Objective: To elucidate the correlation between sleep disturbances and blood pressure during pregnancy in women with no pre-existing hypertension. Design: Prospective cohort study. Setting: Outpatient specialist clinics at KK Women’s and Children’s Hospital, Singapore. Population: Women with viable singleton pregnancies confirmed by ultrasonography at less than 14 weeks of amenorrhea at first visit. Methods: 926 subjects were recruited for this study in the outpatient specialist clinics at KK Women’s and Children’s Hospital, Singapore, between September 1, 2010, and August 31, 2014. They were followed up throughout pregnancy with sleep quality, blood pressure and uterine artery doppler assessed at each visit. Main outcome measures: sleep quality, blood pressure and uterine artery doppler. Results: Sleep progressively worsened as pregnancy advances. Shorter sleep duration and poorer sleep efficiency were associated with higher blood pressure, especially in the first trimester. Mixed model analysis demonstrated overall positive correlation between sleep quality represented by Pittsburgh Sleep Quality Index (PSQI) score and diastolic blood pressure (DBP) (p<0.001) and mean arterial pressure (MAP) (p=0.005) during pregnancy after considering all trimesters. Sleep duration was found to be negatively correlated with both systolic blood pressure (SBP) (p=0.029) and DBP (p=0.002) while sleep efficiency is negatively correlated with DBP (p=0.002) only. Overall poor sleep during pregnancy was also found to be correlated to higher uterine artery pulsatility index. Conclusion: Our prospective study demonstrated that sleep quality is significantly correlated with blood pressure during pregnancy with most prominent effect in the first trimester.

Objective We compare the adverse events in the 12 hours after double balloon catheter(DBC) or first prostaglandin(PGE) inserted and the efficacy of DBC to that of PGE in labour induction. Design Multi-centre Randomised controlled Trial (RCT), in 2 centers with 2 arms: (i)DBC (ii)prostaglandin pessary. Setting 2 tertiary hospitals, Singapore and Malaysia Population Southeast-Asian women Method This is a prospective cohort randomised controlled study. 210 women were recruited in each center and assigned randomly to cervical ripening with either DBC or prostaglandin pessary. Main outcome The adverse events in the 12 hours after DBC or first PGE inserted and the efficacy of a DBC to that of a prostaglandin in labour induction were evaluated. Results There were significantly less women with uterine hyperstimulation in the double balloon catheter group (2 vs 24, p=<0.0001) compared to the prostaglandin group. There were no women with uterine hyperstimulation and non-reassuring fetal status in the double balloon group while there were 5 women with uterine hyperstimulation and fetal distress in the prostaglandin group. Use of pain relief was significantly less in the double balloon catheter group (p=0.009). There were no significant differences in both groups in mode and time to delivery, although significant less time was needed to achieve os dilation more than 4cm in the double balloon catheter group (p=<0.0001). Conclusion DBC remains a good alternative method for inducing women in view of low adverse events and a good safety profile with low risk of hyperstimulation. Keywords: Double balloon catheter;prostaglandin;hyperstimulation;induction of labour ClinicalTrials.govIdentifier:NCT02620215.URL:https://clinicaltrials.gov/ct2/show/NCT02620215