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Maternal sleep-disordered breathing and the risk of delivering small for gestational age infants: a prospective cohort study
  1. Sushmita Pamidi1,
  2. Isabelle Marc2,
  3. Gabrielle Simoneau3,4,
  4. Lorraine Lavigne1,
  5. Allen Olha1,
  6. Andrea Benedetti3,4,
  7. Frédéric Sériès5,
  8. William Fraser6,
  9. François Audibert6,
  10. Emmanuel Bujold2,
  11. Robert Gagnon7,
  12. Kevin Schwartzman1,3,4,
  13. R John Kimoff1
  1. 1Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, Quebec, Canada
  2. 2Departement de Pédiatrie, Centre Hospitalier de l'Université Laval, Québec, Québec, Canada
  3. 3Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada
  4. 4Department of Epidemiology, Biostatistics & Occupational Health, McGill University Health Centre, Montreal, Quebec, Canada
  5. 5Departement de Pneumology, Institut de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Quebec, Canada
  6. 6Hôpital Ste-Justine, Centre de recherche, Université de Montréal, Montreal, Quebec, Canada
  7. 7Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, Quebec, Canada
  1. Correspondence to Dr Sushmita Pamidi, Respiratory Division, McGill University Health Centre—Glen Site, Block D—D05.2506, 1001 Decarie Blvd, Montreal, Quebec, Canada H4A 3J1; sushmita.pamidi{at}


Objective It is unclear whether objectively measured maternal sleep-disordered breathing (SDB) leads to poor fetal outcomes. In this study, we prospectively assessed whether polysomnography-based diagnosis of SDB in the third trimester is associated with the delivery of small for gestational age (SGA) infants.

Study design Participants were recruited from a multicentre pregnancy cohort study. Eligible participants were evaluated for SDB based on symptoms (snoring and/or witnessed apnoeas assessed using the Pittsburgh Sleep Quality Index questionnaire) and in-home complete polysomnography in the third trimester. SGA was defined as <10th centile using customised birthweight centiles adjusted for maternal parity, prepregnancy body mass index (BMI), ethnicity, gestational age and infant sex.

Results Of the 234 pregnant participants who completed a sleep study, 82% were Caucasian, with mean (SD) age of 31 (4.3) years and a prepregnancy BMI of 23 (4) kg/m2. The delivery of SGA infants occurred in 27 (12%) of the study participants. The symptoms of SDB had poor overall sensitivity and specificity for diagnosing SDB identified by polysomnography. Symptoms of SDB in the third trimester demonstrated a potential association with delivering an SGA infant, however this did not reach statistical significance (OR 2.36 (95% CI 0.85 to 6.54, p=0.10)). However, the odds of delivering an SGA infant were significantly increased with polysomnography-based diagnosis of maternal SDB (using apnoea-hypopnoea index cut-off of 10, OR 2.65 (95% CI 1.15 to 6.10, p=0.02)).

Conclusions Objectively measured SDB in the third trimester is significantly associated with the delivery of SGA infants.

  • Sleep apnoea
  • Clinical Epidemiology

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