Trajectories and Depressive Symptoms During the Perinatal Period: A Longitudinal Population-Based Study in China

Abstract

Most women in the perinatal period face sleep issues, which can affect their mental health. Only a few studies have focused on sleep trajectories and depressive symptoms of women during the perinatal period in China. This study aims to explore the development trajectory of sleep quality by classifying pregnant women according to the changes in their sleep quality during pregnancy and postpartum and investigate the correlation between different sleep quality trajectory groups and depressive symptoms. The Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality, and the Edinburgh Postnatal Depression Scale (EPDS) was used to assess the symptoms of depression. Participants (n = 412) completed the assessment of sleep quality, depressive symptoms, and some sociodemographic and obstetric data at 36 weeks of gestation, 1 week after delivery, and 6 weeks after delivery. The group-based trajectory model (GBTM) was used to complete the trajectory classification, and logistic regression was used to analyze the predictive factors of postpartum depressive symptoms. Four different sleep quality trajectories were determined: “stable-good,” “worsening,” “improving,” and “stable-poor” groups. The results demonstrate that poor sleep trajectories, social support and parenting experience during the perinatal period are related to postpartum depression. Screening for prenatal sleep problems is crucial for identifying the onset of perinatal depressive symptoms.

Postpartum Insomnia and Poor Sleep Quality Are Longitudinally Predictive of Postpartum Mood Symptoms

“…Specifically, it is the presence of insomnia or poor sleep quality in the postpartum, rather than in late pregnancy, that uniquely predicts PPD and anxiety. These findings corroborate other studies that have evaluated women with a history of depression (28,50), convenience samples (4,46,48,70), and those without a history (31,44,71). Notably, the results of this longitudinal study demonstrate that, when statistically pitting prenatal insomnia and sleep quality versus postpartum insomnia and quality in the same model, the postpartum variables were found to be relatively more important in uniquely contributing to postpartum mood.…”

“…Most of the research has focused on sleep either during the prenatal period (29,44,45) or in the postpartum period (27,28,31,46,47). Only a few have assessed sleep during pregnancy and into the postpartum and how it is linked with postpartum mood (28,44,45,48,49). Results from those studies indicate that only postpartum insomnia or poor sleep quality increases the risk of postpartum mood when models adjust for prenatal depression (28,45).…”

“…Most of the research has focused on sleep either during the prenatal period (29,44,45) or in the postpartum period (27,28,31,46,47). Only a few have assessed sleep during pregnancy and into the postpartum and how it is linked with postpartum mood (28,44,45,48,49).…”

Trajectories of reproductive transition phase mood disorder from pregnancy to postpartum: A Swiss longitudinal study

“…These studies demonstrated that depressive symptom profiles during pregnancy and the postpartum period seem to be heterogeneous regarding the characteristics and chronicity of symptoms. 4 – 15 …”

“… 13 , 15 A longitudinal study of perinatal women in China ( n = 412) reported that the onset and chronicity of depressive symptoms postpartum was associated with poor sleep trajectories prenatally. 12 …”