Sleep apnea linked to poor perinatal outcomes in obese mothers

By Lucy Piper, Senior medwireNews Reporter

The newborns of obese pregnant women with obstructive sleep apnea (OSA) have an increased chance of being born by cesarean and admitted to the neonatal intensive care unit, study findings indicate.

The research also showed a link between OSA and harmful effects in the mothers, who had an increased risk for pre-eclampsia.

"Our findings show that obstructive sleep apnea can contribute to poor outcomes for both obese mothers and their babies," said Judette Louis, from Case Western Reserve University School of Medicine in Cleveland, Ohio, USA, in a press statement.

"Its role as a risk factor for adverse pregnancy outcomes independent of obesity should be examined more closely."

Louis and colleagues screened for OSA in 175 obese women with a body mass index (BMI) of at least 30 kg/m².

Based on portable polysomnograph data obtained by the women overnight, the prevalence of OSA, defined as an apnea-hypopnea index of 5 or more, was 15.4%, with 13 mothers diagnosed with mild, nine with moderate, and five with severe OSA.

These women had a higher BMI and more chronic hypertension than the women without OSA.

They were also more likely to have a cesarean delivery, at 65.4% versus 32.8%, and to develop pre-eclampsia, at 42.3% versus 16.9%. Indeed, after accounting for BMI, maternal age, and diabetes, OSA was associated with a 3.55-fold increased risk for pre-eclampsia. However, women with OSA were no more likely than those without to have preterm births.

Other maternal complications occurring in the OSA group and not women without OSA were maternal death and cardiac arrest in one patient each.

In all there were 158 live births. Babies born to mothers with OSA were more likely to be admitted to the neonatal intensive care unit, at 46.1% versus 17.8% of those born to mothers without OSA. Respiratory complications were the primary reason for admission.

The researchers suggest that the increased rate of cesarean delivery among mothers with OSA may partly explain the increased rate of neonatal intensive care unit admission, but more study on this is needed.

They conclude in Obstetrics and Gynecology: "An optimal approach to decrease morbidity in women with OSA should be directed at treatment of obesity before pregnancy, which might also improve comorbid OSA.

"Nonetheless, weight loss is often difficult. Evidence of OSA operating as an independent risk factor for adverse maternal and neonatal outcomes also supports the need to address better ways to screen and treat OSA in pregnancy."

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