Sleep quality in late pregnancy is associated with maternal mental health in the early postpartum period

Abstract

Objective: Several studies suggest an association between poor sleep quality during late pregnancy and postpartum depressive symptoms. However, so far no studies have comprehensively examined how sleep quality during pregnancy might impact overall mental well-being postpartum. This study aimed to investigate if sleep quality in pregnancy is associated with postpartum mental well-being, and/or with hormonal fluctuations, immune status, and parity.

Methods: We used data from 56 healthy women acquired in late pregnancy and five weeks postpartum. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), and mental well-being was measured with the World Health Organization Well-Being Index (WHO-5) as the primary outcome. Secondary outcomes included the Total Mood Disturbance (TMD) Score of the Profile of Mood States (POMS) and the Edinburgh Postnatal Depression Scale (EPDS) sum score. Blood samples for estradiol and high-sensitivity C-reactive protein (hsCRP) analysis were taken on the day of delivery and five weeks postpartum.

Results: We found a significant association between poor sleep quality in late pregnancy and lower levels of mental well-being five weeks postpartum (p = 0.02). Post hoc analyses showed a significant interaction with parity in this association (p = 0.016) such that multiparous women appeared more affected by poor sleep quality in late pregnancy. Sleep quality pre- and postpartum were highly correlated (p > 0.001). Meanwhile, hormonal and inflammatory markers did not significantly interact with sleep quality and postpartum well-being.

Conclusion: Sleep quality in late pregnancy is associated with maternal mental health early postpartum and this phenomenon appeared to be most pronounced for multiparous women.

Keywords: Childbirth; Maternal mental health; Non-pharmacological intervention; Parity; Prenatal sleep quality.