Article

0474 A NATIONAL COHORT STUDY OF OBSTRUCTIVE SLEEP APNEA IN PREGNANCY AND ADVERSE NEONATAL OUTCOMES

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Abstract

Introduction Obstructive sleep apnea (OSA) has been associated with adverse neonatal outcomes such as preterm birth and growth restriction in some studies. There are no data regarding resuscitation at birth or risk of congenital anomalies following in-utero exposure to OSA. The aim of this study is to evaluate the association of OSA with resuscitative efforts at birth and the risk of congenital anomalies. Methods The National Perinatal Information Center collects administrative discharge and select medical record data from major perinatal centers in the US. We studied linked maternal records and newborn records with a delivery hospitalization from 2010–2014 to assess newborn outcomes of maternal OSA based on diagnosis and procedure codes. Congenital anomalies were defined based on international classification of diseases-9, and encompassed “any” congenital anomaly as well as specific anomalies. Univariate and Multivariable logistic regression analysis was used to calculate adjusted odds ratios (aOR) and confidence intervals (CI). The model included maternal obesity, pre-pregnancy DM, gestational DM, pre-pregnancy HTN, gestational HTN, preeclampsia, tobacco, alcohol, and drug use. Results There were 1,577,632 pregnant women; 0.1% had OSA; 1,423,099 of all records were linked to live newborn records. Mothers with OSA had a higher likelihood of having obesity, pre-gestational hypertension and diabetes. Neonates born to mothers with OSA were more likely to be admitted to the intensive care unit (25.3% vs. 8.1%, p<0.001) or special care nursery (34.9% vs. 13.6%, p<0.001). Similarly these newborns were more likely to have resuscitation at birth (aOR 2.76, 1.35–5.64), and a longer hospital stay (aOR 2.25, 1.85–2.65) even after adjusting for covariates. The risk for congenital anomalies was higher in babies of women with OSA (aOR 1.26, 1.11–1.43), with the highest risk being that of musculoskeletal anomalies (aOR 1.89, 1.16–3.07). The risk of bronchopulmonary dysplasia was no longer significant after adjusting for covariates. Conclusion This is the first study to demonstrate a higher risk of congenital anomalies and resuscitation at birth in neonates born to mothers with OSA. These data further highlight the importance of identifying this condition in pregnancy and testing the impact of therapy on these complications. Support (If Any) Restricted fund-Lifespan.

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... In pregnancy, OSA is associated with adverse perinatal outcomes, including GDM and preeclampsia, as well as long-term cardiometabolic complications in both women and their offspring via mechanisms including intermittent hypoxia, oxidative stress, endothelial dysfunction, and hypothalamic-pituitary-adrenal axis (HPA) dysfunction. [61][62][63] When a woman has OSA, her oxygen saturations periodically decrease through the night, leaving her tired in the morning and exposing her body and her fetus to stress. 64 In a recent meta-analysis of 33 studies (N = 963,310), women with sleep-disordered breathing during pregnancy were more likely to be overweight or obese than controls and were twice as likely to experience stillbirth or perinatal death (OR, 2.02; 95% CI, 1.25-3.28). ...
... and to have congenital anomalies (adjusted OR, 1.26; 95% CI, 1.11-1.43). 63 OSA is common in women with prepregnancy obesity but is often ignored by clinicians because OSA symptoms are dismissed as normal in pregnancy. In surveys of pregnant women with a range of BMIs, more than onethird reported snoring and restless sleep. ...
... On the other hand, there is no clear evidence to suggest that untreated maternal sleep apnoea causes intrauterine growth restriction. However, it has been demonstrated that SDB in pregnant women is an independent risk factor for neonatal heart failure and respiratory failure (or cardiorespiratory arrest), which require postnatal resuscitation and/or neonatal intensive care [168,169]. ...
... On the other hand, there is no clear evidence to suggest that untreated maternal sleep apnoea causes intrauterine growth restriction. How-ever, it has been demonstrated that SDB in pregnant women is an independent risk factor for neonatal heart failure and respiratory failure (or cardiorespiratory arrest), which require postnatal resuscitation and/or neonatal intensive care [168,169]. ...
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