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Fetal Heart Rate Decelerations in Women with Sleep-Disordered Breathing

  • Maternal Fetal Medicine/Biology: Original Article
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Abstract

Emerging literature has shown that women with sleep-disordered breathing (SDB) have increased risk for gestational hypertension/preeclampsia and gestational diabetes. Case reports suggest an association between maternal apnea and fetal heart rate deceleration but data are lacking on how maternal sleep impacts fetal health. Since decelerations may be associated with adverse outcomes, we sought to determine whether fetal heart rate decelerations were associated with SDB. A cohort study of third trimester pregnant women with a singleton fetus was conducted. Participants underwent a home sleep test with continuous portable electronic fetal monitoring. SDB was defined as a respiratory disturbance index (RDI)≥10 events/hour. The temporality between a respiratory event and fetal heart rate decelerations was determined to be present if a deceleration occurred < 30 s after a respiratory event. Forty women were included with mean (±SD) age, BMI, and gestational age of 32.0±5.5 years, 37.1±8.0 kg/m2, and 34.6±2.4 weeks respectively. Overall, n=23 (57.5%) women had SDB. Thirty-seven late decelerations were observed in 18 women; of these, 84% were temporally associated with a respiratory event. Nine of the 18 women (50%) had SDB. Ten prolonged decelerations were observed in 6 women of which nine (90%) were temporally associated with a respiratory event. Five of the six women (83%) had an RDI≥10. These initial data suggest that, in this population, the majority of both late and prolonged fetal heart rate decelerations occur with a maternal respiratory event. Since respiratory events are characteristic of maternal SDB, this raises the possibility that SDB may influence fetal well-being.

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Acknowledgements

We thank the participants of the study for their time and dedication. We also acknowledge our research assistants Brittany Loder, Alexandra Mangus, Mallory Newsted, and Joslin Musick for their assistance in all aspects of the clinical research.

Funding

This study was supported by the Gilmore Fund for Sleep Research and the Edward Dunster Fellowship Research Award.

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Authors and Affiliations

  1. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Henry Ford Health System, Detroit, MI, USA

    D’Angela S. Pitts

  2. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA

    Marjorie C. Treadwell & Louise M. O’Brien

  3. Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, MI, USA

    Louise M. O’Brien

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  1. D’Angela S. Pitts
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  2. Marjorie C. Treadwell
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  3. Louise M. O’Brien
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Correspondence to D’Angela S. Pitts.

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Ethics Approval

This study was approved by the University of Michigan IRB: HUM00059952

Conflict of Interest

LMO has received home sleep testing devices from Itamar Medical Inc. DSP and MCT have no disclosures.

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Pitts, D.S., Treadwell, M.C. & O’Brien, L.M. Fetal Heart Rate Decelerations in Women with Sleep-Disordered Breathing. Reprod. Sci. 28, 2602–2609 (2021). https://doi.org/10.1007/s43032-021-00563-w

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