Can insomnia in pregnancy predict postpartum depression? A longitudinal, population-based study.

Signe K Dørheim,Bjørn Bjorvatn,Malin Eberhard-Gran,Marianna Mazza

doi:10.1371/journal.pone.0094674

Abstract

BackgroundInsomnia and depression are strongly interrelated. This study aimed to describe changes in sleep across childbirth, and to evaluate whether insomnia in pregnancy is a predictor of postpartum depression.MethodsA longitudinal, population-based study was conducted among perinatal women giving birth at Akershus University Hospital, Norway. Women received questionnaires in weeks 17 and 32 of pregnancy and eight weeks postpartum. This paper presents data from 2,088 of 4,662 women with complete data for insomnia and depression in week 32 of pregnancy and eight weeks postpartum. Sleep times, wake-up times and average sleep durations were self-reported. The Bergen Insomnia Scale (BIS) was used to measure insomnia. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure depressive symptoms.ResultsAfter delivery, sleep duration was reduced by 49 minutes (to 6.5 hours), and mean sleep efficiency was reduced from 84% to 75%. However, self-reported insomnia scores (BIS) improved from 17.2 to 15.4, and the reported prevalence of insomnia decreased from 61.6% to 53.8%. High EPDS scores and anxiety in pregnancy, fear of delivery, previous depression, primiparity, and higher educational level were risk factors for both postpartum insomnia and depression. Insomnia did not predict postpartum depression in women with no prior history of depression, whereas women who recovered from depression had residual insomnia.LimitationsDepression and insomnia were not verified by clinical interviews. Women with depressive symptoms were less likely to remain in the study.ConclusionsAlthough women slept fewer hours at night after delivery compared to during late pregnancy, and reported more nights with nighttime awakenings, their self-reported insomnia scores improved, and the prevalence of insomnia according to the DSM-IV criteria decreased. Insomnia in pregnancy may be a marker for postpartum recurrence of depression among women with previous depression.

Highlights

Insomnia is both a symptom of depression and a separate disorder that may precede depression [1]
Conclusions: women slept fewer hours at night after delivery compared to during late pregnancy, and reported more nights with nighttime awakenings, their self-reported insomnia scores improved, and the prevalence of insomnia according to the DSM-IV criteria decreased
Insomnia in pregnancy may be a marker for postpartum recurrence of depression among women with previous depression

Summary

Introduction

Insomnia is both a symptom of depression and a separate disorder that may precede depression [1]. Women sleep poorly during pregnancy and sleep even less in the postpartum period [2,3]. The perinatal period is a time of increased risk for depressive disorders [4]. There may not be adequate time and opportunity for sleep; the newborn baby requires attention and will disturb maternal sleep in the first months after delivery [6]. Postnatal women may be exposed to similar practical challenges with sleep and infant care postpartum, but some may develop larger sleep problems than others or be more vulnerable to these changes. This study aimed to describe changes in sleep across childbirth, and to evaluate whether insomnia in pregnancy is a predictor of postpartum depression

Methods

Results

Conclusion