First-trimester nocturnal cardiorespiratory coupling during home sleep testing and later pregnancy complications: a secondary analysis of the nuMoM2b cohort

Lower respiration-to-heart rate coupling strength in the first trimester is linked to later gestational diabetes mellitus in 2504 nulliparous women, with cumulative odds ratio 0.45.

• Why it matters: Early, home-based signals are needed to identify pregnancies at risk for complications before clinical diagnosis, especially when mechanisms may involve altered cardiorespiratory coordination.
• What they did: In the nuMoM2b cohort, direction-specific nocturnal CRC was quantified from level 3 home sleep recordings at 6–13 weeks using bivariate phase-rectified signal averaging in consecutive 5-min segments, then modeled with proportional-odds analyses across GDM, preeclampsia, preterm birth, and fetal macrosomia.
• The result: GDM showed lower coupling strength (0.45; 95% CI 0.31–0.64; P < 0.001) and shallower anchor-point slope (0.63; 0.45–0.89; P = 0.03), while fetal macrosomia was linked to lower within-night variability in heart rate-to-respiration waveform irregularity (0.59; 0.45–0.77; P < 0.001); preeclampsia and preterm birth were not significant after Holm correction.

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