First-trimester nocturnal cardiorespiratory coupling during home sleep testing and later pregnancy complications: a secondary analysis of the nuMoM2b cohort
- 1Eindhoven University of Technology
Abstract
We tested whether direction-specific nocturnal cardiorespiratory coupling (CRC) in the first trimester differed in pregnancies that later developed obstetric complications. The analysis included 2504 nulliparous women from the nuMoM2b cohort with valid level 3 home sleep recordings at 6-13 weeks' gestation. Bidirectional CRC between RR intervals and abdominal respiratory effort was quantified using bivariate phase-rectified signal averaging in consecutive 5-min segments. Coupling strength, local transition dynamics, and waveform irregularity were summarized by nightly mean and standard deviation. Associations with gestational diabetes mellitus (GDM; n = 111), preeclampsia (n = 149), preterm birth (n = 192), and fetal macrosomia (n = 186) were examined using proportional-odds models with CRC feature quintile as the ordered outcome. Models included all four complications simultaneously and adjusted for maternal age, pre-pregnancy body mass index, race and ethnicity, gestational age at recording, relevant medical and family history, medication use, and apnea-hypopnea index >5 events/h. Holm correction was applied across outcomes. GDM was associated with lower respiration-to-heart rate coupling strength (cumulative odds ratio, 0.45; 95% CI, 0.31-0.64; P < 0.001) and shallower slope at the anchor point (0.63; 0.45-0.89; P = 0.03). Fetal macrosomia was associated with lower within-night variability in heart rate-to-respiration waveform irregularity (0.59; 0.45-0.77; P < 0.001). No associations with preeclampsia or preterm birth remained significant after correction. Direction-specific differences in nocturnal CRC were detectable in the first trimester in pregnancies that later developed GDM or resulted in fetal macrosomia.
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BibTeX
@misc{wu2026firsttrimester,
title = {{First-trimester nocturnal cardiorespiratory coupling during home sleep testing and later pregnancy complications: a secondary analysis of the nuMoM2b cohort}},
author = {Y. Wu and S. Asvadi and M. van der Ven and M. B. van der Hout-van der Jagt and E. Peri and R. Vullings and J. OEH van Laar and P. Fonseca and S. Overeem and M. Mischi and X. Long},
howpublished = {medRxiv},
year = {2026},
month = nov,
doi = {10.64898/2026.11.02.26367117},
url = {https://www.medrxiv.org/content/10.64898/2026.11.02.26367117v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - First-trimester nocturnal cardiorespiratory coupling during home sleep testing and later pregnancy complications: a secondary analysis of the nuMoM2b cohort
AU - Y. Wu
AU - S. Asvadi
AU - M. van der Ven
AU - M. B. van der Hout-van der Jagt
AU - E. Peri
AU - R. Vullings
AU - J. OEH van Laar
AU - P. Fonseca
AU - S. Overeem
AU - M. Mischi
AU - X. Long
PY - 2026
DA - 2026/11/02
PB - medRxiv
DO - 10.64898/2026.11.02.26367117
UR - https://www.medrxiv.org/content/10.64898/2026.11.02.26367117v1
AB - We tested whether direction-specific nocturnal cardiorespiratory coupling (CRC) in the first trimester differed in pregnancies that later developed obstetric complications. The analysis included 2504 nulliparous women from the nuMoM2b cohort with valid level 3 home sleep recordings at 6-13 weeks' gestation. Bidirectional CRC between RR intervals and abdominal respiratory effort was quantified using bivariate phase-rectified signal averaging in consecutive 5-min segments. Coupling strength, local transition dynamics, and waveform irregularity were summarized by nightly mean and standard deviation. Associations with gestational diabetes mellitus (GDM; n = 111), preeclampsia (n = 149), preterm birth (n = 192), and fetal macrosomia (n = 186) were examined using proportional-odds models with CRC feature quintile as the ordered outcome. Models included all four complications simultaneously and adjusted for maternal age, pre-pregnancy body mass index, race and ethnicity, gestational age at recording, relevant medical and family history, medication use, and apnea-hypopnea index >5 events/h. Holm correction was applied across outcomes. GDM was associated with lower respiration-to-heart rate coupling strength (cumulative odds ratio, 0.45; 95% CI, 0.31-0.64; P < 0.001) and shallower slope at the anchor point (0.63; 0.45-0.89; P = 0.03). Fetal macrosomia was associated with lower within-night variability in heart rate-to-respiration waveform irregularity (0.59; 0.45-0.77; P < 0.001). No associations with preeclampsia or preterm birth remained significant after correction. Direction-specific differences in nocturnal CRC were detectable in the first trimester in pregnancies that later developed GDM or resulted in fetal macrosomia.
ER -