PROJECT SUMMARY/ABSTRACT Cardiovascular disease (CVD) is the leading cause of death in women in the U.S, and complications during pregnancy, including gestational diabetes (GDM), are associated with risk of CVD and type 2 diabetes mellitus (DM) later in life. Women with DM have increased risk of CVD, and women with a history of GDM have 7 times higher risk for DM post-delivery compared with women who had a normoglycemic pregnancy. An increasingly important risk factor for GDM and DM is sleep deficiency, and women appear to be more vulnerable to the effects of sleep deficiency on cardiometabolic risk and mortality. Pregnancy and postpartum offer a window of opportunity to mitigate DM1 risk in high risk women of diverse racial/ethnic background. Sleep deficiencies are commonly reported during pregnancy and about 50% of women with history of GDM develop DM, however little is known about sleep deficiency and glycemic status at postpartum. Furthermore, sleep deficiencies and associated risk of diabetes and CVD unequally affect racial/ethnic minorities. Our long-term goal is to identify and disseminate evidence-based, culturally sensitive interventions to reduce sleep deficiencies in women during pregnancy and postpartum, and thus reduce the risk of type 2 DM. The objectives of this study are to understand the association between sleep deficiencies and glycemic status in women with a history of GDM. We propose a study with 200 women with history of GDM in the A Sweeter Choice (ASC) program, an established outpatient diabetes program at Kapi`olani Medical Center, Honolulu, Hawai`i, started in 1995 that has recruited over 10,000 multi-ethnic women with GDM and/or preexisting DM. We will assess sleep deficiency - sleep duration, sleep quality, insomnia severity, and morning-evening sleep choronotype using validated assessment tools. Our first aim is to describe the underlying factors contributing to risk for sleep deficiency in a population of postpartum women from diverse race/ethnic backgrounds with a prior history of GDM. We will conduct a total of 4-8 focus groups with 5-10 participants in each focus group by recruiting women from the ASC program at 6 – 12 months postpartum. Our goal is to gain a deeper understanding of the perspectives of women with a prior pregnancy complicated by GDM on sleep deficiency during pregnancy and postpartum. Our second aim is to examine the association of sleep deficiencies and glycemic status in a population of women from diverse race/ethnic backgrounds with a history of GDM. Sleep deficiencies and HbA1c will be evaluated in 150 women from the ASC program at 6 – 12 months postpartum. Sleep deficiencies will be assessed using the Pittsburgh Sleep Quality Index (PSQI), insomnia severity index, and the morning-evening chronotype assessment, and glycemic status using an HbA1c home test kit. The association between sleep deficiencies and glycemic status will be estimated using linear regression of glycemic status on each measure of sleep deficiency and as a composite sleep deficiency score, adjusted for confounders.

PROJECT NARRATIVE This is the first study to examine the associations between sleep deficiencies and glycemic status in a population of postpartum women from diverse race/ethnic backgrounds with a prior history of GDM. This information is needed because sleep deficiencies, DM, and CVD are public health epidemics and knowledge about the association between sleep deficiencies and glycemic status will inform public health prevention strategies to reduce the burden of DM through sleep interventions.