Association of sleep quality during pregnancy with stress and depression: a prospective birth cohort study in China
Abstract Background: Sleep quality in the third trimester of pregnant women is related to mental health. However, There is still a lack of large-scale cohort research in the second trimester to confirms this relationship. We aim to assess the associations of sleep quality during the second trimester with antenatal stress and antenatal and postnatal depression. Methods: We examined 1152 pregnant women from a prospective cohort study in China to assess the associations of sleep quality in the second trimester with antenatal stress, antenatal depression, and postnatal depression. We used linear regression models and logistic regression models to examine the associations of sleep quality (Pittsburgh Sleep Quality Index [PSQI]) during pregnancy with perinatal stress (Pregnancy Pressure Scale [PPS]) and depression (Edinburgh Postnatal Depression Scale [EPDS]) status. We further assessed the relationship in groups divided according to age. Results: PSQI scores were positively associated with antenatal PPS scores (β: 1.52, 95% confidence interval [CI]: 1.28, 1.76), antenatal EPDS scores (β: 0.68, 95% CI: 0.58, 0.78), and postpartum EPDS scores (β: 0.51, 95% CI: 0.38, 0.64). Poor sleep quality was associated with antenatal stress status (odds ratio [OR]: 2.60, 95% CI: 1.79, 3.77), antenatal depression status (OR: 3.42, 95% CI: 2.48, 4.72), and postpartum depression status (OR: 2.40, 95% CI: 1.58, 3.64). The association of sleep quality in the second trimester with depression status was found in women older than 30 years old (OR: 4.12, 95% CI: 2.18, 7.78) and not in women younger than 30 years old. Conclusion: Poor sleep quality in the second trimester among Chinese pregnant women is associated with stress and depression symptoms. Strategies to boost sleep quality should be considered during prenatal health care to improve women’s mental health status.