Abstract P237: Poor Sleep Quality After Delivery: A Contributor to Increased Cardiovascular Disease Risk for Women With Gestational Hypertension and Preeclampsia?
Authors: Aggarwal Brooke A , Hauspurg Alisse , St-Onge Marie-Pierre , Jelic Sanja , Catov Janet M 
Published: March 2020

Background:
Hypertensive disorders of pregnancy (HDP) including preeclampsia and gestational hypertension are pregnancy complications which have been shown to increase women’s risk for development of CVD later in life. Pregnant women are predisposed to sleep disturbances which may contribute to risk of HDP; however, whether HDP are associated with poor sleep after delivery has not been well-studied.

Hypotheses:
We hypothesized that sleep quality would be worse among women with a history of HDP vs those with normotensive pregnancies in the years after delivery among women in harmonized AHA Go Red for Women SFRN Population Science cohorts from Columbia University and Magee Women’s Research Institute.

Methods:
Baseline data from combined AHA cohorts of 893 women (Magee, n=387; Columbia, n=506) were examined. Women completed a validated pregnancy history questionnaire (kappa=0.71 for self-reported preeclampsia compared to medical record) to list the dates of pregnancies lasting ≥ 24 wks. Women were categorized as having a history of HDP if they indicated they had preeclampsia, eclampsia, or hypertension during pregnancy. Sleep quality was assessed using the validated Pittsburgh Sleep Quality Index (PSQI); higher global sum (range 0-21) indicates worse sleep quality. Insomnia symptoms were assessed using the validated Insomnia Severity Index; higher score (range 0-28) indicates greater insomnia symptoms. Multivariable linear regression models were used to analyze relations between history of HDP and sleep. Models were adjusted for age, race/ethnicity, and education.

Results:
Overall, 59% of women had ≥1 pregnancy meeting inclusion criterion, with mean time since delivery 13.1±10.7y. Of those women (mean±SD age=41.4±10.6y, 53% racial/ethnic minority), 20% had a history of HDP. Mean sleep quality scores were worse among women who reported a history of HDP vs. those with normotensive pregnancies (6.6 vs. 5.8, p=0.04), and vs those who had never been pregnant (6.6 vs 5.0, p<.0001). Sleep duration was lower in women who had HDP vs. those who had never pregnant (6.2 vs 7.0 h/night, p<.0001), but not vs those with normotensive pregnancies (6.2 vs 6.3 h/night p=0.45). Women with history of HDP had significantly greater insomnia symptoms than those with normotensive pregnancies, after adjustment for confounders (β=4.4, P=0.04).

Conclusions:
In this diverse sample of women, having a history of HDP was related to poorer sleep in later life. These preliminary findings suggest that women with HDP may be at enhanced risk of CVD due to poor sleep. Analyses are ongoing to confirm these results in a larger sample with sleep data assessed in the short- and long-term post-partum periods. Future studies should also assess the directionality of this association. Sleep behavior may deserve further investigation as a potential target for intervention to reduce CVD risk in women with pregnancy complications.