Can Insomnia in Pregnancy Predict Postpartum Depression? A Longitudinal, Population-Based Study

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.

Insomnia in Pregnancy Is Associated With Depressive Symptoms and Eating at Night

“…37,38 Moreover, the hypothesis about a common pathophysiology of insomnia and depression may be supported by the fact that insomnia in pregnancy increases the risk of postpartum depression. 12,39 In addition, we found that women with insomnia that developed during pregnancy more often suffered from nightmares and tingling in the legs in comparison with women with insomnia starting before pregnancy. Previous studies have also indicated that these symptoms are common during pregnancy, especially in its late stages.…”

The relationship between sleep and postpartum mental disorders: A systematic review

“…The percentage response/consent rate was reported in less than half of the articles (Bilszta et al, 2010;Chaudron et al, 2001;Coble et al, 1994;Dennis and Ross, 2005;Dorheim et al, 2014Dorheim et al, , 2009aDorheim et al, , 2009bKhazaie et al, 2013;Mead-Bennett, 1990;Okun et al, 2009Okun et al, , 2011Piteo et al, 2013;Wilkie and Shapiro, 1992) and many did not use representative samples (Bilszta et al, 2010;Calcagni et al, 2012;Chaudron et al, 2001;Coble et al, 1994;Dorheim et al, 2014Dorheim et al, , 2009bFrank et al, 1987;Lee and Kimble, 2009;Piteo et al, 2013;Posmontier, 2008;Swain et al, 1997;Swanson et al, 2013Swanson et al, , 2011Tsai and Thomas, 2012) or did not provide sufficient information to rate representativeness (Godfroid et al, 1997;Goyal et al, 2009Goyal et al, , 2007Okun et al, 2009Okun et al, , 2011. Outcome assessments were generally well performed, although their timing was irregular or unclear in some cases.…”

Sleep disorders during pregnancy

“…(95). A few studies have investigated PPD and sleep during pregnancy, but the results are divergent and possibly, but not necessarily, may result because different methods for measuring sleep-associated factors were used in different studies (96)(97)(98)(99)(100). There is also some evidence that subjective perception of sleep, more than objective sleep quality, is associated with PPD symptoms (101,102).…”

“…Since disturbed sleep might precede depressive symptoms in the general population (85) and poor sleep quality in early pregnancy might contribute to antepartum depressive symptoms during pregnancy (92) it is likely that poor sleep during pregnancy increases vulnerability for development of PPD. Although review articles state that there is an association between sleep and pre-and postpartum depressive symptoms (158,159), studies focusing on the connection between sleep during pregnancy and depressive symptoms after delivery are either rather small (96)(97)(98) or have only considered insomnia (99,100). The results from these surveys are also contradictory.…”