Postpartum Insomnia and Poor Sleep Quality are Longitudinally Predictive of Postpartum Mood Symptoms

Abstract

Objective Insomnia and poor sleep quality are frequently reported by perinatal women. Both are noted to increase risk for postpartum depression, with less known about their association with postpartum anxiety. The study sought to assess whether perinatal sleep disturbances predicted depression and anxiety symptomatology across each month of the first 6 months postpartum in women with a history of depression. Methods Pregnant women without active depression at enrollment (N = 159) aged 18-45 years of age were recruited. In late pregnancy and for up to six months postpartum, women completed monthly online questionnaires including the ISQ, PSQI, EPDS, and GAD-7. Repeated-measures multilevel models were used to predict depression and anxiety across the postpartum. Results The prevalence of insomnia was 20.4%, and the prevalence of poor sleep quality was 67.8% across the first 6 months postpartum. Postpartum insomnia and poor sleep quality at the between-subjects and within-subjects levels tended to uniquely predicted greater depressive and anxiety symptoms, even after controlling for demographic characteristics, prenatal insomnia, and prenatal poor sleep quality. Conclusions Most of the women in our sample had sleep disturbances across the perinatal period. Consistent with the extant literature, postpartum insomnia and poor sleep quality, but not prenatal measures of sleep, longitudinally predicted greater postpartum depression and anxiety symptoms. The chronic sleep deprivation of insomnia and the subjective experience of poor sleep quality are uniquely relevant risks for postpartum mood disorders. Evaluation and mitigation of perinatal sleep disturbance is an ideal opportunity to reduce postpartum mood disorders and subsequent health outcomes.

Impact of pre-pregnancy and pregnancy sleep on the risk of postpartum depression in the Japan Environment and Children’s Study

“…Factors associated with postpartum depression include physical characteristics, psychosocial and family background, psychiatric history, nutrition, sleep, baby status, experiences during pregnancy and delivery, mode of delivery, medical interventions, and complications; such as age, obesity and overweight, marital status, violence and abuse, immigration status, race, depressive history, vitamin D de ciency, sleep disruption and poor sleep, life events during pregnancy, lack of social support, parity, cesarean section, multiple births, preterm and low-birth-weight infants, negative birth experience, and postpartum anemia [8,9] . Among these risk factors, in particular, that poor postpartum sleep quality is a predictor of depressive symptoms [10,11] . Women in the postpartum period were affected by their infants' sleep problems, and experience insomnia and poor sleep quality [11][12][13] .…”

“…Among these risk factors, in particular, that poor postpartum sleep quality is a predictor of depressive symptoms [10,11] . Women in the postpartum period were affected by their infants' sleep problems, and experience insomnia and poor sleep quality [11][12][13] . Furthermore, not only poor postpartum sleep quality, but also poor sleep quality during pregnancy has been reported likewise to be a risk factor of postpartum depression [14][15][16] .…”