The Role of Sleep Behaviors in Regulating Energy Balance Among Pregnant Women with Overweight and Obesity

Open Access
- Author:
- Pauley, Abigail
- Graduate Program:
- Kinesiology
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- July 15, 2020
- Committee Members:
- Danielle Symons Downs, Dissertation Advisor/Co-Advisor
Danielle Symons Downs, Committee Chair/Co-Chair
Peter Cm Molenaar, Outside Member
Ginger A Moore, Outside Member
Scherezade Kelly Mama, Committee Member
Jonathan Bates Dingwell, Program Head/Chair - Keywords:
- Energy Balance
Pregnancy
Sleep Behaviors
Overweight
Obesity
Energy Intake
Physical Activity
Gestational Weight Gain - Abstract:
- Poor prenatal sleep behaviors (e.g., short nighttime sleep duration, frequent nighttime awakenings, long daytime nap duration) may lead to adverse pregnancy outcomes, one of which is excessive gestational weight gain (GWG). Excessive GWG is a major public health concern, especially among pregnant women with overweight/obesity (PW-OW/OB) because it can elevate the risk for poor maternal-fetal birth outcomes. Regulating GWG has largely focused on the concept of energy balance – or offsetting “energy in” (e.g., food intake) and “energy out” (e.g., physical activity) to meet GWG guidelines. It is critical that PW-OW/OB regulate their GWG over pregnancy as they are recommended to gain a small amount of weight (e.g., 0.4-0.7 pounds/week) for optimal maternal-fetal health outcomes. Sleep behaviors may influence GWG, however, little research has examined the extent to which sleep behaviors are related to the components of energy balance to regulate GWG. Thus, the overarching goal of this three study dissertation was to examine sleep behaviors in relation to energy intake, physical activity, and GWG with the aim to inform if and how future interventions may address sleep behaviors to better regulate GWG and promote maternal-fetal health and well-being. The first study was a systematic, narrative review of the literature to examine the magnitude and direction of the associations between prenatal sleep behaviors (i.e., nighttime sleep duration, sleep quality, night awakenings, and daytime nap duration) and eating behaviors, physical activity, and GWG. The second study examined the correspondence and associations between self-report and actigraphy measures of nighttime sleep duration, nighttime awakenings, and daytime nap duration and over- and under-reporting patterns of these sleep behaviors among PW-OW/OB. The third study examined means and associations between sleep behaviors and energy intake, physical activity, and GWG, and the extent to which sleep behaviors explained changes in weekly energy intake, physical activity, and GWG in PW-OW/OB randomized to an intervention to regulate GWG. Both the second and third studies capitalized on existing data from the Healthy Mom Zone Study, a two phase feasibility adaptive intervention that included education on healthy eating, physical activity, sleep behaviors, mental health, and GWG to effectively regulate GWG in PW-OW/OB from ~8 to 36 weeks gestation. This intervention used the theoretical framework of a prenatal energy balance model to develop goals for energy intake, physical activity, and GWG. Overall, there are three key findings from this dissertation. First, while prenatal sleep behaviors are associated with energy intake, physical activity, and GWG, the strength of the ES were small and based on a limited number of studies. Second, there was variability in measurement agreement, association, and over/under-reporting of the sleep behaviors among PW-OW/OB. However, there was agreement in nighttime sleep duration and actigraphy may be used in replacement of self-report measures of nighttime sleep duration. Third, there were significant small to large effects of sleep behaviors on energy balance components such that increases in nighttime sleep duration and nighttime awakenings explained decreases in weekly physical activity and increases in weekly GWG, but not energy intake, among the overall sample of PW-OW/OB and by study group assignment (intervention vs control group). Most notably, increases in nighttime awakenings explained increases in GWG above GWG guidelines among PW-OW/OB in the control group compared to women in the intervention group, and this effect was medium-large. Collectively, the findings from these three dissertation studies may be useful for future research studies as they highlight the potential role that sleep behaviors may have in energy balance to regulate GWG among PW-OW/OB. Since pregnant women, especially PW-OW/OB, are at a high risk for poor sleep behaviors, high energy intake, low physical activity, and excessive GWG, it is crucial to further understand these interrelationships, develop strategies on how to improve these behaviors, and examine the inclusion of sleep behaviors in an prenatal energy balance model to reduce the risk for adverse maternal and fetal outcomes. For example, future interventions may wish to consider educating pregnant women about how too little or too much sleep at night and too many nighttime awakenings relate to decreases in physical activity and increases in GWG. In addition, personalized goals that aim to improve nighttime sleep duration and nighttime awakenings (i.e., reduce food and water intake prior to bedtime and exercise at least 2 hours prior to bedtime) in relation to energy intake, physical activity, and GWG may be beneficial. In summary, nighttime sleep duration and nighttime awakenings may play a role in regulating energy intake, physical activity, and GWG within the context of a prenatal energy balance model in PW-OW/OB.