Abstract
BackgroundAlthough many perinatal women are affected by anxiety, few studies have focused on perinatal anxiety and its potential triggers. The primary aim of this study was to examine concurrent and prospective associations between mid-pregnancy insomnia and perinatal anxiety. Furthermore, we compared psychosocial and reproductive characteristics between participants with and without mid-pregnancy insomnia and explored changes in the prevalence of obsessive-compulsive disorder (OCD) symptoms from mid-pregnancy to 8 weeks postpartum. MethodsThis study was part of the Norwegian Depression and Anxiety in the Perinatal Period (DAPP) prospective, population-based, cohort study. We analyzed hospital birth records and questionnaire responses from pregnancy week 17 and postpartum week 8 (n = 530). The Bergen Insomnia Scale was used to measure insomnia and the Hopkins Symptom Checklist to measure anxiety. OCD symptoms were measured based on questions from the Mini-International Neuropsychiatric Interview. ResultsMid-pregnancy insomnia was significantly associated with both concurrent and postpartum anxiety in a linear mixed model adjusted for several potential confounders. Participants with mid-pregnancy insomnia had significantly higher levels of perinatal anxiety and postpartum OCD symptoms than participants with normal mid-pregnancy sleep. OCD symptoms affected more women after delivery than before (6.4% vs. 3.8% p = 0.034). LimitationsImmigrants were underrepresented in our sample. ConclusionOur results suggest that mid-pregnancy insomnia is a marker for concurrent anxiety and predictor of postpartum anxiety. Future research should examine whether insomnia treatment starting in mid-pregnancy reduces both perinatal insomnia and anxiety. Health providers should also be aware that postpartum women have an increased risk of developing OCD symptoms.
Highlights
Most research on perinatal mental disorders has focused on depression (Fisher et al, 2016), whereas anxiety, despite being prevalent (Fairbrother et al, 2016), has often been overlooked (Howard et al, 2014) and under-treated (Smith et al, 2009)
We explored the association between antenatal insomnia and perinatal anxiety from as early as mid-pregnancy, a point when nonpharmacological treatment interventions for insomnia can be completed before delivery (Riemann et al, 2017)
Girl Boy Breastfeeding Exclusively Partly Not breastfeeding Smoking in pregnancy Dipping tobacco use in pregnancy Smoking after delivery Dipping tobacco use after delivery Alcohol use in pregnancy Alcohol use after delivery Q1: Sick leave during pregnancy Q1: Sick leave due to pregnancy-related problems Q2: Sick leave during pregnancy Q2: Sick leave due to mental issues Q2: Economic worries Frequently Sometimes Rarely Never
Summary
Most research on perinatal mental disorders has focused on depression (Fisher et al, 2016), whereas anxiety, despite being prevalent (Fairbrother et al, 2016), has often been overlooked (Howard et al, 2014) and under-treated (Smith et al, 2009). The few previous studies on the relationship between perinatal insomnia and anxiety are subject to limited access to covariates, small sample sizes, and the use of only antenatal measurements (Polo-Kantola et al, 2017); cross-sectional design and recruitment from psychiatric settings (Swanson et al, 2011); or assessments late in pregnancy (Osnes et al, 2019). The primary aim of this study was to examine concurrent and prospective associations between mid-pregnancy insomnia and perinatal anxiety. We compared psychosocial and reproductive characteristics between participants with and without mid-pregnancy insomnia and explored changes in the prevalence of obsessive-compulsive disorder (OCD) symptoms from mid-pregnancy to 8 weeks postpartum. Results: Mid-pregnancy insomnia was significantly associated with both concurrent and postpartum anxiety in a linear mixed model adjusted for several potential confounders. Health providers should be aware that postpartum women have an increased risk of developing OCD symptoms
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