Thanks for letting us interview you, Dr. O’Brien. Would you mind introducing yourself to our audience—where do you work, what do you do?
I’m Louise O’Brien, an Associate Professor at the Division of Sleep Medicine, Department of Neurology, at the University of Michigan. My work focuses mostly on sleep disruption in pregnant women and its consequences. I’m also interested in treatments and therapies available to intervene to improve the health of women and babies.
Your work largely centers around sleep and its connections to pregnancy and maternal health. What led you to this field of study?
That’s a great question. Going back a long time ago when I was a graduate student, I was really interested in SIDS (Sudden Infant Death Syndrome) and why seemingly healthy babies died suddenly at night. So, I was spending a lot of time monitoring babies overnight to understand what was going on physiologically. That led me to really want to understand more about what happens during sleep, because I realized I’m doing all this nocturnal monitoring, and I really don’t know that much about sleep. That brought me to the United States—to become trained in sleep.
What are some of the things that are really well-known about how sleep affects pregnancy?
I think most pregnant women know that sleep can be quite disrupted during pregnancy. Healthcare professionals can dismiss this as normal, or it’s the body’s way of getting ready for a baby, etc. But I think we’re now learning that certain types of sleep disruption, such as frequent snoring or obstructive sleep apnea can actually lead to poor health outcomes for mom and baby. Poor maternal sleep can lead to high blood pressure or diabetes in the mom, and can also result in poor fetal growth, preterm birth, even an increase in c-section deliveries.
We are learning more and more with the work that we do. For instance, in recent years we’re learning that sleep behaviors, like sleeping on your back, appear to be related to poor outcomes such as stillbirth. A woman who has a stillbirth in late pregnancy has been shown to be more than twice as likely to have fallen asleep on their back. So, this is a relatively new area, and an area that we’re very interested in. I think that behaviors such as sleep position are particularly interesting to me because they can be changed. And If we can change behaviors, that offers an opportunity for intervention that could potentially reduce poor outcomes.
What are some of the current research questions around sleep, circadian rhythms, and pregnancy that are most exciting to you?
I’m becoming really interested in the timing of sleep. A lot of my previous research has been on sleep disorders, like obstructive sleep apnea, which is a medical condition that can be treated. We all sleep, but we don’t all have a sleep disorder. And so, what we’re learning from the general non-pregnant population is, even if we get sufficient sleep (7-8 hours as an adult), if that sleep is mistimed against your body’s natural rhythm there appears to be an increase in blood pressure. So, I’m interested to take those findings to the pregnancy population and to see if mistiming sleep during a critical developmental window for a fetus has adverse consequences which impact the health of the mom , and also the health of the baby. Because we know that what goes on in utero can sometimes have long term effects decades later, potentially even transgenerational, this is an important area that we really don’t know anything about. So the timing of sleep is something I’m really getting interested in. Because, again, we can change it.
The obvious place we see mistimed sleep is in shift workers, but they may not be able to change so easily because they’re working shifts, and they’re working against their body’s natural rhythm. That’s an extreme example, but we know that miscarriage is higher in shift workers than non-shift workers. So the question is, what is mistimed sleep against our body’s natural rhythm really doing?
Since we’re a company that does wearable analytics: What’s the current state-of-the-art for wearable tracking during pregnancy?
It’s not very good. I think with lots of wearables out there that claim to be able to track your sleep, the reality is that none of them are really validated against the gold standard- which is an overnight sleep study. There is an algorithm that has been validated against polysomnography, a type of sleep study, but none have been validated in pregnant women. So, we just really don’t know. While there are lots of things out there that claim to track your sleep, there is nothing out there that tracks it accurately in pregnant women. There is definitely an opportunity for growth in this area, absolutely. Wearables let you look in your app, and it says “REM sleep or deep sleep”, but how accurate is that? We really do not know. So many people have wearables, and I think if we can somehow harness that technology and validate it, then we have a real opportunity to see how sleep across gestation impacts maternal and fetal health. Now this is a window of opportunity. We should be doing this now, because we could then make a huge difference to the lives of mothers and babies if we just had this data.
People sometimes use sleep and circadian rhythms interchangeably, even though they’re not the same. Are there any circadian-specific angles to pregnancy and delivery outcomes that you think are particularly important to call attention to?
I would go back to this idea of mistimed sleep. You can get sufficient sleep and still have poor outcomes, potentially if your sleep is mistimed. We’re learning that in the nonpregnant population now. So, the timing of when we sleep is really important. We already know that getting insufficient sleep is bad for us, but we just assume if we get 7-8 hours of sleep we must be fine. But, if we mistime that, then maybe we’re NOT so fine. I think this is a really interesting area, and how does that relate to pregnancy? We just don’t know, the data is not there. But, I think that this is going to be the next niche area.
Some literature that’s coming out now is adding another layer on top of that. For instance, our diet—WHEN we eat. What’s the impact of eating late at night or mistiming our eating, and how does that affect pregnancy? I think this is a more complicated area that’s going to get a lot of work in the next decade. This is where the field is going to go, and I would like to think that we would be in there somewhere you know, making some inroads into this really important area. I think it’s crucial that we understand what’s going on with our timing, and our eating, and how that’s impacting our own health and the health of that developing baby. Timing is everything, right?
Anything else you’d like to highlight, from your own work, or as an area that needs more attention?
One of the things I would like to mention is: how does sleep play into disparity in healthcare and disparities in outcomes? So for instance, we know that minority women have worse outcomes than caucasian women, we also know that minorities in general tend to have poorer sleep. How does this whole sleep, pregnancy, and disparities play together? That’s a little bit unknown at this point. This is another area that I think is really important—is there a role for sleep and addressing sleep issues in being able to improve outcomes for minority pregnant women? Outside of pregnancy, we know that minorities in general have worse sleep than caucasians, especially Black women. We also know that Black women have worse pregnancy outcomes. For instance, they have double the risk of having growth-restricted babies, and also have higher risk of preterm birth. Nobody’s really looked at pulling sleep into that. We’re looking at two parallel angles, and what I think we need to do is bring these things together to see if there is a role for sleep in these poor outcomes. Because if there is, then we can intervene.
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