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Learning Objective 1: The learner will understand how the proposed theoretical framework related to chronic circadian misalignment impacts reproductive outcomes.
Learning Objective 2: The learner will understand that pregnant shiftworkers constitute a vulnerable population and a better understanding of the biological implications is critical to their health.
A theoretical framework is proposed to explain how chronic circadian misalignment (CCM) may contribute to adverse birth outcomes. CCM refers to abnormal neuroendocrine activity resulting from chronic sleep disruption. Peripheral circadian clocks exist in reproductive and immune tissues and coordinate ovulation, implantation, and pregnancy maintenance. Peripheral circadian clocks are controlled by the master circadian pacemaker in the hypothalamus. Research indicates shift work may lead to CCM thereby influencing pregnancy outcomes.
Methods:
A narrative review identified relationships between circadian rhythms, shiftwork, and birth outcomes. Findings were compared, themes synthesized, and limitations reviewed. The Bollinger sleep- immune model was used in conjunction with the reproductive circadian literature to explore associations between sleep, immunity, and reproduction.
Results:
Narrative review identified knowledge deficits and advances in the study of CCM in relation to birth outcomes. Altered sleep and abnormal exposure to light were found to affect synchronization of the master circadian pacemaker with peripheral sites. From this, CCM may develop and contribute to immune dysregulation and reproductive consequences including altered fertility, menstrual irregularities, and decreased term pregnancy.
Conclusions: This theory provides a framework for how inflammation may develop from CCM and influence birth outcomes. Further clarification of theoretical linkage between CCM and reproductive outcomes will shed light on how the environment impacts health, fertility, and reproduction.