnant women[J]. Arch Gynecol Obstet, 2013, 287(3): 429-433. [DOI]

[17]

OLIVAREZ S A, FERRES M, ANTONY K, et al. Obstructive sleep apnea screening in pregnancy, perinatal outcomes, and impact of maternal obesity[J]. Am J Perinatol, 2011, 28(8): 651-658. [DOI]

[18]

TAUMAN R, MANY A, DEUTSCH V, et al. Maternal snoring during pregnancy is associated with enhanced fetal erythropoiesis--a preliminary study[J]. Sleep Med, 2011, 12(5): 518-522. [DOI]

[19]

NETZER N C, STOOHS R A, NETZER C M, et al. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome[J]. Ann Intern Med, 1999, 131(7): 485-491.

[20]

UGUR M G, BOYNUKALIN K, ATAK Z, et al. Sleep disturbances in pregnant patients and the relation to obstetric outcome[J]. Clin Exp Obstet Gynecol, 2012, 39(2): 214-217.

[21]

CHEN Y H, KANG J H, LIN C C, et al. Obstructive sleep apnea and the risk of adverse pregnancy outcomes[J]. Am J Obstet Gynecol, 2012, 206(2): 136. e1-e5.

[22]

LOUIS J M, AUCKLEY D, SOKOL R J, et al. Maternal and neonatal morbidities associated with obstructive sleep apnea complicating pregnancy[J]. Am J Obstet Gynecol, 2010, 202(3): 261. e1-e5.

[23]

SHARMA S K, NEHRA A, SINHA S, et al. Sleep disorders in pregnancy and their association with pregnancy outcomes: a prospective observational study[J]. Sleep Breath, 2016, 20(1): 87-93. [DOI]

[24]

GUILLEMINAULT C, QUERRA-SALVA M, CHOWDHURI S, et al. Normal pregnancy, daytime sleeping, snoring and blood pressure[J]. Sleep Med, 2000, 1(4): 289-297. [DOI]

[25]

BROWN N T, TURNER J M, KUMAR S. The intrapartum and perinatal risks of sleep-disordered breathing in pregnancy: a systematic review and metaanalysis[J]. Am J Obstet Gynecol, 2018, 219(2): 147-161. e1. [DOI]

[26]

LI L W, ZHAO K, HUA J, et al. Association between sleep-disordered breathing during pregnancy and maternal and fetal outcomes: an updated systematic review and meta-analysis[J]. Front Neurol, 2018, 9: 91. [DOI]

[27]

O'BRIEN L M, BULLOUGH A S, OWUSU J T, et al. Snoring during pregnancy and delivery outcomes: a cohort study[J]. Sleep, 2013, 36(11): 1625-1632. [DOI]

[28]

FARABI S S, BARBOUR L A, HERNANDEZ T L. Sleep-disordered breathing in pregnancy: a developmental origin of offspring obesity?[J]. J Dev Orig Health Dis, 2021, 12(2): 237-249. [DOI]

[29]

HIRSHKOWITZ M, WHITON K, ALBERT S M, et al. National Sleep Foundation's sleep time duration recommendations: methodology and results summary[J]. Sleep Health, 2015, 1(1): 40-43. [DOI]

[30]

OKUN M L, LUTHER J F, WISNIEWSKI S R, et al. Disturbed sleep and inflammatory cytokines in depressed and nondepressed pregnant women: an exploratory analysis of pregnancy outcomes[J]. Psychosom Med, 2013, 75(7): 670-681. [DOI]

[31]

ABEYSENA C, JAVAWARDANA P, SENEVIRATNE RDE A. Effect of psychosocial stress and physical activity on low birthweight: a cohort study[J]. J Obstet Gynaecol Res, 2010, 36(2): 296-303. [DOI]

[32]

FRANCO-SENA A B, KAHN L G, FARIAS D R, et al. Sleep duration of 24 h is associated with birth weight in nulli- but not multiparous women[J]. Nutrition, 2018, 55-56: 91-98. [DOI]

[33]

WANG W Y, ZHONG C R, ZHANG Y, et al. Shorter sleep duration in early pregnancy is associated with birth length: a prospective cohort study in Wuhan, China[J]. Sleep Med, 2017, 34: 99-104. [DOI]

[34]

RABKIN C S, ANDERSON H R, BLAND J M, et al. Maternal activity and birth weight: a prospective, population-based study[J]. Am J Epidemiol, 1990, 131(3): 522-531. [DOI]

[35]

OWUSU J T, ANDERSON F J, COLEMAN J, et al. Association of maternal sleep practices with pre-eclampsia, low birth weight, and stillbirth among Ghanaian women[J]. Int J Gynaecol Obstet, 2013, 121(3): 261-265. [DOI]

[36]

ZAFARGHANDI N, HADAVAND S, DAVATI A, et al. The effects of sleep quality and duration in late pregnancy on labor and fetal outcome[J]. J Matern Fetal Neonatal Med, 2012, 25(5): 535-537. [DOI]

[37]

MURATA T, KYOZUKA H, FUKUDA T, et al. Maternal sleep duration and neonatal birth weight: the Japan Environment and Children's Study[J]. BMC Pregnancy Childbirth, 2021, 21(1): 295. [DOI]

[38]

MARINELLI M, CARSIN A E, TURNER M C, et al. Maternal sleep duration and neonate birth weight: a population-based cohort study[J]. Int J Gynaecol Obstet, 2021.

[39]

WILSON D L, BARNES M, ELLETT L, et al. Decreased sleep efficiency, increased wake after sleep onset and increased cortical arousals in late pregnancy[J]. Aust N Z J Obstet Gynaecol, 2011, 51(1): 38-46. [DOI]

[40]

SIGNAL T L, GANDER P H, SANGALLI M R, et al. Sleep duration and quality in healthy nulliparous and multiparous women across pregnancy and post-partum[J]. Aust N Z J Obstet Gynaecol, 2007, 47(1): 16-22. [DOI]

[41]

BUYSSE D J, REYNOLDS C F, MONK T H 3RD, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research[J]. Psychiatry Res, 1989, 28(2): 193-213. [DOI]

[42]

RAJENDIRAN S, SWETHA KUMARI A, NIMESH A, et al. Markers of oxidative stress in pregnant women with sleep disturbances[J]. Oman Med J, 2015, 30(4): 264-269. [DOI]

[43]

LIU H, LI H, LI C, et al. Associations between maternal sleep quality throughout pregnancy and newborn birth weight[J]. Behav Sleep Med, 2021, 19(1): 57-69. [DOI]

[44]

DOLATIAN M, MEHRABAN Z, SADEGHNIAT K. The effect of impaired sleep on preterm labour[J]. West Indian Med J, 2014, 63(1): 62-67.

[45]

KERR M G, SCOTT D B, SAMUEL E. Studies of the inferior vena cava in late pregnancy[J]. Br Med J, 1964, 1(5382): 532-533.

[46]

JEFFREYS R M, STEPANCHAK W, LOPEZ B, et al. Uterine blood flow during supine rest and exercise after 28 weeks of gestation[J]. BJOG, 2006, 113(11): 1239-1247. [DOI]

[47]

THURLOW J A, KINSELLA S M. Intrauterine resuscitation: active management of fetal distress[J]. Int J Obstet Anesth, 2002, 11(2): 105-116. [DOI]

[48]

MORONG S, HERMSEN B, VRIES DE N. Sleep-disordered breathing in pregnancy: a review of the physiology and potential role for positional therapy[J]. Sleep Breath, 2014, 18(1): 31-37. [DOI]

[49]

O'BRIEN L M, WARLAND J. Typical sleep positions in pregnant women[J]. Early Hum Dev, 2014, 90(6): 315-317. [DOI]

[50]

ANDERSON N H, GORDON A, LI M, et al. Association of supine going-to-sleep position in late pregnancy with reduced birth weight: a secondary analysis of an individual participant data meta-analysis[J]. JAMA Netw Open, 2019, 2(10): e1912614. [DOI]

[51]

VICKERS M H. Early life nutrition, epigenetics and programming of later life disease[J]. Nutrients, 2014, 6(6): 2165-2178. [DOI]

[52]

PIRES G N, BENEDETTO L, CORTESE R, et al. Effects of sleep modulation during pregnancy in the mother and offspring: evidences from preclinical research[J]. J Sleep Res, 2021, 30(3): e13135.

[53]

POT G K. Sleep and dietary habits in the urban environment: the role of chrono-nutrition[J]. Proc Nutr Soc, 2018, 77(3): 189-198. [DOI]

[54]

YADAV D K, SHUKLA G S, GUPTA N, et al. Maternal and obstetric factors associated with low birth weight[J]. J Nepal Health Res Counc, 2020, 17(4): 443-450. [DOI]

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