Sleep complaints in early pregnancy. A cross-sectional study among women attending prenatal care in general practice

Abstract

Background: Sleep problems in late pregnancy are common, but sleep in early pregnancy is less well described. The aim of this study was to describe the occurrence and severity of sleep complaints in early pregnancy. We asked the women about worries due to sleep problems. Furthermore, we investigated the associations between sleep complaints and pregnancy-related symptoms. This association was studied taking into account physical and mental health, sociodemographic characteristics, and reproductive history of the women. Methods: Cross-sectional study in Danish general practice based on an electronic questionnaire completed by pregnant women and a Pregnancy Health Record filled in by the general practitioner (GP). The questionnaire measured three sleep complaints and 11 common physical pregnancy-related symptoms. The sleep complaints were measured as mild, moderate or severe, and it was recorded how much they worried the women. The associations between the physical pregnancy-related symptoms and sleep complaints were assessed by odds ratios from multivariable logistic regression models. Results: The questionnaire was completed by 1338 out of 1508 eligible women before the end of gestation week 16. The gestational age ranged from 5 to 16 weeks (median 11 weeks) among the included women. On average, more than one third of the women reported to have at least one of the three sleep complaints in the questionnaire. Problems "taking a long time to fall asleep" was reported by 312 women (23%), "waking up too early" was reported by 629 (47%), and 183 (14%) had been "lying awake most of the night". One sleep complaint was reported by 38%, two by 16, and 4% had all three symptoms. The majority were not at all or only mildly worried because of their sleep disturbances, but moderate or severe worries were found among 46% of those" taking a long time to fall asleep" and among 40% of those "lying awake most of the night". "Moderate or severe complaints" were reported by 277 (21%) women "Moderate or severe complaints" were associated with pregnancyrelated physical symptoms, such as back pain, pelvic girdle pain and pelvic cavity pain, but only the association with pelvic cavity pain stayed significant after adjustment for depression. Conclusion: This study showed that sleep complaints in early pregnancy are common, and sleep complaints showed association with physical as well as mental symptoms. It may be important for pregnant patients that clinicians address depression, and mood in relation to sleep problems during pregnancy.

What factors are most important for the development of the maternal–fetal relationship? A prospective study among pregnant women in Danish general practice

“…192 randomly selected GP practices in The Capital Region and Region Zealand participated. A detailed description of the recruitment process is described elsewhere [26]. All women booking an appointment for a first antenatal care visit in the participating GPs' practices between 1 April 2015 and 15 August 2016 were eligible for participation.…”

Sleep quality in women with nausea and vomiting of pregnancy: a cross-sectional study

“…In a cohort study by Mindell et al [ 13 ], designed to estimate sleep patterns and sleep disturbances with Pittsburgh Sleep Quality Index in all months of pregnancy in 2427 women, nausea was frequently reported as a symptom disturbing sleep in the first 3 months of pregnancy. On the contrary, Ertmann et al [ 11 ] studied 1338 women for sleep complaints in early pregnancy with questions from Nottingham Health Profile (long time to fall asleep, waking up too early and lying awake most of the night) and associated pregnancy-related physical symptoms. In their study, waking up too early was the most prevalent sleep complaint (47%) but nausea or vomiting were not associated with any sleep complaints in the multivariable analysis which included physical and mental health status.…”

“…Previous literature has described worsening of sleep quality and increase in sleep disturbances during pregnancy [ 7 – 9 ]. These changes in sleep begin already during the first trimester [ 7 , 10 , 11 ]. Sleep disturbances can be specified as sleep onset disturbances (difficulty falling asleep) and sleep maintenance disturbances (night awakenings, too early morning awakenings) [ 12 – 14 ], however, occurrence of these distinct sleep disturbances especially in early pregnancy are less studied [ 7 , 9 , 10 , 13 ].…”

“…Previous studies evaluating associations between NVP and sleep quality are sparse [ 11 , 13 , 19 , 20 ]. In a study by Mindell et al [ 13 ], nausea was frequently reported as a symptom disturbing sleep, whereas Ertmann et al [ 11 ], Ebrahimi et al [ 19 ] and Heitmann et al [ 20 ] found no association. Despite the term “morning sickness”, NVP symptoms are usually experienced throughout the day and also nighttime [ 21 ].…”

Selection bias in general practice research: analysis in a cohort of pregnant Danish women

“…Such measures of interest may theoretically be distributed differently in women that are recruited and women that are not recruited, irrespective of selection in the sociodemographic variables in the cohort [ 14 ]; well-being may be related to participation status even when no selection is found in sociodemographic factors, and the other way around. The problems mentioned above, however, and indeed many other health problems, do show strong associations with sociodemographic characteristics [ 14 , 21 , 22 ]. We consider our survey of selection using the available register data indicative, therefore, of a general tendency of selection at various steps of sampling in our cohort.…”