Mid-Pregnancy Insomnia and its Association with Perinatal Depressive Symptoms: A Prospective Cohort Study

Abstract

Objective/Background: Insomnia and depression are disorders that affect many perinatal women and that often are interrelated. The present study aimed to examine concurrent and prospective associations between midpregnancy insomnia and depression during mid-pregnancy and 8 weeks postpartum. Furthermore, differences in depression and in the sleep-related characteristics insomnia, chronotype, and sleep efficiency were explored between the two time points (mid-pregnancy versus 8 weeks postpartum), and between primiparous and multiparous participants. Participants/Methods: The study was part of the Norwegian populationbased Depression and Anxiety in the Perinatal Period (DAPP) prospective cohort study. Among 539 women that were recruited for participation when receiving a routine ultrasound examination, we analyzed data from hospital birth records and questionnaire responses from pregnancy week 17 and postpartum week 8. We used the Edinburgh Postnatal Depression Scale to measure depression. The Bergen Insomnia Scale, the reduced Horne-Östberg Morningness-Eveningness Questionnaire, and three questions from the Pittsburgh Sleep Quality Index were used to measure the sleep-related characteristics. Results: Mid-pregnancy insomnia was significantly associated with concurrent depression (p < .001), but not with postpartum depression (p = .288), in a linear mixed model with adjustment for several reproductive and psychosocial variables. Sleep efficiency was reduced from mid-pregnancy to postpartum (from 88% to 77%), and primiparous women reported less efficient sleep than multiparous women after childbirth. Conclusions: The results indicate that mid-pregnancy insomnia may be a marker for concurrent depression but not a predictor of postpartum depression. Future research should examine the extent to which treatment of insomnia from mid-pregnancy on reduces both perinatal insomnia and depression.

Insomnia symptoms during pregnancy: A meta‐analysis

“…Of the 24 articles included in the analyses, all were comprised of convenience samples and none assessed insomnia symptoms using a structured clinical interview. In terms of the scales used, 12 studies used the Insomnia Severity Index (Dolatian et al., 2014; Felder et al., 2019; Fernández‐Alonso et al., 2012; Kalmbach et al., 2020; Manber et al., 2013; Mindell et al., 2015; Mourady et al., 2017; Palagini et al., 2019; Sedov, Madsen, et al., 2018; Swanson et al., 2011; Umeno et al., 2020; Wang et al., 2020), five studies used the Women`s Health Initiative Insomnia Rating Scale (Facco et al., 2010; Kızılırmak et al., 2012; Ko et al., 2012; Louis et al., 2018; Nacar & Tashan, 2019), two studies used the Insomnia Symptoms Questionnaire (Okun, Buysse, et al., 2015; Okun & O’Brien, 2018), two studies used the Athens Insomnia Scale (Román‐Gálvez et al., 2018; Wołyńczyk‐Gmaj et al., 2017), two studies used the Bergen Insomnia Scale (Dorheim et al., 2012; Osnes et al., 2020), and one study used the Basic Nordic Sleep Questionnaire (Kiviruusu et al., 2020). Table 2 displays the included studies along with the scale used to measure insomnia, cut‐scores utilized to characterize groups, and mean scores as well as associated standard deviations.…”

“…Of the 24 articles, 22 reported a mean or median maternal age, which ranged from 25.2 to 32.5 years (Dorheim et al., 2012; Facco et al., 2010; Felder et al., 2019; Fernández‐Alonso et al., 2012; Kalmbach et al., 2020; Kiviruusu et al., 2020; Kızılırmak et al., 2012; Ko et al., 2012; Louis et al., 2018; Manber et al., 2013; Mourady et al., 2017; Nacar & Tashan, 2019; Okun, Buysse, et al., 2015; Okun & O’Brien, 2018; Osnes et al., 2020; Palagini et al., 2019; Román‐Gálvez et al., 2018; Sedov, Madsen, et al., 2018; Swanson et al., 2011; Umeno et al., 2020; Wang et al., 2020; Wołyńczyk‐Gmaj et al., 2017). Seventeen articles provided a mean or median gestational age for the sample, which ranged from 14 to 39 weeks (Dorheim et al., 2012; Facco et al., 2010; Felder et al., 2019; Fernández‐Alonso et al., 2012; Kalmbach et al., 2020; Kiviruusu et al., 2020; Ko et al., 2012; Manber et al., 2013; Mourady et al., 2017; Nacar & Tashan, 2019; Okun & O’Brien, 2018; Osnes et al., 2020; Palagini et al., 2019; Sedov, Madsen, et al., 2018; Umeno et al., 2020; Wang et al., 2020; Wołyńczyk‐Gmaj et al., 2017). Eleven articles provided information on prevalence of depression within the sample, which ranged from 9.8% to 68.0% (Dorheim et al., 2012; Kalmbach et al., 2020; Kiviruusu et al., 2020; Kızılırmak et al., 2012; Louis et al., 2018; Manber et al., 2013; Mourady et al., 2017; Nacar & Tashan, 2019; Osnes et al., 2020; Palagini et al., 2019; Swanson et al., 2011).…”

“…Seventeen articles provided a mean or median gestational age for the sample, which ranged from 14 to 39 weeks (Dorheim et al., 2012; Facco et al., 2010; Felder et al., 2019; Fernández‐Alonso et al., 2012; Kalmbach et al., 2020; Kiviruusu et al., 2020; Ko et al., 2012; Manber et al., 2013; Mourady et al., 2017; Nacar & Tashan, 2019; Okun & O’Brien, 2018; Osnes et al., 2020; Palagini et al., 2019; Sedov, Madsen, et al., 2018; Umeno et al., 2020; Wang et al., 2020; Wołyńczyk‐Gmaj et al., 2017). Eleven articles provided information on prevalence of depression within the sample, which ranged from 9.8% to 68.0% (Dorheim et al., 2012; Kalmbach et al., 2020; Kiviruusu et al., 2020; Kızılırmak et al., 2012; Louis et al., 2018; Manber et al., 2013; Mourady et al., 2017; Nacar & Tashan, 2019; Osnes et al., 2020; Palagini et al., 2019; Swanson et al., 2011). Four articles provided prevalence of anxiety within the sample, which ranged from 13.6% to 64.5% (Kiviruusu et al., 2020; Mourady et al., 2017; Palagini et al., 2019; Swanson et al., 2011).…”

“…The prevalence of insomnia was higher in the third trimester (39.7%) than in both the second (27.2%) and first trimesters (25.3%). It is notable that fewer studies contributed to the first and second trimester estimates than to the third trimester estimates (Felder et al., 2019; Ko et al., 2012; Manber et al., 2013; Mindell et al., 2015; Mourady et al., 2017; Okun, Buysse, et al., 2015; Osnes et al., 2020; Palagini et al., 2019; Román‐Gálvez et al., 2018; Umeno et al., 2020; Wang et al., 2020). This finding is in line with the existing literature base, with many studies demonstrating higher sleep disruption during the latter part of pregnancy (Facco et al., 2010; Tomfohr et al., 2015).…”

“…Of the 24 articles, 22 reported a mean or median maternal age, which ranged from 25.2 to 32.5 years (Dorheim et al, 2012;Facco et al, 2010;Felder et al, 2019;Fernández-Alonso et al, 2012;Kalmbach et al, 2020;Kiviruusu et al, 2020;Kızılırmak et al, 2012;Ko et al, 2012;Louis et al, 2018;Manber et al, 2013;Mourady et al, 2017;Nacar & Tashan, 2019;Okun, Buysse, et al, 2015;Okun & O'Brien, 2018;Osnes et al, 2020;Palagini et al, 2019;Román-Gálvez et al, 2018;Swanson et al, 2011;Umeno et al, 2020;Wang et al, 2020;Wołyńczyk-Gmaj et al, 2017). Seventeen articles provided a mean or median Note: If insomnia was measured multiple times throughout the pregnancy, then the data from the earliest time-point were selected.…”