Trajectories of perinatal sleep quality from early pregnancy to six weeks postpartum and their risk factors: A multicenter longitudinal study in China.

BACKGROUND

Poor sleep quality during pregnancy is common and linked to adverse maternal and fetal outcomes. This study examined different sleep trajectories during pregnancy and risk factors associated with sleep quality.

METHOD: Data came from a prospective cohort study of 1210 Chinese pregnant women who were within 13 weeks of gestation. Participants completed surveys at seven time points: five during pregnancy (gestational week 10-13 (T1), week 15-18 (T2), week 23-25 (T3), week 30-32 (T4) and week 36-37 (T5)) and two postpartum (7 days (T6) and 6 weeks (T7)). The Pittsburgh Sleep Quality Index (PSQI) was administered at seven time points to assess the sleep quality. Depression, anxiety and stress level were assessed at T1 using the Edinburgh Postnatal Depression Scales (EPDS), Zung's Self-rating Anxiety Scale (SAS) and the Pregnancy Pressure Scale (PPS) at T1. Sleep-quality trajectories were identified by growth mixture modeling.

RESULTS

We identified three sleep development trajectories during the perinatal period: "stable-good" (n = 697, 57.6%)", "stable-poor"(n = 495, 40.9%), and "severe-improving" (n = 18, 1.5%). The women with pressure, anxiety and poor sleep quality at T1 have 0.49, 0.78, 7.97 times risk of poor perinatal sleep quality compare to women with no symptoms, respectively. Notably, although depression was significant in univariate analysis, it was no significantly associated with perinatal sleep outcomes after adjusting for confounders.

CONCLUSION

Perinatal sleep quality follows distinct trajectories, with the most prevalent being a persistent pattern of poor sleep. Early-pregnancy stress, anxiety, and pre-existing sleep problems are significant risk factors. These findings highlight the need for early screening and intervention for sleep and mood issues in prenatal care, starting from the first trimester.