Abstract
BackgroundThe sleep quality of pregnant women in the third trimester is related to mental health. However, there is still a lack of large-scale cohort research exploring this relationship in the second trimester. Thus, we assessed the associations of sleep quality during the second trimester with antenatal stress and antenatal and postnatal depression.MethodsWe examined 1152 pregnant women from a prospective cohort study in China to assess the associations of sleep quality in the second trimester with antenatal stress, antenatal depression, and postnatal depression. We used linear regression models and logistic regression models to examine the associations of sleep quality (Pittsburgh Sleep Quality Index [PSQI]) during pregnancy with perinatal stress (Pregnancy Pressure Scale [PPS]) and depression (Edinburgh Postnatal Depression Scale [EPDS]) status. We further assessed the relationship in groups divided according to maternal age.ResultsPSQI scores were positively associated with antenatal PPS scores (β: 1.52, 95% confidence interval [CI]: 1.28, 1.76), antenatal EPDS scores (β: 0.68, 95% CI: 0.58, 0.78), and postpartum EPDS scores (β: 0.51, 95% CI: 0.38, 0.64). Poor sleep quality (PSQI scores ≥5) was associated with antenatal stress status (odds ratio [OR]: 2.60, 95% CI: 1.79, 3.77), antenatal depression status (OR: 3.42, 95% CI: 2.48, 4.72), and postpartum depression status (OR: 2.40, 95% CI: 1.58, 3.64) after adjusting maternal age, BMI, gestational age, smoking, educational level, annual household income and social support. The association of poor sleep quality (PSQI scores ≥5) in the second trimester with postnatal depression status was significant among women more than or equal to 30 years old (OR: 4.12, 95% CI: 2.18, 7.78) but not among women less than 30 years old after adjusting covariates above.ConclusionPoor sleep quality in the second trimester among Chinese pregnant women is associated with stress and depression symptoms. Strategies to boost sleep quality should be considered during prenatal health care to improve women’s mental health status.
Highlights
The sleep quality of pregnant women in the third trimester is related to mental health
There were no significant differences in age, gestational age, body mass index (BMI), smoking, or social support between the two sleep quality groups (PSQI < 5 vs. Pittsburgh Sleep Quality Index (PSQI) ≥5)
After adjustment for age, BMI, gestational age, smoking, educational level, income level, and social support, higher PSQI scores were associated with higher antenatal Pregnancy Pressure Scale (PPS) scores (β: 1.52, 95% confidence interval (CI): 1.28, 1.76), antenatal Edinburgh Postnatal Depression Scale (EPDS) scores (β: 0.68, 95% CI: 0.58, 0.78), and postpartum EPDS scores (β: 0.51, 95% CI: 0.38, 0.64)
Summary
Study population and design The research sample was derived from the Born in Shenyang Cohort Study (BISCS), which follows mothers and children from pregnancy to 12 months postpartum. The following variables were considered potential confounders: maternal age, pre-pregnancy BMI, educational level, household income, pre-pregnancy smoking, gestational age, and social support. We used logistic regression models to assess the odds ratio (OR) and 95% confidence interval (CI) for stress during pregnancy, antenatal depression, and postnatal depression in relation to sleep quality using PSQI scores of participants < 5 as reference. We conducted crude and adjusted analyses using the following models: Model 1, the crude model; Model 2, adjusted for maternal age, pre-pregnancy BMI, educational level, household income, pre-pregnancy smoking, and gestational age; and Model 3, adjusted for social support based on Model 2. Multiple imputation was used to impute the missing values (SSRS scores and gestational age), which may be confounders in the study. All analyses were conducted with Stata S.E. version 15 (Stata Corp., Texas, TX, USA)
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