Associations between evening shift work, irregular sleep timing, and gestational diabetes in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b)

Abstract

Study objectives: Shift work is a risk factor for cardiometabolic disease, possibly through effects on sleep-wake rhythms. We hypothesized that evening (afternoon and night combined) and irregular (irregular/on-call or rotating combined) shift work during pregnancy is associated with increased odds of preeclampsia, preterm birth, and gestational diabetes mellitus (GDM), mediated by irregular sleep timing.

Methods: The Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b) is a prospective cohort study (n = 10 038) designed to investigate risk factors for adverse pregnancy outcomes. Medical outcomes were determined with medical record abstraction and/or questionnaires; sleep midpoint was measured in a subset of participants with ≥5-day wrist actigraphy (ActiWatch). We estimated the association of evening and irregular shift work during pregnancy with preeclampsia, preterm birth, and GDM using logistic regression, adjusted for adversity (cumulative variable for poverty, education, health insurance, and partner status), smoking, self-reported race/ethnicity, and age. Finally, we explored whether the association between shiftwork and GDM was mediated by variability in sleep timing.

Results: Evening shift work is associated with approximately 75% increased odds of developing GDM (adjusted OR = 1.75, 95% CI: 1.12-2.66); we did not observe associations with irregular shifts, preterm birth, or preeclampsia after adjustment. Pregnant evening shift workers were found to have approximately 45 minutes greater variability in sleep timing compared to day workers (p < .005); sleep-timing variability explained 25% of the association between evening shift work and GDM in a mediation analysis.

Conclusions: Evening shift work was associated with GDM, and this relationship may be mediated by variability in sleep timing.

Keywords: gestational diabetes; pre-eclampsia; pregnancy; premature birth; shift work; sleep.