Skip to main content
SpringerLink
Log in

Effects of sleep quality in early pregnancy on pregnancy outcomes and mood state

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

To clarify the relationship between quality of sleep and pregnancy outcomes and to explore how sleep quality affects mood state in the first trimester of pregnancy.

Methods

This prospective cohort study enrolled pregnant women from June 2020 to June 2021. Maternal sleep conditions, daytime sleepiness, and mood state in the first trimester were assessed using four Chinese self-rating scales, namely, the Pittsburgh Sleep Quality Index (PSQI), the Sleep Hygiene Practice Scale (SHPS), Epworth Sleepiness Scale (ESS), and the abbreviated version of the Profile of Mood States (a-POMS). Participants were divided into an exposed group (PSQI score > 5, poor sleep quality group) and a non-exposed group (PSQI score ≤ 5, good sleep quality group). Maternal characteristics, pregnancy outcomes, and the relationship among sleep quality, sleepiness, and mood state were analyzed. Comparisons of sleep hygiene behavior variables between the two subgroups were also analyzed.

Results

A total of 2703 pregnant women were enrolled in the study. Poor sleep quality increased the probability of gestational diabetes mellitus (GDM) (1.573, 1.315–1.863), liver function damage (1.467, 1.021–2.107), preterm delivery (1.468, 1.077–2.002), mild sleepiness (1.612, 1.357–1.915), and excessive sleepiness (2.134, 1.686–2.701). Poor maternal sleep quality was significantly associated with the occurrence of preterm premature rupture of membranes (1.947, 1.168–3.243) and perinatal death (1.003, 1.000–1.006). Additionally, a significant positive correlation between the PSQI score and the total mood disturbance (TMD) score was revealed by Spearman’s correlation analysis (r = 0.378, P < 0.01). Enter Regression analysis demonstrated that sleep quality (R2 = 0.390, P < 0.01) and sleepiness (R2 = 0.234, P < 0.01) exerted significant direct effects on mood state during pregnancy. Furthermore, Spearman’s correlation analysis indicated a positive association between the PSQI score and the SHPS total score (r = 0.227, P < 0.01).

Conclusions

Poor sleep quality is significantly associated with elevated rates of maternal mood disturbances, obstetric complications, and adverse outcomes in infants. The findings suggest that it may be useful to provide comprehensive sleep assessment and education on sleep hygiene during the early stages of pregnancy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The datasets are available from the corresponding author upon reasonable request.

References

  1. Johnson DA, Javaheri S, Guo N et al (2020) Objective measures of sleep apnea and actigraphy-based sleep characteristics as correlates of subjective sleep quality in an epidemiologic study: the Jackson Heart Sleep Study. Psychosom Med 82(3):324–330. https://doi.org/10.1097/PSY.0000000000000778

    Article  PubMed  PubMed Central  Google Scholar 

  2. Mindell JA, Cook RA, Nikolovski J (2015) Sleep patterns and sleep disturbances across pregnancy. Sleep Med 16(4):483–488. https://doi.org/10.1016/j.sleep.2014.12.006

    Article  PubMed  Google Scholar 

  3. Sedov ID, Cameron EE, Madigan S, Tomfohr-Madsen LM (2018) Sleep quality during pregnancy: a meta-analysis. Sleep Med Rev 38:168–176. https://doi.org/10.1016/j.smrv.2017.06.005

    Article  PubMed  Google Scholar 

  4. Wilson DL, Barnes M, Ellett L et al (2011) Decreased sleep efficiency, increased wake after sleep onset and increased cortical arousals in late pregnancy. Aust N Z J Obstet Gynaecol 51(1):38–46. https://doi.org/10.1111/j.1479-828X.2010.01252.x

    Article  PubMed  Google Scholar 

  5. Schorr SJ, Chawla A, Devidas M et al (1998) Sleep patterns in pregnancy: a longitudinal study of polysomnography recordings during pregnancy. J Perinatol 18(6 Pt 1):427–430

    CAS  PubMed  Google Scholar 

  6. Sweet L, Arjyal S, Kuller JA, Dotters-Katz S (2020) A review of sleep architecture and sleep changes during pregnancy. Obstet Gynecol Surv 75(4):253–262. https://doi.org/10.1097/OGX.0000000000000770

    Article  PubMed  Google Scholar 

  7. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Buysse Kupfer DJ, DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ, (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatr Res 28(2):193–213. https://doi.org/10.1016/0165-1781(89)90047-4

    Article  CAS  Google Scholar 

  8. Qi H, Liu R, Zhou J, Feng Y, Feng L, Feng Z, Yan F (2023) Investigating sleep quality and sleep hygiene awareness among Chinese adults: an association and network analysis study. Sleep Breath 27(5):2049–2058. https://doi.org/10.1007/s11325-023-02798-0

    Article  PubMed  Google Scholar 

  9. Tsai SY, Lee CN, Wu WW, Landis CA (2016) Sleep hygiene and sleep quality of third-trimester pregnant women. Res Nurs Health 39(1):57–65. https://doi.org/10.1002/nur.21705

    Article  PubMed  Google Scholar 

  10. Holding BC, Sundelin T, Schiller H, Åkerstedt T, Kecklund G, Axelsson J (2020) Sleepiness, sleep duration, and human social activity: an investigation into bidirectionality using longitudinal time-use data. Proc Nat Acad Sci United States Am 117(35):21209–21217. https://doi.org/10.1073/pnas.2004535117

    Article  CAS  Google Scholar 

  11. Effati-Daryani F, Mohammad-Alizadeh-Charandabi S, Mohammadi A, Zarei S, Mirghafourvand M (2021) Fatigue and sleep quality in different trimesters of pregnancy. Sleep Sci 14(Spec 1):69–74. https://doi.org/10.5935/1984-0063.20200091

    Article  PubMed  PubMed Central  Google Scholar 

  12. Insana SP, Montgomery-Downs HE (2010) Maternal postpartum sleepiness and fatigue: associations with objectively measured sleep variables. J Psychosom Res 69(5):467–473. https://doi.org/10.1016/j.jpsychores.2010.07.004

    Article  PubMed  PubMed Central  Google Scholar 

  13. Sarberg M, Bladh M, Svanborg E, Josefsson A (2016) Postpartum depressive symptoms and its association to daytime sleepiness and restless legs during pregnancy. BMC Pregnancy Childbirth 16(1):137. https://doi.org/10.1186/s12884-016-0917-9

    Article  PubMed  PubMed Central  Google Scholar 

  14. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545. https://doi.org/10.1093/sleep/14.6.540

    Article  CAS  PubMed  Google Scholar 

  15. Baumgartel KL, Terhorst L, Conley YP, Roberts JM (2013) Psychometric evaluation of the Epworth sleepiness scale in an obstetric population. Sleep Med 14(1):116–121. https://doi.org/10.1016/j.sleep.2012.10.007

    Article  PubMed  Google Scholar 

  16. McNair DM, Lorr M, Droppleman LF (1992) EDITS manual profile of mood states. San Diego: Educational and Industrial Testing Service

  17. Grussu P, Quatraro RM, Nasta MT (2005) Profile of Mood States and parental attitudes in motherhood: comparing women with planned and unplanned pregnancies. Birth 32(2):107–114. https://doi.org/10.1111/j.0730-7659.2005.00353.x

    Article  PubMed  Google Scholar 

  18. Ho KY, Lam KKW, Xia W et al (2021) Psychometric properties of the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) among Hong Kong Chinese childhood cancer survivors. Health Qual Life Outcomes 19(1):176. https://doi.org/10.1186/s12955-021-01803-y

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Tsai PS, Wang SY, Wang MY, Su CT, Yang TT, Huang CJ, Fang SC (2005) Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects. Qual Life Res 14(8):1943–1952. https://doi.org/10.1007/s11136-005-4346-x

    Article  CAS  PubMed  Google Scholar 

  20. Dauvilliers Y, Arnulf I, Foldvary-Schaefer N et al (2022) Safety and efficacy of lower-sodium oxybate in adults with idiopathic hypersomnia: a phase 3, placebo-controlled, double-blind, randomised withdrawal study. Lancet Neurol 21(1):53–65. https://doi.org/10.1016/S1474-4422(21)00368-9

    Article  CAS  PubMed  Google Scholar 

  21. Chen NH, Johns MW, Li HY, Chu CC, Liang SC, Shu YH, Chuang ML, Wang PC (2002) Validation of a Chinese version of the Epworth sleepiness scale. Qual Life Res 11(8):817–821. https://doi.org/10.1023/a:1020818417949

    Article  PubMed  Google Scholar 

  22. Hollingworth W, Metcalfe C, Mancero S, Harris S, Campbell R, Biddle L, McKell-Redwood D, Brennan J (2013) Are needs assessments cost effective in reducing distress among patients with cancer? A randomized controlled trial using the Distress Thermometer and Problem List. J Clin Oncol 31(29):3631–8. https://doi.org/10.1200/JCO.2012.48.3040

    Article  PubMed  Google Scholar 

  23. Kakko J, von Wachenfeldt J, Svanborg KD, Lidström J, Barr CS, Heilig M (2008) Mood and neuroendocrine response to a chemical stressor, metyrapone, in buprenorphine-maintained heroin dependence. Biol Psychiatry 63(2):172–7. https://doi.org/10.1016/j.biopsych.2007.05.001

    Article  CAS  PubMed  Google Scholar 

  24. O’connor PJ, Poudevigne MS, Johnson KE, Brito de Araujo J, Ward-Ritacco CL (2018) Effects of resistance training on fatigue-related domains of quality of life and mood during pregnancy: a randomized trial in pregnant women with increased risk of back pain. Psychosom Med 80(3):327–332. https://doi.org/10.1097/PSY.0000000000000559

    Article  PubMed Central  Google Scholar 

  25. Chen KM, Snyder M, Krichbaum K (2002) Translation and equivalence: the Profile of Mood States short form in English and Chinese. Int J Nurs Stud 39(6):619–624. https://doi.org/10.1016/s0020-7489(01)00068-2

    Article  PubMed  Google Scholar 

  26. Kakoschke N, Zajac IT, Tay J et al (2021) Effects of very low-carbohydrate vs. high-carbohydrate weight loss diets on psychological health in adults with obesity and type 2 diabetes: a 2-year randomized controlled trial. Eur J Nutr 60(8):4251–4262. https://doi.org/10.1007/s00394-021-02587-z

    Article  CAS  PubMed  Google Scholar 

  27. Nyenhuis DL, Yamamoto C, Luchetta T, Terrien A, Parmentier A (1999) Adult and geriatric normative data and validation of the profile of mood states. J Clin Psychol 55(1):79–86. https://doi.org/10.1002/(sici)1097-4679(199901)55:1%3c79::aid-jclp8%3e3.0.co;2-7

    Article  CAS  PubMed  Google Scholar 

  28. Yang CM, Lin SC, Hsu SC, Cheng CP (2010) Maladaptive sleep hygiene practices in good sleepers and patients with insomnia. J Health Psychol 15(1):147–155. https://doi.org/10.1177/1359105309346342

    Article  PubMed  Google Scholar 

  29. Wu R, Wang CY, Wang F, Wang YJ, Zhu H, Wang GH, Jiang CL (2022) Association between sleep and suicidal ideation in Chinese undergraduate students. Int J Environ Res Public Health 19(23):15433. https://doi.org/10.3390/ijerph192315433

    Article  PubMed  PubMed Central  Google Scholar 

  30. Grandner MA, Seixas A, Shetty S, Shenoy S (2016) Sleep duration and diabetes risk: population trends and potential mechanisms. Curr Diab Rep 16(11):106. https://doi.org/10.1007/s11892-016-0805-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Gooley JJ, Mohapatra L, Twan DCK (2017) The role of sleep duration and sleep disordered breathing in gestational diabetes mellitus. Neurobiol Sleep Circadian Rhythms 4:34–43. https://doi.org/10.1016/j.nbscr.2017.11.001

    Article  PubMed  PubMed Central  Google Scholar 

  32. Wang H, Leng J, Li W, Wang L, Zhang C, Li W (2017) Sleep duration and quality, and risk of gestational diabetes mellitus in pregnant Chinese women. Diabet Med 34(1):44–50. https://doi.org/10.1111/dme.13155

    Article  CAS  PubMed  Google Scholar 

  33. Eckel-Mahan KL, Patel VR, Mohney RP, Vignola KS, Baldi P, Sassone-Corsi P (2012) Coordination of the transcriptome and metabolome by the circadian clock. Proc Natl Acad Sci USA 109(14):5541–5546. https://doi.org/10.1073/pnas.1118726109

    Article  PubMed  PubMed Central  Google Scholar 

  34. Marin-Alejandre BA, Abete I, Cantero I et al (2019) Association between sleep disturbances and liver status in obese subjects with nonalcoholic fatty liver disease: a comparison with healthy controls. Nutrients 11(2):322. https://doi.org/10.3390/nu11020322

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Arble DM, Bass J, Behn CD et al (2015) Impact of sleep and circadian disruption on energy balance and diabetes: a summary of workshop discussions. Sleep 38(12):1849–1860. https://doi.org/10.5665/sleep.5226

    Article  PubMed  PubMed Central  Google Scholar 

  36. Li R, Zhang J, Zhou R et al (2017) Sleep disturbances during pregnancy are associated with cesarean delivery and preterm birth. J Matern Fetal Neonatal Med 30(6):733–738. https://doi.org/10.1080/14767058.2016.1183637

    Article  PubMed  Google Scholar 

  37. Chen YH, Kang JH, Lin CC, Wang IT, Keller JJ, Lin HC (2012) Obstructive sleep apnea and the risk of adverse pregnancy outcomes. Am J Obstet Gynecol 206(2):136.e1-136.e1365. https://doi.org/10.1016/j.ajog.2011.09.006

    Article  PubMed  Google Scholar 

  38. Kajeepeta S, Sanchez SE, Gelaye B, Qiu C, Barrios YV, Enquobahrie DA, Williams MA (2014) Sleep duration, vital exhaustion, and odds of spontaneous preterm birth: a case-control study. BMC Pregnancy Childbirth 14:337. https://doi.org/10.1186/1471-2393-14-337

    Article  PubMed  PubMed Central  Google Scholar 

  39. Okun ML, Schetter CD, Glynn LM (2011) Poor sleep quality is associated with preterm birth. Sleep 34(11):1493–1498. https://doi.org/10.5665/sleep.1384

    Article  PubMed  PubMed Central  Google Scholar 

  40. Blair LM, Porter K, Leblebicioglu B, Christian LM (2015) Poor sleep quality and associated inflammation predict preterm birth: heightened risk among African Americans. Sleep 38(8):1259–1267. https://doi.org/10.5665/sleep.4904

    Article  PubMed  PubMed Central  Google Scholar 

  41. Wang L, Jin F (2020) Association between maternal sleep duration and quality, and the risk of preterm birth: a systematic review and meta-analysis of observational studies. BMC Pregnancy Childbirth 20(1):125. https://doi.org/10.1186/s12884-020-2814-5

    Article  PubMed  PubMed Central  Google Scholar 

  42. Melatonin (2022) In: Drugs and Lactation Database (LactMed®). Bethesda (MD): National Institute of Child Health and Human Development.

  43. McCowan LM, Thompson JM, Cronin RS et al (2017) Going to sleep in the supine position is a modifiable risk factor for late pregnancy stillbirth; findings from the New Zealand multicentre stillbirth case-control study. PloS one 12(6):e0179396. https://doi.org/10.1371/journal.pone.0179396

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Cronin RS, Wilson J, Gordon A et al (2020) Associations between symptoms of sleep-disordered breathing and maternal sleep patterns with late stillbirth: findings from an individual participant data meta-analysis. PloS one 15(3):e0230861. https://doi.org/10.1371/journal.pone.0230861

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Warland J, Dorrian J, Morrison JL, O’Brien LM (2018) Maternal sleep during pregnancy and poor fetal outcomes: a scoping review of the literature with meta-analysis. Sleep Med Rev 41:197–219. https://doi.org/10.1016/j.smrv.2018.03.004

    Article  PubMed  Google Scholar 

  46. Kubota C, Inada T, Shiino T et al (2019) Relation between perinatal depressive symptoms, harm avoidance, and a history of major depressive disorder: a cohort study of pregnant women in Japan. Front Psychiatry 10:515. https://doi.org/10.3389/fpsyt.2019.00515

    Article  PubMed  PubMed Central  Google Scholar 

  47. Lillis TA, Hamilton NA, Pressman SD et al (2018) Sleep quality buffers the effects of negative social interactions on maternal mood in the 3–6 month postpartum period: a daily diary study. J Behav Med 41(5):733–746. https://doi.org/10.1007/s10865-018-9967-y

    Article  PubMed  PubMed Central  Google Scholar 

  48. Bei B, Coo S, Trinder J (2015) Sleep and mood during pregnancy and the postpartum period. Sleep Med Clin 10(1):25–33. https://doi.org/10.1016/j.jsmc.2014.11.011

    Article  PubMed  Google Scholar 

  49. Beijers R, Buitelaar JK, de Weerth C (2014) Mechanisms underlying the effects of prenatal psychosocial stress on child outcomes: beyond the HPA axis. Eur Child Adolesc Psychiatry 23(10):943–956. https://doi.org/10.1007/s00787-014-0566-3

    Article  PubMed  Google Scholar 

  50. Liu J, Ji X, Wang G, Li Y, Leung PW, Pinto-Martin J (2020) Maternal emotions during the pre/postnatal periods and children’s sleep behaviors: the mediating role of children’s behavior. J Affect Disord 273:138–145. https://doi.org/10.1016/j.jad.2020.03.178

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank the patients who participated in the study and all International Peace Maternity and Child Health Hospital workers. We thank Jinwen Zhang for her support in data statistics and analysis.

Funding

Jianxia Fan provided financial support in the form of the National Key R&D Program of China [grant number 2018YFC1004602] and the National Natural Science Foundation of China [grant numbers 82261128001].

Author information

Author notes

  1. Yanqing Cai and Guojun Ma contributed equally to this work and should be considered as co-first authors.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road, Shanghai, 200030, China

    Yanqing Cai, Guojun Ma & Jianxia Fan

  2. Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China

    Yanqing Cai, Guojun Ma & Jianxia Fan

  3. Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences, Shanghai, China

    Yanqing Cai, Guojun Ma & Jianxia Fan

Authors
  1. Yanqing Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Guojun Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jianxia Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YQC designed the study and prepared the draft; GJM contributed to the analysis and wrote the manuscript; JXF contributed to the study design and revision of the manuscript. The final submission was checked and approved by all contributors.

Corresponding author

Correspondence to Jianxia Fan.

Ethics declarations

Ethical approval

All procedures performed in this study involving human participants were reviewed and approved by the Ethics Committee of the International Peace Maternity and Child Health Hospital (GKLW 2019-58). The procedures used in this study adhere to the 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cai, Y., Ma, G. & Fan, J. Effects of sleep quality in early pregnancy on pregnancy outcomes and mood state. Sleep Breath (2023). https://doi.org/10.1007/s11325-023-02968-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11325-023-02968-0

Keywords

Search

Navigation