Abstract: Objective To determine the association among maternal sleep in late pregnancy, insulin level, and insulin resistance in offspring at the age of 2 years old by establishing a birth cohort. Methods Totally 255 healthy late pregnancy women (pregnant for 36~38 weeks) and their infants were recruited in this prospective cohort study from Renji Hospital in Shanghai. Actigraph was used to measure sleep parameters in women during late pregnancy. Random venous blood was collected at 2 years of follow-up in children for measuring glucose and insulin levels. Insulin resistance was assessed using homeostasis model assessment for insulin resistance (HOMA-IR), and HOMA-IR=[glucose (mmol/l)×insulin (uU/ml)]/22.5. Results The levels of glucose, insulin and HOMA-IR were (4.58 ±0.53) mmol / L, (4.65 ±3.61) μU / ml and (0.98 ±0.84) respectively in children at the age of 2 years old. After adjustment for maternal age in late pregnancy, educational level, family income and children′ gender, the longer wake time after sleep onset of late pregnancy women at night, the higher insulin level(β=0.236,P=0.016) and higher insulin resistance (β=0.241,P=0.015) were observed in offspring at the age of 2 years old. Conclusions The wake time after sleep onset of late pregnancy women is significantly associated with insulin and insulin resistance level in offspring at the age of 2 years old, which suggests that health care providers should pay more attention and improve sleep quality of women in the third trimester of pregnancy, thereby improving the metabolic outcome of the offspring.

Key words: late pregnancy, sleep, offspring, insulin, insulin resistance

摘要： 目的 通过建立出生队列研究孕晚期母亲睡眠与子代2岁胰岛素水平和胰岛素抵抗之间的相关性。方法 在上海浦东新区仁济医院招募255位健康孕晚期(孕36~38周)母亲及其婴儿入组,采用手表式睡眠-活动记录仪(actigraph)评估孕晚期母亲的睡眠状况,在儿童2岁时采集随机静脉血,检测血糖和胰岛素水平。胰岛素抵抗用HOMA-IR来评估,HOMA-IR=[血糖(mmol/l)×胰岛素(μU/ml)]/22.5。结果 儿童在2岁时平均血糖为(4.58±0.53)mmol/L,胰岛素为(4.65±3.61)μU/mL,HOMA-IR为0.98±0.84。在校正了孕晚期母亲年龄,受教育程度,家庭经济收入和儿童性别之后,孕晚期母亲夜间入睡后觉醒时间越长,其子代在2岁时的胰岛素水平越高(β=0.236,P=0.016),胰岛素抵抗指数越高(β=0.241,P=0.015)。结论 孕晚期母亲入睡后觉醒时间与其子代2岁时胰岛素和胰岛素抵抗密切相关,提示孕期保健医护人员应密切关注并改善孕晚期母亲的睡眠状况,以改善子代的代谢结局。

关键词: 孕晚期, 睡眠, 子代, 胰岛素, 胰岛素抵抗