{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T13:17:28Z","timestamp":1788182248176,"version":"build-2803163510"},"reference-count":11,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100006474","name":"Columbia University","doi-asserted-by":"publisher","award":["U10 HD063047"],"award-info":[{"award-number":["U10 HD063047"]}],"id":[{"id":"10.13039\/100006474","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006733","name":"Indiana University","doi-asserted-by":"publisher","award":["U10 HD063037"],"award-info":[{"award-number":["U10 HD063037"]}],"id":[{"id":"10.13039\/100006733","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007921","name":"University of Pittsburgh","doi-asserted-by":"publisher","award":["U10HD063041"],"award-info":[{"award-number":["U10HD063041"]}],"id":[{"id":"10.13039\/100007921","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007059","name":"Northwestern University","doi-asserted-by":"publisher","award":["U10 HD063020"],"award-info":[{"award-number":["U10 HD063020"]}],"id":[{"id":"10.13039\/100007059","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006920","name":"University of Pennsylvania","doi-asserted-by":"publisher","award":["U10 HD063048"],"award-info":[{"award-number":["U10 HD063048"]}],"id":[{"id":"10.13039\/100006920","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007747","name":"University of Utah","doi-asserted-by":"publisher","award":["U10 HD063053"],"award-info":[{"award-number":["U10 HD063053"]}],"id":[{"id":"10.13039\/100007747","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008476","name":"University of California, Irvine","doi-asserted-by":"publisher","award":["U10 HD063046"],"award-info":[{"award-number":["U10 HD063046"]}],"id":[{"id":"10.13039\/100008476","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008476","name":"University of California, Irvine","doi-asserted-by":"publisher","award":["UL1TR000153"],"award-info":[{"award-number":["UL1TR000153"]}],"id":[{"id":"10.13039\/100008476","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pregnancy"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sleep disorders in pregnancy have been associated with adverse pregnancy outcomes including hypertensive disorders of pregnancy, preterm birth, and gestational diabetes mellitus, yet these findings are largely from retrospective studies. Using data from a prospective study that used validated tools to assess sleepiness in pregnancy, we aimed to assess the association of sleepiness in pregnancy with adverse pregnancy outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this secondary analysis of data from a large, diverse prospective cohort of nulliparous individuals conducted at eight United States medical centers, those with self\u2010reported sleep data were included. Sleepiness was evaluated in early (6\u201313\u00a0weeks) and mid\u2010pregnancy (22\u201329\u00a0weeks) via the Epworth Sleepiness Scale, a validated tool to assess daytime sleep propensity (i.e., the ability to fall and stay asleep). Those with scores \u226410 were categorized as having no sleepiness (referent), 11\u201315 moderate sleepiness, and 16\u201324 severe sleepiness. The outcomes were hypertensive disorders of pregnancy, gestational diabetes, preterm birth, and small\u2010for\u2010gestational\u2010age birth\u00a0&lt;\u00a010 percentile. Multivariable logistic regression analysis adjusting for multiple potential confounders was performed to evaluate the associations of moderate and severe sleepiness with each outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 6806 eligible participants who completed daytime sleepiness questionnaires at both time points, the mean score in early and mid\u2010pregnancy was 7.8 (standard deviation 4.1) and 6.5 (standard deviation 4.0), respectively. In early pregnancy, 20.0% and 4.3% of people reported moderate and severe daytime sleepiness, respectively; in mid\u2010pregnancy, 14.4% and 2.5% of people experienced moderate and severe sleepiness. Severe sleepiness in mid\u2010pregnancy was associated with gestational diabetes (7.1% severe sleepiness vs. 3.8% no sleepiness; adjusted odds ratio [aOR], 1.78; 95% confidence interval [CI], 1.01\u20133.12) and small\u2010for\u2010gestational\u2010age birth (14.8% severe sleepiness vs. 10.3% no sleepiness; aOR, 1.35; 95% CI, 1.06\u20131.71).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Severe daytime sleepiness during mid\u2010pregnancy, a symptom reflective of sleep quality, length, and often sleep disordered breathing, is associated with gestational diabetes and small\u2010for\u2010gestational\u2010age birth, suggesting a potential relationship with maternal glucose metabolism and placental function.<\/jats:p>\n                  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USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phyllis","family":"Zee","sequence":"additional","affiliation":[{"name":"Department of Neurology Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0643-1859","authenticated-orcid":false,"given":"Sadiya S.","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Greenland","sequence":"additional","affiliation":[{"name":"Department of Medicine Northwestern University Feinberg School of Medicine  Chicago Illinois USA"},{"name":"Department of Preventive Medicine Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca L","family":"Facco","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology UC Irvine Health  Orange California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William A.","family":"Grobman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Brown University  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shalini","family":"Manchanda","sequence":"additional","affiliation":[{"name":"Department of Medicine Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uma M.","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Columbia University  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George R.","family":"Saade","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Eastern Virginia Medical School  Norfolk Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Silver","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Utah Health  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6274-0544","authenticated-orcid":false,"given":"Lynn M.","family":"Yee","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine  Chicago Illinois 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