Although many perinatal women are affected by anxiety, few studies have focused on perinatal anxiety and its potential triggers. The primary aim of this study was to examine concurrent and prospective associations between mid-pregnancy insomnia and perinatal anxiety. Furthermore, we compared psychosocial and reproductive characteristics between participants with and without mid-pregnancy insomnia and explored changes in the prevalence of obsessive-compulsive disorder (OCD) symptoms from mid-pregnancy to 8 weeks postpartum.
This study was part of the Norwegian Depression and Anxiety in the Perinatal Period (DAPP) prospective, population-based, cohort study. We analyzed hospital birth records and questionnaire responses from pregnancy week 17 and postpartum week 8 (n = 530). The Bergen Insomnia Scale was used to measure insomnia and the Hopkins Symptom Checklist to measure anxiety. OCD symptoms were measured based on questions from the Mini-International Neuropsychiatric Interview. Results Mid-pregnancy insomnia was significantly associated with both concurrent and postpartum anxiety in a linear mixed model adjusted for several potential confounders. Participants with mid-pregnancy insomnia had significantly higher levels of perinatal anxiety and postpartum OCD symptoms than participants with normal mid-pregnancy sleep. OCD symptoms affected more women after delivery than before (6.4% vs. 3.8% p = 0.034).
Immigrants were underrepresented in our sample.
Our results suggest that mid-pregnancy insomnia is a marker for concurrent anxiety and predictor of postpartum anxiety. Future research should examine whether insomnia treatment starting in mid-pregnancy reduces both perinatal insomnia and anxiety. Health providers should also be aware that postpartum women have an increased risk of developing OCD symptoms.
Most research on perinatal mental disorders has focused on depression (Fisher et al., 2016), whereas anxiety, despite being prevalent (Fairbrother et al., 2016), has often been overlooked (Howard et al., 2014) and under-treated (Smith et al., 2009). Perinatal anxiety has been acknowledged as an essential topic, and a growing number of studies have addressed it (Field, 2018; Furtado et al., 2018), with an ongoing discussion regarding which instruments should be used for detection (Matthey, 2016; Sinesi et al., 2019). Anxiety can be defined as specific anxiety and related disorders (ADs), including obsessive-compulsive disorder (OCD) (Fairbrother et al., 2019), as well as less specific symptoms of excessive worry, restlessness, and malaise. Maternal anxiety may have negative implications not only for the obstetric outcome (Schetter and Tanner, 2012) and the child's health and development (Glasheen et al., 2010; Hoffman et al., 2017), but also for the mother's relationship with both the infant (Dawson et al., 2000) and the other parent (Wenzel et al., 2005), but more research on perinatal anxiety is needed (Ali, 2018; Goodman et al., 2016; McGuinness et al., 2011). Insomnia, a syndrome characterized by difficulties in sleep onset or continuity, poor sleep quality, and impaired daytime functioning (Reichner, 2015), is twice as frequent among women as men (Bei et al., 2015). During pregnancy, the prevalence of insomnia ranges from 13% early in the first trimester (Okun et al., 2015) up to 74% late in the third trimester (Fernández-Alonso et al., 2012). Insomnia can occur independently or in comorbidity with other psychiatric disorders (Morin and Benca, 2012) and is a risk factor for the development of anxiety in non-perinatal populations (Hertenstein et al., 2018). Thus, antenatal insomnia may be associated with perinatal anxiety. The few previous studies on the relationship between perinatal insomnia and anxiety are subject to limited access to covariates, small sample sizes, and the use of only antenatal measurements (Polo-Kantola et al., 2017); cross-sectional design and recruitment from psychiatric settings (Swanson et al., 2011); or assessments late in pregnancy (Osnes et al., 2019).