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Poster session I Clinical obstetrics, medical-surgical-disease, neonatology, physiology-endocrinology: Abstracts 87 – 236| Volume 206, ISSUE 1, SUPPLEMENT , S84, January 2012

161: Maternal sleep health and fetal outcomes

      Objective

      There are little data on the fetal outcomes of polysommographoically confirmed obstructive sleep apnoea (OSA) in pregnancy. Our hypothesis was that OSA may be associated with; (i) acute fetal compromise, as evidenced by fetal heart decelerations on continuous fetal cardiotocography during periods of maternal hypoxia, hypercapnia and sympathetic activation. (ii) chronic fetal compromise, as evidenced by a fall in fetal growth trajectory on serial third trimester ultrasound examinations, and altered cord blood levels of fetal growth regulators.

      Study Design

      Preliminary questionnaires identified women as potential OSA cases and controls. The fetal growth trajectory across the third trimester was determined by performing serial ultrasound examinations, and a fall of >30% of the customised fetal weight centile from 32 weeks to birth was considered significant . At 37 weeks gestation, polysommography with synchronised fetal heart rate monitoring was performed, and cord blood collected at delivery.

      Results

      36 women have completed the study, 10 of whom had confirmed OSA. Acute Compromise: one case of an abnormal CTG occurred in a woman with OSA and a growth restricted fetus. There were no other fetal heart rate abnormalities detected, despite moderate OSA associated with significant maternal oxygen desaturation. Chronic compromise: women with OSA were more likely to demonstrate an impaired growth trajectory during the third trimester than women without OSA (33% vs 4%, p <0.05). In addition, insulin growth factor-II (IGF-2) was significantly lower in the cord blood of infants whose mothers had OSA compared with BMI-matched controls (p<0.05).

      Conclusion

      We have confirmed that OSA may be associated with acute and chronic fetal compromise. Given the established link between obesity and stillbirth, it is intriguing to consider whether OSA may be an important intermediary. That there is therapy for OSA available in the form of Continuous Positive Airway Pressure (CPAP), is particularly exciting, but further study with larger numbers is needed to confirm these results.
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