Sleep intervention and glycemic control in gestational diabetes mellitus: a feasibility study

Over 50% of pregnant people report poor sleep quality and insomnia, with approximately 25% reporting short sleep (<7 hours per night). Short sleep duration is associated with impaired glucose functioning, insulin resistance, and type 2 diabetes mellitus. Although short sleep is associated with elevated blood glucose in patients with gestational diabetes mellitus, it is not known whether education on healthy sleep habits during pregnancy can improve sleep and thus glycemic control in these patients.We developed a sleep education program specific to pregnancy and targeted to patients with gestational diabetes mellitus. We aimed to evaluate the feasibility of this intervention in the setting of a randomized controlled trial.A sleep education program specific to pregnancy, "Sleep-4-2," was developed via multidisciplinary collaboration between specialists in maternal-fetal medicine, sleep medicine, and psychiatry. The program was presented to focus groups of pregnant people and a separate group of healthcare providers to gauge acceptability of the program and to modify content. This program was then tested on a group of patients diagnosed with gestational diabetes mellitus. Participants were randomized to a group receiving standard gestational diabetes mellitus care or a group participating in the sleep education program. Baseline demographics, sleep knowledge, and self-reported sleep quality information were obtained from all participants at enrollment and again at 35 weeks of pregnancy. Change in sleep knowledge and quality and degree of glycemic control were compared between groups.Between December 2017 and July 2019, 140 patients were screened and 74 were enrolled in the study and randomized. Recruitment to the study was acceptable, with >50% of eligible approached patients agreeing to participate, and retention in the intervention group was high at 94%. We did not demonstrate any difference in sleep knowledge or in the proportion of patients achieving glycemic control during pregnancy.Implementation of a sleep education program specific to pregnancy for patients with gestational diabetes mellitus was feasible in the context of typical care. A definitive trial could be developed on the basis of this pilot study to evaluate whether a sleep intervention in pregnancy can improve glycemic control in patients with gestational diabetes mellitus.