Objectives: The increasing prevalence of advanced maternal age (AMA) coupled with poor sleep quality
among pregnant women makes it important to study their association with perinatal outcomes. However,
little is known about the interaction of AMA and maternal antenatal sleep on perinatal outcomes. Here, we
examined whether associations between AMA and perinatal outcomes are modified by antenatal sleep
Participants: Data were collected from 446 women, with a singleton pregnancy and no pregnancy complications, who participated in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort study.
Measurements: Participants completed the Pittsburgh Sleep Quality Index (PSQI) at 26-28 weeks gestation
and had perinatal outcome data collected upon delivery. Interactions between AMA and maternal sleep
quality on perinatal outcomes were investigated and where significant, analyses were further stratified
by maternal age. All analyses were adjusted for maternal BMI at 26-28 weeks gestation, ethnicity, and
Results: Neonates of mothers of AMA and poor sleep quality (PSQI score >5) had increased odds of stay in
the neonatal intensive care unit (adjusted odds ratio¼ 3.53, 95% CI: 1.21 to 10.27) and shorter birth length
(adjusted mean difference¼ 1.05 cm, 95% CI: 1.82 to 0.20), as compared with women of AMA and good
sleep quality (PSQI score 5). In women <35 years, sleep quality did not associate with perinatal outcomes.
Conclusion: Poor sleep quality in women of AMA was associated with neonatal health outcomes. Improving
maternal antenatal sleep may potentially improve perinatal outcomes in offspring of women of AMA.