Dysfunctional Sleep-Related Cognitions and Maladaptive Behaviors Perpetuating Insomnia During Pregnancy: A Cross-Sectional Study.

BACKGROUND

Insomnia is highly prevalent during pregnancy, but the role of modifiable cognitive and behavioral factors remains understudied.

OBJECTIVE

We aimed to investigate factors associated with insomnia symptoms in pregnant women, with a focus on sleep-related psychological and behavioral factors.

METHODS

A cross-sectional study was conducted among 545 pregnant women recruited from 2 tertiary hospitals in Eastern China (December 2023-March 2024). Participants completed self-reported questionnaires assessing insomnia severity, pregnancy-related rumination, physical discomfort, anxiety symptoms, depressive symptoms, presleep arousal, dysfunctional sleep-related cognitions, maladaptive sleep habits, and demographic information. Univariable and binary logistic regression were used to identify factors associated with insomnia symptoms.

RESULTS

Among the 545 participants (mean age = 29.1 years), 27.0% reported insomnia symptoms. In the regression model, insomnia was significantly associated with prepregnancy insomnia symptoms (OR = 2.82; 95% CI, 1.69-4.70; P < .001), increased physical discomfort (OR = 1.05; 95% CI, 1.01-1.09; P = .012), higher presleep arousal (OR = 1.13; 95% CI, 1.07-1.20; P < .001), dysfunctional sleep-related cognitions (OR = 0.95; 95% CI, 0.92-0.98; P < .001), and maladaptive sleep habits (OR = 1.03; 95% CI, 1.01-1.05; P = .005).

CONCLUSION

Insomnia during pregnancy is associated with prepregnancy insomnia, physical discomfort, and key modifiable perpetuating factors including presleep arousal, dysfunctional sleep-related cognitions, and maladaptive sleep behaviors. Interventions targeting these modifiable factors are needed to improve insomnia symptoms in pregnant women.