Substance Use, Poor Sleep, and Gestational Diabetes: Concerns in Adolescent Pregnancy

Abstract

Adolescence is a stage of development in which several social and biological parameters change drastically. Behavioral alterations are common during puberty, including the appearance of risk-taking behaviors such as substance use and unprotected sex, which can lead to unintended pregnancy. Of note, in addition to the inherent risks of pregnancy at a young age, sleep impairment and substance use are commonly seen in adolescents, even during pregnancy. The increased risk for the development of gestational diabetes, which has been linked to both sleep impairment and drug use, further complicates this scenario and deserves consideration among the scientific community and in the clinical setting. Therefore, in this commentary, we discuss the pathways connecting the risk of substance misuse, sleep impairment, and the development of gestational diabetes, a network that demonstrates the vulnerability of the pregnant teenage population. Future studies evaluating the complicating factors and modulators of pregnancy outcomes in these individuals are of the utmost importance.

 

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Keywords

sleep - gestational diabetes - substance use disorder - adolescent pregnancy

Adolescence is accompanied by multiple health and behavioral challenges in modern society. Increased impulsivity and risk-taking behavior, which may include drug-seeking behavior and can be influenced by insufficient sleep, are extremely prevalent in adolescence.[1] Alongside unprotected sex, substance use (encompassing the use of both licit substances, such as alcohol and tobacco, and illicit substances, such as cocaine and cannabis) and sleep has been considered highly clustered lifestyle factors among adolescents.[2] The implications of this synergy need to be discussed, because sleep impairment, substance use, and teenage pregnancy significantly affect the health of this population.

Of importance, the use of tobacco, alcohol, or illicit substances during pregnancy has been shown to impair the health of the offspring.[3] Rates of lifetime alcohol, tobacco, and illicit substance use (namely cannabis, cocaine, and heroin) were found to be significantly higher in adolescent mothers compared to the general teenager population.[4] Even when substance use is interrupted during pregnancy, substance use tends to resume after birth, presenting other risks to both the mother and the newborn.[4]

Poor sleep is both a contributor to and a consequence of licit and illicit drug use,[5] and is also markedly present during pregnancy.[6] Therefore, sleep impairment may contribute to the negative health outcomes of drug use during pregnancy, including gestational diabetes.[7] Gestational diabetes increases the risk for infant development problems, including alterations in size, birth injuries, being admitted to the neonatal intensive care unit, and developing metabolic syndrome in childhood and later life.[8] This disease, when associated with the use of substances (of which the most commonly reported were alcohol, tobacco, cannabis, and cocaine/crack), has been associated with a higher occurrence of orofacial clefts in newborns,[9] contributing to an already critical health setting.

Therefore, sleep, teenage pregnancy, and substance use might form a network that plays an important role in the risk of gestational diabetes. Considering how vulnerable adolescents are to substance use and sleep impairment, both of which may directly affect diabetes outcomes, future studies addressing this relationship are needed for a better understanding of this triad in the context of teenage pregnancy.

 

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Conflict of Interests

The authors have no conflicts of interest to disclose.

Acknowledgments

Our studies are supported by grants from the Associacão Fundo de Incentivo à Pesquisa (AFIP), by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brazil (CAPES) – Finance Code 001) and by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP – grant #2020/13467-8 to MLA). Dr. Galduróz, Dr. Andersen and Dr. Tufik are fellowship recipients from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). Dr. Berro's research is supported by the National Institutes of Health (DA049886).

• References

• 1 Short MA, Weber N. Sleep duration and risk-taking in adolescents: A systematic review and meta-analysis. Sleep Med Rev 2018; 41: 185-196
• 2 Mewton L, Champion K, Kay-Lambkin F, Sunderland M, Thornton L, Teesson M. Lifestyle risk indices in adolescence and their relationships to adolescent disease burden: findings from an Australian national survey. BMC Public Health 2019; 19 (01) 60
• 3 Britto Silveira T, dos Santos M, Tavella RA. et al. Newborn outcomes exposure to crack cocaine during pregnancy: a critical review. Brazilian Journal of Development 2020; 6 (03) 11220-11232
• 4 Chapman SL, Wu LT. Substance Use among Adolescent Mothers: A Review. Child Youth Serv Rev 2013; 35 (05) 806-815
• 5 Valentino RJ, Volkow ND. Drugs, sleep, and the addicted brain. Neuropsychopharmacology 2020; 45 (01) 3-5
• 6 Sedov ID, Cameron EE, Madigan S, Tomfohr-Madsen LM. Sleep quality during pregnancy: A meta-analysis. Sleep Med Rev 2018; 38: 168-176
• 7 Zhu B, Shi C, Park CG, Reutrakul S. Sleep quality and gestational diabetes in pregnant women: a systematic review and meta-analysis. Sleep Med 2020; 67: 47-55
• 8 Brown J, Ceysens G, Boulvain M. Exercise for pregnant women with gestational diabetes for improving maternal and fetal outcomes. Cochrane Database Syst Rev 2017; 6 (06) CD012202
• 9 Trindade-Suedam IK, Kostrisch LM, Pimenta LA, Negrato CA, Franzolin SB, Trindade AS. Diabetes mellitus and drug abuse during pregnancy and the risk for orofacial clefts and related abnormalities. Rev Lat Am Enfermagem 2016; 24: e2701

Publication History

Received: 23 August 2024

Accepted: 20 March 2025

Article published online:
04 August 2025