A prospective investigation of the relationships among sleep quality, physical symptoms, and depressive symptoms during pregnancy

Feasibility and Acceptability of Mindfulness-based Stress Reduction and Prenatal Sleep Classes for Poor Prenatal Sleep Quality: Pilot Randomized Controlled Trial

OBJECTIVES

The main objectives of the current paper were to examine the feasibility, acceptability, and adherence of a remotely delivered intervention consisting of mindfulness-based stress reduction plus prenatal sleep classes (MBSR+PS) compared with treatment as usual (TAU).

METHOD

In this pilot randomized controlled trial, 52 pregnant women with poor sleep quality were randomized to MBSR+PS or TAU. MBSR was delivered through eight weekly 2.5-hour sessions, and PS was delivered through eight weekly 30-minute sessions. PS content drew material from cognitive behavioral therapy for insomnia tailored for the perinatal period and from a mindfulness- and acceptance-based lens. Participants completed endpoint measures 10-12 weeks after randomization.

RESULTS

We surpassed all acceptability targets, including the percentage of eligible participants willing to be randomized (96%), percentage of participants who initiated treatment (88%), and satisfaction scores (Client Satisfaction Questionnaire-8 score M = 28.04, SD = 3.6). We surpassed all feasibility targets, including our enrollment target, retention rate (92%), and measure completion (96%). Finally, we surpassed adherence targets, including MBSR and PS session attendance (≥80%). Though sleep outcomes were exploratory, increases in sleep efficiency were greater in the MBSR+PS group relative to TAU (SMD=.68).

CONCLUSIONS

Patient-reported poor sleep quality during pregnancy has high public health significance because it is common, consequential, and under-treated. The current feasibility and acceptability data for using remotely delivered MBSR and PS to improve prenatal sleep quality are encouraging and warranting future research that is sufficiently powered and designed to provide efficacy data. In addition, exploratory sleep outcomes offer preliminary evidence that this sleep program may improve sleep efficiency during pregnancy.

Assessment of Mental Health Comorbidities and Relief Factors in Moroccan Women during the Third Trimester of Pregnancy: A Cross-Sectional Study

BACKGROUND

During pregnancy, women can experience mental alterations, particularly anxiety and depression, which mark an important transition period in their lives. Social support appears to be a crucial alleviating factor for these disorders. The aim of this study is to assess the extent of psychological disturbances and their relieving factors by investigating correlations between mental status and different sociodemographic and clinical characteristics during the third trimester of pregnancy.

METHODS

A cross-sectional study including 160 pregnant women in their last trimester was carried out in Morocco, notably at the Ibn Sina University Hospital and in two health centers. A pre-structured questionnaire, including sociodemographic and clinical variables and internationally recognized scales such as the Multidimensional Scale of Perceived Social Support (MSPSS), the Perceived Stress Scale (PSS), the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Bergen Insomnia Scale (BIS), and the Hospital Anxiety and Depression Scale (HADS), was mobilized.

RESULTS

The prevalence of depression and anxiety was 18.75% and 12.5%, respectively. A correlation between these two mental disorders and the level of education, pregnancy planning, monthly income, and provision of health coverage was found (p-value < 0.05). The main determinants of anxiety were stress (p-value = 0.047) and social support (p-value < 0.001), while depression was limited to social support (p-value < 0.001) and sleep quality (p-value = 0.015).

CONCLUSIONS

It is essential to take action against these disorders and their predictive factors by raising awareness and implementing a diagnosis and care protocol with healthcare professionals to guide and orient distressed women.

A Descriptive Comparative Pilot Study: Association Between Use of a Self-monitoring Device and Sleep and Stress Outcomes in Pregnancy

Pregnancy is a challenging time for maintaining quality sleep and managing stress. Digital self-monitoring technologies are popular because of assumed increased patient engagement leading to an impact on health outcomes. However, the actual association between wear time of such devices and improved sleep/stress outcomes remains untested. Here, a descriptive comparative pilot study of 20 pregnant women was conducted to examine associations between wear time (behavioral engagement) of self-monitoring devices and sleep/stress pregnancy outcomes. Women used a ring fitted to their finger to monitor sleep/stress data, with access to a self-monitoring program for an average of 9½ weeks. Based on wear time, participants were split into two engagement groups. Using a linear mixed-effects model, the high engagement group showed higher levels of stress and a negative trend in sleep duration and quality. The low engagement group showed positive changes in sleep duration, and quality and experienced below-normal sleep onset latency at the start of the pilot but trended toward normal levels. Engagement according to device wear time was not associated with improved outcomes. Further research should aim to understand how engagement with self-monitoring technologies impacts sleep/stress outcomes in pregnancy.

Prevalence of Antenatal Anxiety in European Women: A Literature Review

The presence of anxiety during pregnancy is associated with adverse consequences for both mothers and their babies. The aim of this study was to review the prevalence of anxiety in European pregnant women in order to find out which countries have published the most studies in respect to the presence of anxiety during pregnancy, which countries are the most and least prevalent in terms of anxiety within pregnant women, and which are the most common tools used to assess anxiety during this stage. As such, a literature review was conducted regarding the studies that were published in the last twenty years in the PsycInfo, Medline, and SCOPUS databases. Thirty-eight studies were selected for the purposes of this review. The prevalence of anxiety in pregnancy and generalized anxiety disorder (GAD) varies considerably between studies. The European countries that have carried out the most research on this issue are Spain, Italy, and the United Kingdom. The most widely used assessment instrument is the State Trait Anxiety Inventory (STAI). The lowest prevalence rate of anxiety, using the STAI-E, was found in Poland, 7.7%, and the highest was found in Italy, 36.5%. The prevalence of GAD ranges from 0.3% to 10.8%. This indicates that anxiety in pregnant women is a very relevant mental health problem. It is therefore important to detect and intervene early in order to promote the well-being of both mothers and children.

Maternal Sleep Problems in the Periconceptional Period and the Impact on Health of Mother and Offspring: A Systematic Review

Knowledge of the impact of sleep problems in the periconceptional period is scarce. Since this period is the most sensitive time window for embryonic and placental development, we aim to study the impact of maternal sleep problems in the periconceptional period on both mother and offspring. We systematically searched various databases up until September 2021 for studies reporting on maternal sleep in the periconceptional period and any outcome in mother and offspring. We included observational studies describing maternal sleep problems in the periconceptional period and associations with either maternal and/or offspring outcomes. The search produced 8596 articles, of which we selected 27 studies. Some associations were found between sleep problems and lower fertility, more hypertensive disorders, more mood disorders in mothers, higher risk of preterm birth and low birth weight, and more sleep and behavior problems in offspring, with associations with maternal mood disorders being most consistent. This systematic review shows that maternal sleep problems in the periconceptional period are associated with a higher risk of various adverse outcomes in both mother and offspring, although not consistently. It shows that good sleep during pregnancy is crucial, starting as early as before conception, especially for maternal mood. Therefore, it is important for clinicians to pay attention to sleep problems in the periconceptional period and provide adequate treatment for potential sleep problems, even before pregnancy.

Antepartum sleep quality, mental status, and postpartum depressive symptoms: a mediation analysis

BACKGROUND

Poor sleep quality and maternal mood disturbances are common during pregnancy and may play pivotal roles in the development of postpartum depression. We aim to examine the trajectories of sleep quality and mental health in women from early pregnancy to delivery and explore the mediating effects of sleep quality and mental status on the link between antepartum depressive symptoms and postpartum depressive symptoms.

METHODS

In an ongoing prospective birth cohort, 1301 women completed questionnaires in the first, second and third trimesters and at 6 weeks postpartum. In each trimester, sleep quality was measured utilizing the Pittsburgh Sleep Quality Index (PSQI), and mental health was assessed with the Center for Epidemiologic Studies Depression Scale (CES-D), the Self-Rating Anxiety Scale (SAS) and the Perceived Stress Scale (PSS). Postpartum depressive symptoms were evaluated by the Edinburgh Postnatal Depression Scale (EPDS). The bootstrap method was used to test the mediation effect.

RESULTS

The PSQI, CES-D, and SAS scores presented U-shaped curves across the antenatal period while the PSS score followed a descending trend. Antenatal sleep quality, depressive symptoms, anxiety symptoms and perceived stress all predicted depressive symptoms at 6 weeks postpartum. The influence of antepartum depressive symptoms on postpartum depressive symptoms was mediated by antepartum sleep quality and anxiety symptoms, which accounted for 32.14%, 39.25% and 31.25% in the first, second and third trimesters (P = 0.002, P = 0.001, P = 0.001, respectively).

CONCLUSIONS

Poor sleep quality and anxiety symptoms in pregnancy mediated the relationship between antepartum depressive symptoms and postpartum depressive symptoms. Interventions aimed at detecting and managing sleep quality and elevated anxiety among depressed women in pregnancy warrant further investigation as preventative strategies for postpartum depression.

Associations between childhood maltreatment, poor sleep, and prenatal distress in pregnant adolescents

Childhood maltreatment (CM) is a known risk factor for adolescent pregnancy. Sleep disturbances and psychological distress, both common negative sequelae of CM, often co-occur during pregnancy, although directionality remains unclear. Furthermore, little is known about how CM affects sleep-distress associations during pregnancy. In pregnant adolescents, we examined: (a) whether there are significant predictive associations from CM to sleep quality and distress and (b) bidirectional influences of distress and sleep quality. Healthy pregnant adolescents (n = 204) were recruited before or during the 2nd trimester. CM was assessed at enrollment; sleep quality and distress were assessed in the 2nd and 3rd trimesters. Hypotheses were tested using path analysis. Findings revealed that CM was associated with worse 2nd trimester sleep quality and distress (β = .19, p < .05 for sleep; β = .30, p < .001 for distress). Higher levels of 2nd trimester distress were associated with lower 3rd trimester sleep quality (β = .19, p < .05). Findings provide novel information about (a) associations from CM to prenatal mood and sleep in pregnant adolescents, and (b) sleep-distress directionality over the course of pregnancy. These results have implications for better understanding the ways in which CM potentially exerts influences later in life, and for targeting interventions to address physical and mental health during pregnancy.

Insomnia and sleep quality among women during the perinatal period

Background

Insomnia is the most common sleep disorder affecting sleep quality and quality of life among women during the perinatal period. The aim of the study is to study the frequency of insomnia and sleep quality among perinatal women and their effect on quality of life: 131 participants; 64 perinatal and 67 control groups from the outpatient clinics of Suez Canal University Hospital, Ismailia, Egypt. DSM-5 criteria were used to diagnose insomnia. Sleep quality was assessed using PSQI, and SF-36 questionnaire was used for assessment of health-related quality of life.

Results

Insomnia was statistically significant higher among the perinatal group than the control; 28.1% and 10.4%, respectively (P < 0.05). The perinatal women had poor sleep quality as compared with the control group with a higher mean global PSQI score; 8.02 ± 2.97 and 4.97 ± 2.45, respectively (P < 0.05). The quality of life in the perinatal group was lower than the control group with scores of 54.96 ± 14.63 versus 62.34 ± 14.63, respectively.

Conclusions

Insomnia and poor sleep quality are found in higher frequency in perinatal women than their counterpart control. The study also showed a significant impact of these changes on maternal HRQoL.

Effects of music on sleep quality and comfort levels of pregnant women

OBJECTIVES

This pilot randomized controlled experimental study was conducted to investigate effects of music on sleep quality and comfort levels of pregnant women.

METHODS

The sample of the study consisted of 70 pregnant women who met the inclusion criteria and agreed to participate in the study. The pregnant women were assigned to the music (n=35) and control groups (n=35). In the study, the musical pieces composed in Uşşak mode were played for the participants in the music group. The pregnant women in the music group were first asked to empty their bladder and then listen to music for 30 min in a semi-Fowler's position with their head and shoulders raised 30°, in a quiet and dim environment, every other day for two weeks before going to sleep. The Pregnant Information Form, Prenatal Comfort Scale (PCS) and Pittsburgh Sleep Quality Index - 1 week (PSQI-1 week) were used to collect the study data.

RESULTS

The analysis of the mean scores obtained from the overall PSQI-1 week by the pregnant women in the music and control groups by weeks demonstrated that there was a statistically significant difference between the music and control groups in the second week (p<0.05). There was no statistically significant difference between the two groups in terms of the mean scores they obtained from the overall PCS (p>0.05).

CONCLUSIONS

Music increased the sleep quality of the pregnant women in the music group, but had no effect on their comfort levels.

Evaluation of the Effect of Supervised Group Exercise on Self-Reported Sleep Quality in Pregnant Women with or at High Risk of Depression: A Secondary Analysis of a Randomized Controlled Trial

Poor sleep quality is common during pregnancy. Our objective was to evaluate the effect of supervised group physical exercise on self-reported sleep quality in pregnant women with or at high risk of depression, and secondly, to describe the association between sleep quality and psychological well-being during pregnancy and postpartum. This was a secondary analysis of a randomized controlled trial (n = 282) (NCT02833519) at Rigshospitalet, Denmark. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), psychological well-being by the five-item WHO Well-Being Index (WHO-5). The intention-to-treat analysis showed no difference in mean global PSQI score neither at 29−34 weeks, 6.56 (95% CI: 6.05−7.07) in the intervention group and 7.00 (95% CI: 6.47−7.53) in the control group, p = 0.2, nor at eight weeks postpartum. Women with WHO-5 ≤ 50 reported higher mean global PSQI scores at baseline, 7.82 (95% CI: 7.26−8.38), than women with WHO-5 score > 50, mean 5.42 (95% CI: 5.02−5.82), p < 0.0001. A significant difference was also present post-intervention and eight weeks postpartum. No significant effect of group exercise regarding self-reported sleep quality was seen at 29−34 weeks of gestation or postpartum. Low psychological well-being was associated with poor sleep quality during pregnancy and postpartum.

A Prospective Study of the Relationship Between Sleep Quality and Depression in Pregnancy

Objective

Poor sleep and depression are common problems during pregnancy, but there has been little investigation into the association between them. This prospective study aims to examine the relationship between sleep quality and depression during pregnancy.

Methods

Pregnant women under 14 weeks’ gestation attending routine outpatient antenatal care in Singapore’s largest maternity hospital were recruited between 2012 and 2014. Women with multiple pregnancies and deemed at high risk of miscarriage were excluded. Six hundred and forty participants completed the Pittsburgh Sleep Quality Index (PSQI) and Edinburgh Postnatal Depression Scale (EPDS) at the three trimesters during pregnancy.

Results

Mean PSQI score was highest in the third visit, suggesting poorer quality sleep in the late third trimester compared to other trimesters. 15.6% of participants at each time point fulfilled the criteria for antenatal depression according to the EPDS cut-off score > 14. PSQI scores were significantly correlated with EPDS scores, and also prospectively predicted EPDS scores in all three trimesters.

Conclusion

Sleep quality in Singaporean pregnant women was poorest in the third trimester, and was associated with the development of depressive symptoms. With more than 1 in 10 women having antenatal depression, interventions targeting sleep quality might be particularly beneficial.

The Relevance of Insomnia in the Diagnosis of Perinatal Depression: Validation of the Italian Version of the Insomnia Symptom Questionnaire

BACKGROUND

Sleep disorders are common in perinatal women and may underlie or trigger anxiety and depression. We aimed to translate and validate and evaluate the psychometric properties of the Italian version of the Insomnia Symptom Questionnaire (ISQ), in a sample of women during late pregnancy and 6-months postpartum according to the DSM-5 criteria.

METHODS

The ISQ was administered to 292 women prenatally along with other measures of sleep quality, depression, and anxiety, to examine its construct and convergent validity. Women were readministered the ISQ six months postdelivery to assess test-retest reliability. Women were divided into DSM-5 No-Insomnia (N = 253) and Insomnia (N = 39) groups.

RESULTS

The insomnia group had received more psychopharmacotherapy, had more psychiatric family history, increased rates of medically assisted reproduction, of past perinatal psychiatric disorders, and scored higher on almost all TEMPS-A dimensions, on the EPDS, HCL-32, PSQI, and on ISQ prenatally and postnatally. ISQ scores correlated with all scales, indicating adequate convergent and discriminant validity; furthermore, it showed antenatal-postnatal test-retest reliability, 97.5% diagnostic accuracy, 79.5% sensitivity, 94.9% specificity, 70.5% positive predictive power, and 92.8% negative predictive power.

CONCLUSIONS

The ISQ is useful, valid, and reliable for assessing perinatal insomnia in Italian women. The Italian version showed equivalent properties to the original version.

Sleep quality and associated factors among pregnant women attending antenatal care at Jimma Medical Center, Jimma, Southwest Ethiopia, 2020: cross-sectional study

BACKGROUND

Sleep is a natural physiological process vital for the physical and mental wellbeing of pregnant women and their fetuses. Even though poor sleep quality is a common problem among pregnant women, it is not studied in developing countries including Ethiopia. Therefore, this study was aimed to assess the poor sleep quality and associated factors among pregnant women attending antenatal care at Jimma medical center, Jimma, Southwest Ethiopia, 2020.

METHODS

A cross-sectional study design was conducted among 415 pregnant women at Jimma Medical Center (JMC). The study subjects were selected using a systematic random sampling technique. Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality using face-to-face interviews. SPSS version 25 was used to analyze data. Bivariate and multivariable logistic regressions were done to identify factors related to sleep quality. In multivariable logistic regression variables with a p-value less than 0.05 was considered significant and, adjusted OR (AOR) with 95% CI was used to present the strength of the association.

RESULTS

The prevalence of poor sleep quality among pregnant women was found to be 30.8% (95% CI (26.5, 35.2). In multivariable analysis, age ≥ 30 years old (AOR = 1.94;95%CI:1.03,3.66), Multigravida (AOR = 1.90;95%CI:1.90,3.32),depression (AOR = 4.26;95%CI:2.54,7.14),stress (AOR = 1.85;95%CI:1.20,3.02) were variables significantly associated with poor sleep quality.

CONCLUSION

This study found a high prevalence of poor sleep quality among pregnant women. Older age, gravidity, depression, and stress were associated with poor sleep quality. It is better to have routine sleep pattern screening and teach sleep hygiene practice for pregnant women.

Prevalence of Depression during Pregnancy in Spanish Women: Trajectory and Risk Factors in Each Trimester

The aims of this research were to determine the trajectories of probable depression and major depression during pregnancy and to identify the associated and predictor variables (sociodemographic, pregnancy-related, and psychological) for both conditions in each trimester of pregnancy. A longitudinal study was carried out with 569 pregnant Spanish women who were assessed in the first, second, and third trimesters of pregnancy. Depression was assessed using the Edinburgh Postnatal Depression Scale and a clinical interview. Measures of anxiety and stress were also included. The prevalence of probable depression in the first, second, and third trimesters was 23.4%, 17.0%, and 21.4%, respectively, and that of major depression was 5.1%, 4.0%, and 4.7%. Thus, the prevalence of both conditions was the highest in the first and third trimesters. The trajectories of probable depression and major depression followed the same pattern throughout pregnancy. All of the psychological variables studied were associated with both conditions in all three trimesters, with perceived stress being a predictor at all times. The association between the other variables and both conditions of depression was similar. Two exceptions stand out: having had previous miscarriages, which was only associated with probable depression and was also a predictor, in the first trimester; and complications during pregnancy, which was only associated with probable and major depression in the third trimester. These findings should be taken into account in routine pregnancy follow-ups, and necessary interventions should be started in the first trimester.

Trajectories of Insomnia Symptoms and Associations with Mood and Anxiety from Early Pregnancy to the Postpartum

Objective/Background: The current study identified heterogeneous trajectories of insomnia symptoms from early pregnancy to early postpartum. The relationship between demographic and psychological predictors of trajectories and associations between trajectory group membership and symptoms of postpartum depression and anxiety were also explored.Participants: 142 pregnant women were enrolled in a prospective online survey.Method: Women were recruited from a maternity clinic in Calgary, AB and completed measures of insomnia symptoms, depression, generalized anxiety, and interpersonal support at four time-points. Women were recruited and completed the first survey before 20 weeks gestation and were reassessed every 10 weeks. Women were on average 15 weeks gestation, 25 weeks gestation, 35 weeks gestation, and 6 weeks postpartum at the respective time-points. Group-based trajectory analysis was used to determine trajectories of pregnancy insomnia symptoms.Results: Three trajectory groups were identified. A no insomnia group (42.3%) in which women reported consistently low insomnia symptoms. A subclinical insomnia group (44.3%) in which women reported subclinical symptoms which briefly elevated to clinical levels in late-pregnancy, and a clinical insomnia group (13.4%) in which women reported consistently elevated insomnia symptoms. Baseline predictors of membership group included anxiety, depression, and ethnicity such that members of the clinical insomnia group were more likely to also endorse anxiety and depression. Membership in the clinical insomnia group was associated with higher postpartum generalized anxiety and depressive symptoms. Additionally, the clinical insomnia group were more likely to experience symptoms indicative of clinically significant depression.Conclusions: A small group of pregnant women experienced consistently high and elevated insomnia symptoms throughout pregnancy and another larger group endorsed consistently elevated but subthreshold symptoms. Future studies should explore long-term consequences of experiencing high insomnia symptomatology during pregnancy and early postpartum, as well as safe and efficacious interventions.

Mid-Pregnancy Insomnia and its Association with Perinatal Depressive Symptoms: A Prospective Cohort Study

Objective/Background: Insomnia and depression are disorders that affect many perinatal women and that often are interrelated. The present study aimed to examine concurrent and prospective associations between mid-pregnancy insomnia and depression during mid-pregnancy and 8 weeks postpartum. Furthermore, differences in depression and in the sleep-related characteristics insomnia, chronotype, and sleep efficiency were explored between the two time points (mid-pregnancy versus 8 weeks postpartum), and between primiparous and multiparous participants.Participants/Methods: The study was part of the Norwegian population-based Depression and Anxiety in the Perinatal Period (DAPP) prospective cohort study. Among 539 women that were recruited for participation when receiving a routine ultrasound examination, we analyzed data from hospital birth records and questionnaire responses from pregnancy week 17 and postpartum week 8. We used the Edinburgh Postnatal Depression Scale to measure depression. The Bergen Insomnia Scale, the reduced Horne-Östberg Morningness-Eveningness Questionnaire, and three questions from the Pittsburgh Sleep Quality Index were used to measure the sleep-related characteristics.Results: Mid-pregnancy insomnia was significantly associated with concurrent depression (p < .001), but not with postpartum depression (p = .288), in a linear mixed model with adjustment for several reproductive and psychosocial variables. Sleep efficiency was reduced from mid-pregnancy to postpartum (from 88% to 77%), and primiparous women reported less efficient sleep than multiparous women after childbirth.Conclusions: The results indicate that mid-pregnancy insomnia may be a marker for concurrent depression but not a predictor of postpartum depression. Future research should examine the extent to which treatment of insomnia from mid-pregnancy on reduces both perinatal insomnia and depression.

Snoring and depression symptoms in pregnant women

OBJECTIVE

Pregnant patients are vulnerable to both depression and sleep-disordered breathing, and both convey risks for maternal and fetal outcomes. Previous research has indicated that sleep-disordered breathing is associated with depression, but further information related to the risk of depression based on timing of onset of snoring is needed.

DESIGN

When presenting to clinic for their initial prenatal visit, pregnant patients completed a packet of questionnaires, which included measures related to depression (Edinburgh Postnatal Depression Scale) and snoring. Habitual snoring was defined as snoring 3 or more nights per week.

RESULTS

In total, 1367 women were included and 34.1% reported habitual snoring, either chronic (24.4%) or pregnancy-onset (9.8%), with increased frequency of pregnancy-onset habitual snoring in later stages of pregnancy. Unadjusted analyses suggested increased odds of depressive symptoms in chronic and pregnancy-onset habitual snoring groups relative to nonsnorers (odds ratio [OR]: 2.01, 95% confidence interval [CI]: 1.39, 2.92, P < .01; OR: 2.50, 95% CI: 1.54, 4.07, P < .01, respectively). These findings were maintained after adjusting for maternal age, marital status, gestational age, and parity (chronic habitual snoring OR: 1.69, 95% CI: 1.14, 2.53, P < .01; pregnancy-onset habitual snoring OR: 2.79, 95% CI: 1.35, 5.78, P < .01).

CONCLUSIONS

Maternal snoring may be a risk factor for prenatal depressive symptoms. Pregnancy-onset habitual snoring confers additional risk for depression compared to not snoring during pregnancy.

A prospective study on the course of sleep disturbances in first-time fathers during the transition to parenthood

INTRODUCTION

This study examined sleep disturbances in first-time fathers from the third trimester of their partner's pregnancy to 2 months postpartum to determine prevalence, incidence, and persistence of sleep disturbances and identify associated determinants.

METHODS

Men expecting their first child were recruited from local prenatal classes and university-affiliated obstetric clinics. During their partner's third trimester of pregnancy and 2 months postpartum, 459 men completed standardized online self-report questionnaires measuring sociodemographics, lifestyle, and psychosocial variables and sleep quality.

RESULTS

Disturbed sleep (Pittsburgh Sleep Quality Index [PSQI] global score >5) increased from 29.6% during the third trimester to 44.7% at 2 months postpartum. The incidence of poor sleep at 2 months postpartum was 33.7%. Among men with disturbed sleep at the antenatal assessment, 70.6% continued to have sleep disturbances at 2 months postpartum. An increase in depressive symptoms and higher parenting stress was independently associated with onset and persistence of disturbed sleep at 2 months postpartum.

CONCLUSIONS

Sleep is compromised in expectant and new fathers. Strategies aimed at improving sleep, depressed mood, and managing the challenges of parenting may be important components to include in prenatal interventions aimed at enhancing the transition to parenthood and infant development.

Poor Sleep and Decision-Making Disturbance Are Associated With Suicidal Ideation in Pre-natal Depression

Although many risk factors for suicidal ideation have been identified, few studies have focused on suicidal ideation and pre-natal depression. The purpose was to investigate the relationship between decision-making (DM) dysfunction and sleep disturbance on suicidal ideation in pre-natal depression. Participants included 100 women in the third trimester of pregnancy, including pregnant women with pre-natal depression who had recent suicidal ideation (n = 30), pre-natal depression without SI (n = 35) and healthy controls (n = 35). The Iowa Gambling Task (IGT) was used to evaluate the DM function and the Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep index. The Edinburgh Post-natal Depression Scale (EPDS) was used to assess suicidal ideation and the seriousness of depression. Overall, the two groups with pre-natal depression showed worse sleep quality and decreased DM function compared with healthy controls. The pre-natal depression with suicidal ideation group showed a significantly higher score in subjective sleep quality and a lower score in block 5 of IGT than the pre-natal depression without suicidal ideation group. Further correlation analysis showed that suicidal ideation positively correlated with subjective sleep quality, sleep duration, and daytime function, and negatively correlated with IGT scores. Sleep disturbance and impaired DM function may be risk factors for suicidal ideation in pre-natal depression.

Maternal insomnia during the COVID-19 pandemic: associations with depression and anxiety

BACKGROUND

The COVID-19 outbreak has made people more prone to depression, anxiety and insomnia, and females are at a high risk of developing these conditions. As a special group, pregnant and lying-in women must pay close attention to their physical and mental health, as both have consequences for the mother and the fetus. However, knowledge regarding the status of depression, anxiety and insomnia among these women is limited.

AIM

This study aimed to examine insomnia and psychological factors among pregnant and lying-in women during the COVID-19 pandemic and provide theoretical support for intervention research.

METHODS

In total, 2235 pregnant and lying-in women from 12 provinces in China were surveyed; their average age was 30.25 years (SD = 3.99, range = 19-47 years).

PARTICIPANTS AND SETTING

The participants completed electronic questionnaires designed to collect demographic information and assess levels of depression, anxiety and insomnia.

RESULTS

The prevalence of insomnia in the sample was 18.9%. Depression and anxiety were significant predictors of insomnia. Participants in high-risk areas, those with a disease history, those with economic losses due to the outbreak, and those in the postpartum period had significantly higher insomnia scores.

DISCUSSION

The incidence of insomnia among pregnant and lying-in women is not serious in the context of the epidemic, which may be related to the sociocultural background and current epidemic situation in China.

CONCLUSION

Depression and anxiety are more indicative of insomnia than demographic variables.

Effects of Acupressure and Acupuncture-Like Transcutaneous Electrical Nerve Stimulation on Sleep Quality Among Pregnant Women

BACKGROUND

Despite the adverse consequences of poor sleep during pregnancy, relatively few safe interventions exist for improving sleep among pregnant women. Nonpharmacological interventions are increasingly gaining acceptance. However, the effects of acupressure and acupuncture-like transcutaneous electrical nerve stimulation (ACUTENS) have not been widely reported.

OBJECTIVES

The purpose of this study is to investigate the effects of low-frequency transcutaneous electrical nerve stimulation, otherwise known as ACUTENS, and acupressure on sleep quality among pregnant women.

METHODS

Purposive sampling of 42 pregnant women with sleep disorders was conducted, and the participants were randomized into 3 groups, i.e., acupressure, ACUTENS, and usual care. interventions, which were carried out twice weekly for six weeks. The Pittsburgh Sleep Quality index was used to determine the overall sleep quality.

RESULTS

The preintervention scores of sleep quality were 12.5 (3.75), 12.5 (4.0), and 13.0 (3.5) in the ACUTENS, acupressure, and usual care groups, respectively. The Kruskal-Wallis test did not show any significant difference in the preintervention sleep quality scores (H = 0.379, p = 0.827). Participants in the usual care group recorded the least improvement, with a score of 5.0 (2.25), the ACUTENS group recorded a score of 4.5 (3.0), and the greatest improvement was recorded in the acupressure group, with a score of 4.0 (2.2) after 6 weeks of intervention. The Kruskal-Wallis test did not show any significant difference in the postintervention sleep quality scores among the 3 groups (H = 0.666, p = 0.717).

CONCLUSION

This study showed that ACUTENS and acupressure as an adjunct to usual care are not more effective than usual care alone in improving sleep quality among pregnant women.

Sleep complaints in early pregnancy. A cross-sectional study among women attending prenatal care in general practice

BACKGROUND

Sleep problems in late pregnancy are common, but sleep in early pregnancy is less well described. The aim of this study was to describe the occurrence and severity of sleep complaints in early pregnancy. We asked the women about worries due to sleep problems. Furthermore, we investigated the associations between sleep complaints and pregnancy-related symptoms. This association was studied taking into account physical and mental health, sociodemographic characteristics, and reproductive history of the women.

METHODS

Cross-sectional study in Danish general practice based on an electronic questionnaire completed by pregnant women and a Pregnancy Health Record filled in by the general practitioner (GP). The questionnaire measured three sleep complaints and 11 common physical pregnancy-related symptoms. The sleep complaints were measured as mild, moderate or severe, and it was recorded how much they worried the women. The associations between the physical pregnancy-related symptoms and sleep complaints were assessed by odds ratios from multivariable logistic regression models.

RESULTS

The questionnaire was completed by 1338 out of 1508 eligible women before the end of gestation week 16. The gestational age ranged from 5 to 16 weeks (median 11 weeks) among the included women. On average, more than one third of the women reported to have at least one of the three sleep complaints in the questionnaire. Problems "taking a long time to fall asleep" was reported by 312 women (23%), "waking up too early" was reported by 629 (47%), and 183 (14%) had been "lying awake most of the night". One sleep complaint was reported by 38%, two by 16, and 4% had all three symptoms. The majority were not at all or only mildly worried because of their sleep disturbances, but moderate or severe worries were found among 46% of those" taking a long time to fall asleep" and among 40% of those "lying awake most of the night". "Moderate or severe complaints" were reported by 277 (21%) women "Moderate or severe complaints" were associated with pregnancy-related physical symptoms, such as back pain, pelvic girdle pain and pelvic cavity pain, but only the association with pelvic cavity pain stayed significant after adjustment for depression.

CONCLUSION

This study showed that sleep complaints in early pregnancy are common, and sleep complaints showed association with physical as well as mental symptoms. It may be important for pregnant patients that clinicians address depression, and mood in relation to sleep problems during pregnancy.

Changes in quality of life and sleep across the perinatal period in women with mood disorders

INTRODUCTION

The perinatal period represents a time of significant life changes associated with increases in sleep difficulties, depression, and potentially impaired quality of life (QoL). Associations between QoL and sleep among women with perinatal depression are poorly understood, and changes in QoL across the perinatal period have received little attention.

METHODS

Participants were the treatment-as-usual group (n = 23) from a clinical trial testing an intervention for perinatal mood disorders. They completed the WHOQOL-Bref, had depression assessed with the HAM-D-17, and wore wrist actigraphs to estimate sleep for 1 week during third trimester and at 6 weeks postpartum.

RESULTS

Higher education level was associated with better environmental QoL during pregnancy (p = .044) and presence of older children was associated with worse social QoL postpartum (p = .045). Psychological health QoL worsened (p = .014) across the perinatal period. Total sleep time (p = .001) and sleep efficiency (p = .008) decreased from third trimester to postpartum week 6, but sleep measures were not associated with QoL at either time point. Depressive symptoms decreased from pregnancy to postpartum week 6 and were inversely associated with postpartum physical and social QoL (p = .031 and .048).

DISCUSSION

Factors contributing to self-rated QoL are variable across multiple domains during the perinatal period. QoL among our participants was lower than population norms. In our sample of women with depression and/or anxiety, QoL was related to postpartum depressive symptoms, but not to objectively measured sleep quality, quantity, or timing. Links between QoL and sleep may be inherently complex in perinatal women.

Prevalence of Poor Sleep Quality in Perinatal and Postnatal Women: A Comprehensive Meta-Analysis of Observational Studies

BACKGROUND

Sleep disturbance is common in perinatal and postnatal women, but the epidemiology of sleep problems is highly variable in these populations. This was a meta-analysis that examined the prevalence of poor sleep quality and its correlates among perinatal and postnatal women.

METHODS

A systematic search of both international and Chinese databases (PubMed, EMBASE, PsycINFO, Web of Science, CNKI, and Wangfang) was performed. Studies with data on sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI) were included.

RESULTS

Forty-two studies were included for analyses. The prevalence of poor sleep quality was 54.2% (95% CI: 47.9-60.5%) in perinatal and postnatal women, with 44.5% (95% CI: 37.6-51.6%) in perinatal women and 67.2% (95% CI: 57.6-75.5%) in postnatal women. The pooled total PSQI score was 7.54 ± 0.40 (95% CI: 6.75-8.33), while the average PSQI component scores varied from 0.13 ± 0.04 for use of sleeping medication to 1.51 ± 0.17 for habitual sleep efficiency. Maternal age, study site, survey year, comorbidity, PSQI cut-off value, and quality assessment score had significant moderating effects on the prevalence of poor sleep quality.

CONCLUSION

Given the negative impact of poor sleep quality on health outcomes and well-being, regular screening for poor sleep quality and effective interventions should be conducted for this population.

Poor sleep quality is associated with perinatal depression. A systematic review of last decade scientific literature and meta-analysis

Background Although pregnancy is frequently associated with mental states of happiness, hope and well-being, some physical and psychological changes can contribute to increased sleep disturbances and worsened sleep quality. Sleep quality has been linked to negative emotions, anxiety and depression. The main objective of this paper was to systematically review the impact of sleep during pregnancy on maternal mood, studying the association between objective and subjective measures of sleep quality and perinatal depression. Methods We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, which included studies published between January 2008 and April 2019, and met the following criteria: (i) studies on pregnant women assessing the effects of sleep quality variables on perinatal mood disorders, (ii) studies published in English and (iii) full paper published in a peer-reviewed scientific journal with full-text format available. Results A total of 36 studies published in the last decade met the inclusion criteria for qualitative review and eight of them were suitable for meta-analysis. Both confirmed the negative effects of poor sleep on perinatal mood. However, qualitative analysis showed that unrepresentative samples and low participation rates falling below 80% biased some of the studies. The standard random-effects meta-analysis showed a pooled size effect [ln odds ratio (OR) 1.49 (95% confidence interval [CI] 1.19, 1.79)] for perinatal depression in cases of poor prenatal sleep quality, although heterogeneity was moderate to high [Q 16.05, P ≤ 0.025, H2 2.45 (95% CI 1.01, 13.70)]. Conclusion Poor sleep quality was associated with perinatal mood disturbances. The assessment of sleep quality along the pregnancy could be advisable with a view to offering preventative or therapeutic interventions when necessary.

Sleep quality across pregnancy and postpartum: effects of parity and race

BACKGROUND

Despite high prevalence and clinical implications of disturbed sleep during pregnancy, information on changes in sleep across pregnancy and postpartum is incomplete. Moreover, predictors of differential patterns of sleep quality across the perinatal period are poorly defined.

METHODS

This study examined subjective sleep quality using the Pittsburgh Sleep Quality Index during each trimester of pregnancy and at 4-11 weeks postpartum among 133 women inclusive of nulliparous and multiparous African Americans and Whites.

RESULTS

At any given assessment, 53%-71% of women reported poor overall sleep quality (Pittsburgh Sleep Quality Index total score > 5). Moreover, 92% reported poor overall sleep quality during at least 1 assessment, including 88% at some time during gestation. Compared to nulliparous women, multiparous women reported poorer overall sleep quality, shorter sleep duration, and poorer sleep efficiency during the first trimester; poorer overall sleep quality and longer sleep latency in the second trimester; and more frequent sleep disturbances (eg, night time and early morning awakenings) during the third trimester. Among nulliparous as well as multiparous women, specific aspects of sleep (eg, subjective sleep quality, sleep disturbances, sleep efficiency) were poorer in African American compared to White women at different time points during pregnancy. No effects of race or parity were observed on sleep parameters at postpartum.

CONCLUSIONS

Poor sleep quality during pregnancy as well as early postpartum is highly prevalent among both African American and White women. Both multiparous status and African American race are associated with more disturbed sleep at some time points during pregnancy. These individual differences should be considered in future research and clinical efforts to promote perinatal sleep health.

The Impact of Objective and Subjective Sleep Parameters on Depressive Symptoms during Pregnancy in Women with a Mental Disorder: An Explorative Study

Poor sleep quality during pregnancy is associated with both antepartum and postpartum depression and adverse birth outcomes. This study evaluated both objective and subjective sleep quality and the effects on the subsequent course of antepartum depressive symptoms in psychiatric patients. This observational explorative study was embedded in an ongoing study focusing on pregnant women with a mental disorder and was performed in 18 patients (24–29 weeks pregnant). Depressive symptoms were assessed throughout pregnancy using the Edinburgh Postnatal Depression Scale (EPDS) with 5-week intervals. Sleep was assessed with actigraphy, the Pittsburgh Sleep Quality Index (PSQI) and sleep diaries at the start of the study. We studied correlations between sleep parameters and EPDS scores cross-sectionally using Spearman correlation. Next, we studied the course of antepartum EPDS scores over time per sleep parameter using generalized linear mixed modelling analysis. Objectively measured fragmentation index, total PSQI score and 4 PSQI subscales (sleep quality, sleep duration, sleep disturbances and daytime dysfunctions) were significantly correlated with EPDS scores when measured cross-sectionally at the start. Six objectively and subjectively measured sleep parameters had moderate to large effects on the course of depressive symptoms through the third trimester, but these effects were not statistically significant. More research is necessary to explore the causality of the direction between sleep problems and antepartum depressive symptoms we found in psychiatric patients.

Sleep Disturbances and Modulations in Inflammation: Implications for Pregnancy Health

When a woman becomes pregnant, there is a vast series of physiological, vascular, and psychological changes. Among the most commonly reported changes are those involving sleep. Pregnant women report that their ability to maintain sleep and acquire continuous refreshing sleep is impaired during the perinatal period as compared to the non-pregnant period. A growing literature supports the hypothesis that disturbed sleep (which comes in many forms) during the perinatal period is associated with an increased risk of adverse maternal, delivery, and infant outcomes. Among the suggested biological pathways linking sleep and adverse outcomes are disturbances in the immune and hormonal systems. The following paper will discuss (1) the various sleep processes that are commonly disturbed during the perinatal period and the methods used to collect sleep data; (2) the evidence linking sleep to adverse outcomes; and (3) how one specific biological pathway, the immune system, likely mediates these associations. The goal of this paper is to clarify the role that sleep disturbance has during pregnancy.

Link between insomnia and perinatal depressive symptoms: A meta-analysis

Evidence shows the possible link between insomnia and perinatal depressive symptoms. In order to find a convergent quantitative answer, we collected data via the search of Medline, EMBASE and reference tracking, which included nine studies (a total sample of 1,922 women). An aggregate effect size estimate (correlation coefficient) was generated using the comprehensive meta-analysis software. For the meta-analytic procedure, a random effects model was set a priori. Moderating factors, including study design, method of assessment of depression, geographical origin of data, publication year, mean age, % married, breastfeeding rate, quality and type of data, % primiparous and history of depression, were examined via categorical or univariate mixed-effects (method of moments) meta-regression methods. Heterogeneity and publication bias were examined using standard meta-analytic approaches. We found a significant, medium-size relationship between insomnia and perinatal depressive symptoms (point estimate, 0.366; 95% confidence interval [CI], 0.205-0.508; p < 0.001; n = 9) and this was significantly heterogeneous (Q, 118.77; df, 8; p < 0.001; I² , 93.26%). The effect size estimate was significant for studies reporting no history of depression (point estimate, 0.364; 95% CI, 0.035-0.622; p < 0.05; n = 5) and for study design. With meta-regression, no moderating factor (age, marriage rate, breastfeeding rate, pregnancy history or publication year) significantly mediated the effect size estimate. The depression assessment scale used, but not other categorical variables, explained the magnitude of heterogeneity. We found that insomnia during the perinatal period is associated with depressive symptoms, which warrants screening pregnant mothers for insomnia and depression.

Cognitive Behavioral Therapy for Insomnia and Women's Health: Sex as a Biological Variable

Differences in sleep for men and women begin at a very early age, with women reporting poorer sleep and having a higher risk for insomnia compared with men. Women are particularly vulnerable to developing insomnia during times of reproductive hormonal change. Sleep across the woman's lifespan and special treatment considerations for using cognitive behavioral therapy for insomnia (CBT-I) in women will be addressed in this review.

Maternal Sleep in Pregnancy and Postpartum Part I: Mental, Physical, and Interpersonal Consequences

PURPOSE OF REVIEW

Sleep is a critical restorative behavior which occupies approximately one third of people's lives. Extensive data link sleep health with disease and mortality risk in the general population. During pregnancy and following childbirth, unique factors contribute to overall sleep health. In addition, there are unique implications of poor sleep during these time periods.

RECENT FINDINGS

Poor maternal sleep may contribute to risk for adverse birth outcomes as well as poor maternal physical and mental health in pregnancy, postpartum, and longer term during childrearing. Moreover, the extent to which notable racial disparities in sleep contribute to disparities in adverse perinatal health outcomes remains to be fully explicated. Part I of this two-part review details these implications of poor sleep for mental health, physical health outcomes, and relationship functioning, while Part II delves into biological mechanisms as well as treatment approaches.

Validation of the Edinburgh postnatal depression scale as a screening tool for depression in Spanish pregnant women

BACKGROUND

The Edinburgh Postnatal Depression Scale (EPDS) is a self-reported scale designed to detect postnatal depression, and also has been validated in multiple countries for its use during pregnancy, but not in Spain. The objective of this study was to validate the EPDS as a screening instrument to detect depression during different trimesters of pregnancy in Spanish women.

METHODS

Longitudinal study of a large, unselected sample of 569 pregnant women who were assessed in the first, second and third trimesters of pregnancy by using the EPDS and the Structured Clinical Interview for DSM-IV (SCID). We evaluated the area under the ROC curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy (OA).

RESULTS

The optimal cut-off point score of the EPDS for screening current SCID diagnosis of combined depression was 9 or more in the first trimester of pregnancy (AUC of 0.76, sensitivity of 67.5%, specificity of 70.9%, PPV of 14.9%, NPV of 96.7%; and OA of 70.7%) and 10 or more in the second and third trimesters of pregnancy (AUC of 0.89 and 0.89, respectively; sensitivity of 81.5% and 78.1%, respectively; specificity of 86.0% and 81.9, respectively; PPV of 23.4% and 21.6%, respectively; NPV of 98.9% and 98.3, respectively; and OA 85.8% and 81.7%, respectively). Likewise, the optimal cut-off point score during pregnancy was 10 or more (AUC of 0.76, sensitivity of 72.4%, specificity of 79.3%, PPV of 18.2%, NPV of 97.8%, and OA of 78.9%).

LIMITATIONS

This study is limited due to the low rate of depression cases.

CONCLUSIONS

EPDS is an adequate instrument for screening depression in Spanish pregnant women.

Perinatal Sleep Problems: Causes, Complications, and Management

Changes in sleep are ubiquitous in the perinatal period and it is important to be able to determine when these changes are significant enough to indicate sleep deficiency associated with increased risk for poor maternal and infant outcomes. Guidelines for identifying sleep deficiency include insomnia symptoms, excessively shortened sleep duration, and perception of insufficient or nonrestful sleep. Causes and complicating factors related to such sleep problems have been well-documented and are used to tailor behavioral and pharmacologic treatments for women who are pregnant or in the early postpartum period.

Prenatal sleep quality and mental health symptoms across the perinatal period: A longitudinal study of high-risk women

BACKGROUND

Trauma-exposed women may be at magnified risk for posttraumatic stress (PTSS) and depression symptoms in the perinatal period, but few studies have examined symptomatology across the perinatal period in high-risk samples. Further, the role of sleep in perinatal symptomatology has been largely neglected in the violence literature, despite its well-established associations to mental health in other samples. This study aimed to examine the trajectory of PTSS and depression symptoms across the perinatal period and the effects of childhood adversity, intimate partner violence and prenatal sleep impairment on PTSS and depression symptoms across the perinatal period.

METHOD

In a longitudinal, prospective study, 101 low-income pregnant women were interviewed during pregnancy, at 6-weeks postpartum, and 4 months postpartum. N = 83 women completed at least 2 interviews and were included in the analyses. Prenatal sleep, childhood adversity, and IPV exposure were assessed at the prenatal interview; PTSS and depression were assessed at all interviews.

RESULTS

Past year IPV was associated with elevated prenatal mental health symptoms and prenatal sleep difficulties were associated with a worsening trajectory in perinatal PTSS.

CONCLUSIONS

Screening for IPV and prenatal sleep difficulties may be paramount in identifying those at risk for the development or exacerbation of mental health symptoms in the perinatal period.

Assessing physical symptoms during the postpartum period: reliability and validity of the primary health questionnaire somatic symptom subscale (PHQ-15)

INTRODUCTION

This study aimed at establishing the reliability and validity of the primary health questionnaire (PHQ-15) somatic symptom severity subscale for postpartum women.

METHODS

Women (N = 495) completed the PHQ-15 approximately 6 weeks postpartum during the baseline phase of a randomized controlled trial evaluating a writing intervention for postnatal health in England. Reliability was assessed using internal consistency statistics and convergent validity by comparing differences in self-reported physical health, health-related quality of life (QoL) and primary care usage by PHQ-15 symptom severity category.

RESULTS

Cronbach's α for the PHQ-15 was 0.73 and item-total statistics met recommended guidelines. Validity analyzes showed 6% of women reported severe symptoms, 17% medium, 50% low and 27% minimal symptoms. Women with severe symptoms reported poorer overall physical health, poorer physical health-related QoL and greater use of primary care. Women with severe symptoms also rated their baby's health as worse and used primary care more for their baby.

DISCUSSION

This study suggests the PHQ-15 has the potential to be a useful and valid measure of physical symptoms in postpartum women in high-income countries.

Maternal Sleep Quality and Diurnal Cortisol Regulation Over Pregnancy

Poor sleep in pregnancy is related to adverse neonatal health. Elevated maternal cortisol has been proposed as a pathway, yet the association in pregnancy is not well understood. The goals of the current study were to examine associations between (a) sleep and cortisol, (b) sleep, cortisol, and neonatal outcomes, and (c) variables that could explain these associations. Two hundred pregnant women completed the Pittsburgh Sleep Quality Index (PSQI; Buysse, Reynolds, Monk, Berman, & Kupfer, 1989) and provided diurnal salivary cortisol samples at two times over pregnancy. Poor sleep quality was associated with greater evening cortisol concentrations at 36 weeks' gestation. This association was mediated by anxiety symptoms. Higher evening cortisol at 36 weeks' gestation was associated with shorter gestation.

Pregnancy and postpartum antidepressant use moderates the effects of sleep on depression

This study examined the course of antidepressant use, sleep quality, and depression severity from pregnancy through 6-month postpartum in women with and without a depressive disorder during pregnancy. Women (N = 215) were interviewed during pregnancy, 1- and 6-month postpartum. Mixed linear models were used to examine the longitudinal course and inter-relationships for the time-varying variables of antidepressant use, subjective sleep quality, and depression severity. Pregnant women with a depressive disorder who did not use antidepressants had more variable depression severity over time with improvements in depression severity by 6-month postpartum. In contrast, the depression severity of their medicated counterparts remained stable and high throughout. Pregnant women without a depressive disorder had worse sleep quality when using antidepressants compared with when they were not. Antidepressant use significantly strengthened the magnitude of the effect of sleep quality on depression severity in women with a depressive disorder during pregnancy. When prenatally depressed women use antidepressants, their sleep disturbance is more highly linked to depression severity than when they do not. Furthermore, antidepressants are not adequately treating the sleep disturbance of these women or their remitted counterparts, leaving both groups vulnerable to significant negative mental and physical health outcomes.

Postpartum depressive symptoms and its association to daytime sleepiness and restless legs during pregnancy

Background

Postpartum depression is a common condition, which consequences might be harmful for both mother and child. Since sleep and depression are closely related it is possible that women who suffer from sleep related problems during pregnancy are more likely to develop depression in the postpartum period. This study aims to investigate the possible association between depressive symptoms in the postpartum period and sleep related problems during pregnancy.

Methods

In this study 293 women in the last trimester of pregnancy answered a questionnaire about symptoms of restless legs, snoring and daytime sleepiness. They also completed the Epworth Sleepiness Scale (ESS). The same women were screened for depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) four to ten weeks after giving birth. Additional information about social data, pregnancy and delivery was received from the medical charts.

Results

Women with postpartum depressive symptoms had higher prevalence of excessive daytime sleepiness defined as ESS score ≥10 (OR 3.84, CI 1.57–9.39), and restless legs syndrome (OR 2.837 CI 1.18–6.84) in last trimester of pregnancy, when adjusted for socio-demographic factors and obstetric risk factors. No association was found between postpartum depressive symptoms and snoring.

Conclusions

Depressive symptoms after childbirth are preceded by sleep related problems such as daytime sleepiness and restless legs, already during pregnancy. The results from Epworth Sleepiness Scale and a questionnaire concerning Restless Legs Syndrome completed during pregnancy might be a valuable contribution for detecting women at risk for postpartum depression, enabling preventive interventions.

Stress, sleep, depression and dietary intakes among low-income overweight and obese pregnant women

This study investigated the mediating roles of sleep and depression on the relationships between stress, fat intake, and fruit and vegetable intake among low-income overweight and obese pregnant women by trimesters. Participants (N = 213) completed a self-administered survey including stress (exogenous variable), depression, sleep (mediators), fat intake, and fruit and vegetable intake (endogenous variables). Path analysis was performed to compare mediation effects among pregnant women in each trimester. Consistently across three trimesters, stress was related to depression but not sleep duration, night time sleep disturbance, sleep quality, sleep latency or fat intake. Sleep duration was not associated with depression. Depending on trimester, night time sleep disturbance, sleep quality, and sleep latency were related to depression; night time sleep disturbance and depression affected fat intake; stress influenced fruit and vegetable intake. Sleep duration, sleep disturbance, sleep quality, sleep latency and depression did not mediate the relationships between stress, fat intake, and fruit and vegetable intake in the second and third trimesters. However, depression mediated the relationship between stress and fat intake in the first trimester. Stress management interventions may help low-income overweight and obese pregnant women decrease depressive symptoms and therefore contribute to overall nutritional health.

Polyunsaturated Fatty Acid (PUFA) Status in Pregnant Women: Associations with Sleep Quality, Inflammation, and Length of Gestation

Mechanistic pathways linking maternal polyunsaturated fatty acid (PUFA) status with gestational length are poorly delineated. This study examined whether inflammation and sleep quality serve as mediators, focusing on the antiinflammatory ω-3 docosahexaenoic acid (DHA; 22:6n3) and proinflammatory ω-6 arachidonic acid (AA; 20:4n6). Pregnant women (n = 135) provided a blood sample and completed the Pittsburgh Sleep Quality Index (PSQI) at 20–27 weeks gestation. Red blood cell (RBC) fatty acid levels were determined by gas chromatography and serum inflammatory markers [interleukin (IL)-6, IL-8, tumor necrosis factor-α, IL-1β, and C-reactive protein] by electrochemiluminescence using high sensitivity kits. Both higher serum IL-8 (95% CI = 0.10,3.84) and poor sleep (95% CI = 0.03,0.28) served as significant mediators linking lower DHA:AA ratios with shorter gestation. Further, a serial mediation model moving from the DHA:AA ratio → sleep → IL-8 → length of gestation was statistically significant (95% CI = 0.02, 0.79). These relationships remained after adjusting for depressive symptoms, age, BMI, income, race, and smoking. No interactions with race were observed in relation to length of gestation as a continuous variable. However, a significant interaction between race and the DHA:AA ratio in predicting preterm birth was observed (p = 0.049); among African Americans only, odds of preterm birth decreased as DHA:AA increased (p = 0.048). These data support a role for both inflammatory pathways and sleep quality in linking less optimal RBC PUFA status with shorter gestation in African American and European American women and suggest that African-Americans have greater risk for preterm birth in the context of a low DHA:AA ratio.

Mild Depressive Symptoms During the Third Trimester of Pregnancy Are Associated with Disruptions in Daily Rhythms but Not Subjective Sleep Quality

BACKGROUND

Recent research in major depressive disorder suggests that dysregulation of the circadian system may be a core pathophysiological component. In pregnancy, women often experience significant disruptions in their daily rhythms, including changes in day-to-day schedule and sleep habits. Current evidence suggests that these disruptions in daily rhythms may adversely affect underlying circadian rhythmicity. The purpose of our study was to examine whether subjectively rated daily rhythm disruptions were associated with a greater incidence of depressive symptoms during the third trimester.

METHOD

Our study was a cross-sectional design, assessing sleep quality, symptoms of depression, and daily rhythm disruptions in 51 pregnant women in their third trimester.

RESULTS

We observed a significant relationship between mild depressive symptoms and disruptions in daily rhythms. While we initially observed a strong correlation between subjective sleep quality and depressive symptoms, this was attenuated after accounting for daily rhythm disruptions. Disruptions in daily social rhythms, eating patterns, and general activity were all significantly associated with depressive symptomatology.

CONCLUSION

Our findings point to a strong correlation between daily rhythm disruptions and prenatal depressive symptoms. Given that these daily rhythms are known to act as zeitgebers, longitudinal studies examining the directionality of this relationship between circadian rhythms and depressive symptoms during pregnancy are warranted.

High risk for obstructive sleep apnea and other sleep disorders among overweight and obese pregnant women

BACKGROUND

Obstructive sleep apnea (OSA), a common and serious disorder in which breathing repeatedly stops during sleep, is associated with excess weight and obesity. Little is known about the co-occurrence of OSA among pregnant women from low and middle-income countries.

METHODS

We examined the extent to which maternal pre-pregnancy overweight or obesity status are associated with high risk for OSA, poor sleep quality, and excessive daytime sleepiness in 1032 pregnant women in Lima, Peru. The Berlin questionnaire was used to identify women at high risk for OSA. The Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were used to examine sleep quality and excessive daytime sleepiness, respectively. Multinomial logistic regression procedures were employed to estimate odds ratios (aOR) and 95% confidence intervals (CI) adjusted for putative confounding factors.

RESULTS

Compared with lean women (<25 kg/m(2)), overweight women (25-29.9 kg/m(2)) had 3.69-fold higher odds of high risk for OSA (95% CI 1.82-7.50). The corresponding aOR for obese women (≥30 kg/m(2)) was 13.23 (95% CI: 6.25-28.01). Obese women, as compared with their lean counterparts had a 1.61-fold higher odds of poor sleep quality (95% CI: 1.00-2.63).

CONCLUSION

Overweight or obese pregnant women have increased odds of sleep disorders, particularly OSA. OSA screening and risk management may be indicated among pregnant women in low and middle income countries, particularly those undergoing rapid epidemiologic transitions characterized by increased prevalence of excessive adult weight gain.