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Maternal sleep during pregnancy and poor fetal outcomes: A scoping review of the literature with meta-analysis
Abstract
There is a wealth of evidence to say that sleep impacts maternal health during pregnancy, however, little has been published on fetal health and maternal sleep. This scoping review summarises current literature on maternal sleep including sleep disordered breathing, sleep quality, sleep duration and supine sleep position, as these relate to fetal outcomes specifically birth weight, growth, preterm birth and stillbirth. An overall interpretation of the studies evaluated shows that events occurring during maternal sleep such as obstructive sleep apnea, sleep disruption and sleep position may have a negative effect on the fetus resulting in altered growth, gestational length and even death. These effects are biologically and physically plausible. In conclusion, there is limited and often conflicting information on maternal sleep and fetal outcomes. However, existing evidence suggests that this is an important area for future research. This area is ripe for investigation if there is to be reduction in the physical, emotional, and financial burden of poor fetal outcomes related to maternal sleep.
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“A previous meta-analysis evaluated the association between sleep quality and duration with the risk of preterm birth [15], but there was significantly high heterogeneity among the included studies and no subgroup or sensitivity analysis to identify the sources of heterogeneity and test the robustness of the main findings.”
From Association between maternal sleep duration and quality, and the risk of preterm birth: a systematic review and meta-analysis of observational studies (2020) · cites this paper as [15]
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“It has been reported that poor maternal sleep during the late pregnancy was associated with adverse outcomes in the fetus, such as preterm birth and low birth weight [13].”
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“However, the association between MSD and neonatal birth weight remains unclear [15, 18].”
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Sleep Disturbance in Pregnancy
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“65,66 69 Evidence from the eLABE study suggests that disrupted sleep during pregnancy, associated with prenatal social disadvantage, is also associated with neonatal brain structure.”
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“Additionally, in late pregnancy, supine sleep position can lead to a reduced flow to the placenta [16,17] and result in poor fetal outcome, affecting fetal growth and increasing the risk of stillbirth, pre-eclampsia/eclampsia, gestational diabetes mellitus, cardiomyopathies and heart failure [18,19].”
BackgroundSleep-related breathing disorders during pregnancy: A systematic review and meta-analysis
Poletti, V., Hackethal, S., Castelnovo, A., Riccardi, S., Volpato, E., & Manconi, M. (2025) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2025.102122 · Cited by 15
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“9) [5], and higher blood pressure in the child (β 1.”
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Antenatal sleep quality associated with perinatal outcomes in women of advanced maternal age
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“At present, our knowledge on sleep in pregnancy shows an association between pregnancy-related sleep disturbance and poor maternal and infant outcomes [7, 8].”
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Evening blue‐light exposure, maternal glucose, and infant birthweight
Izci‐Balserak, B., Hermann, R., Hernandez, T. L., Buhimschi, C. S., & Park, C. (2022) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.14852 · Cited by 12
Obstructive Sleep Apnea in Pregnancy: Early Lessons From Our Sleep Pregnancy Clinic.
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Gas Exchange across the Placenta
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Self-citationFetal Heart Rate Decelerations in Women with Sleep-Disordered Breathing
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“9) in women with objective evidence of SDB [18].”
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Pregnant Women’s Attitudes and Beliefs towards Sleep and Exercise: A Cross-Sectional Survey
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Ramadan during pregnancy and neonatal health—Fasting, dietary composition and sleep patterns
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“Previous research suggests that lack of maternal sleep or poor maternal sleep quality may be associated with poorer birth outcomes [24].”
BackgroundQuality of sleep and quality of life measured monthly in pregnant women in South Korea
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“Pregnancy-related sleep disturbances arise as pregnancy continues [1].”
BackgroundInfluentialSleep Disorders During Pregnancy and Postpartum: A Systematic Review
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“[57] emphasized that maternal sleep disorders could predict some poor fetal outcome such as LBW, inappropriate birth growth (LGA, SGA), preterm birth, and stillbirth.”
BackgroundPASSENGER CAR UNIT VALUES FOR URBAN ROADS
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Influencing factors of sleep quality in pregnant: a structural equation model approach
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“Chronic low-quality sleep exacerbates the risk of multiple negative perinatal pregnancy outcomes, including mood disorders [5, 6], cesarean section rate, prolonged labor and delivery, gestational diabetes mellitus [7], preeclampsia, preterm labor, and low birth weight of neonates [1, 8, 9].”
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Association between Sleep Disordered Breathing and Neonatal Outcomes in Nulliparous Individuals
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Pregnant pause: should we screen for sleep disordered breathing in pregnancy?
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“Many prognostic studies have failed to account for confounders such as body mass index (BMI) or maternal age, have used inconsistent indicators of SDB, or had inadequate power to assess rarer outcomes [8, 9].”
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Association between sleep duration during pregnancy and preterm birth: a dose-response meta-analysis
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“Compared with previous meta-analyses [22,23],”
BackgroundMethodBurden of sleep disturbance in non-Hispanic Black pregnant women
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Self-citationEffect of maternal sleep in late pregnancy on leptin and lipid levels in umbilical cord blood
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Positional Treatment of Obstructive Sleep Apnea
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Childhood abuse and perinatal outcomes for mother and child: A systematic review of the literature
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Impact of Intrauterine Insults on Fetal and Postnatal Cerebellar Development in Humans and Rodents
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Prior pregnancy loss and sleep experience during subsequent pregnancy
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Associations Between Maternal Distress, Cortisol Levels, and Perinatal Outcomes
Lundholm, C., Rejnö, G., Brew, B. K., Smew, A. I., Saltvedt, S., & Almqvist, C. (2022) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001049 · Cited by 10
“Regarding maternal sleep quality, a meta-analysis showed an increased risk of prematurity, but no clear association with small-for-gestational-age (7).”
Background
Metadata
- Authors
- Warland, J., Dorrian, J., Morrison, J. L., & O'Brien, L. M.
- Affiliations
- University of South Australia (AU)
- University of Michigan (US)
- Corresponding author
- Warland, Jane
- Venue
- Sleep Medicine Reviews
- Publisher
- Elsevier BV
- Published
- 2018-10
- Volume
- 41
- Pages
- 197-219
- ISSN
- 1087-0792 (ISSN-L)
- OpenAlex
- W2795097012
- Semantic Scholar
- 37c6431fcc314572f6cb399195c326b5d9c73f7a
- Cited by
- 224
- References
- 102
- Citations by year
- 2026: 16 · 2025: 27 · 2024: 24 · 2023: 27 · 2022: 41 · 2021: 36 · 2020: 29 · 2019: 20 · 2018: 2
- FWCI
- 3.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Sleep Medicine Reviews (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- UniSA Research Outputs Repository (University of South Australia) (submittedVersion)
- Funders
- NHMRC Career Development Fellowship (APP1066916)
- American Sleep Medicine Foundation (111-SR-15)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- maternal sleep, pregnancy, fetal outcomes, obstructive sleep apnea, sleep-disordered breathing, sleep quality, sleep duration, supine sleeping, birth weight, fetal growth, preterm birth, stillbirth, gestation length
- MeSH terms
- Female, Fetus, Humans, Mothers, Pregnancy, Pregnancy Complications, Sleep, Sleep Apnea Syndromes, Supine Position, Premature Birth, Stillbirth
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