Dream-associated behaviors affecting pregnant and postpartum women

Abstract

Study objectives: Evaluate the prevalence and phenomenology of dream-associated behaviors affecting pregnant and postpartum mothers. Episodes consist of anxious dreams and nightmares about the new infant that are accompanied by complex behaviors (motor activity, speaking, expressing emotion).

Design: Three-group design (postpartum, pregnant, null gravida), self-report, and repeated measures.

Setting: Pregnancy and postpartum groups: completion of questionnaires in hospital room within 48 hours of giving birth and home telephone interviews; null gravida group: completion of questionnaires and interview in person or by telephone.

Participants: Two hundred seventy-three women in 3 groups: postpartum: n = 202 (mean age = 29.7 +/- 4.94 years; 95 primiparas, 107 multiparas); pregnant: n = 50 (mean age = 31.1 +/- 5.44 years); null gravida: n = 21 (mean age = 28.5 +/- 6.34 years).

Interventions: Subjects completed questionnaires about pregnancy and birth factors, personality, and sleep and participated in interviews concerning the prevalence of recent infant dreams and nightmares, associated behaviors, anxiety, depression, and other psychopathologic factors.

Measurements and results: Most women in all groups recalled dreams (88%-91%). Postpartum and pregnant women recalled infant dreams and nightmares with equal prevalence, but more postpartum women reported they contained anxiety (75%) and the infant in peril (73%) than did pregnant women (59%, P < 0.05 and 42%, P < 0.0001). More postpartum (63%) than pregnant (40%) women reported dream-associated behaviors (P < 0.01), but neither group differed from null gravida women (56%). This was due to different distributions over groups of the behavior subtypes. Motor activity was present in twice as many postpartum (57%) as pregnant (24%) or null gravida (25%) women (all P < 0.0001). Expressing emotion was more prevalent among null gravida (56%) than postpartum women (27%) (P < 0.05) but was not different from pregnant women (37%). Speaking was equally prevalent among the 3 groups (12%-19%). Behaviors were associated with nightmares, dream anxiety and, among postpartum women, post-awakening anxiety (41%), confusion (51%), and a need to check on the infant (60%). Primiparas and multiparas differed in dream and nightmare recall but not in prevalence of dream-associated behaviors.

Conclusion: The prevalent occurrence of pregnancy and postpartum infant dreams and associated behaviors may reflect the pervasive emotional influence of maternal concerns or changes instigated by severe sleep disruption, rapid eye movement sleep deprivation, and altered hormone levels.

Figure 1

Prevalence of women in the null gravida (white bars), pregnancy (grey bars), and postpartum (black bars) groups who recalled dreams, nightmares, infant dreams, and infant nightmares during the interview. Dream recall was equivalent for the 3 groups, and more null gravida women recalled at least 1 nightmare than did the women in either other group. Significantly more pregnant and postpartum mothers recalled dreams and nightmares about the infant than did null gravida women. *P < 0.05; **P < 0.01; ***P < 0.001

Figure 2

Prevalence of dream-associated sleep behaviors reported by women in the null gravida (white bars), pregnancy (grey bars), and postpartum (black bars) groups who were able to recall a dream during the interview. Comparisons with the postpartum group are conservative because prevalence estimates are from the 3 prior months, whereas those for the pregnancy and null gravida groups are from the 9 prior months. Postpartum women nonetheless reported the highest prevalence of any behavior (63%; framed bars at right), which was significantly more than the pregnancy group (40%) but not different from the null gravida group (56%). This is because different distributions characterized the 3 behavior subtypes. An unexpectedly high prevalence of Expressing emotion characterized the null gravida group (56%), whereas a markedly higher prevalence of Motor activity (57%) characterized the postpartum group. Speaking was only slightly higher for the postpartum group. Expressing emotion followed a pattern observed for most other parasomnias previously studied, decreasing from pregnancy to postpartum (see text), whereas Motor activity was atypically elevated postpartum. Due to the conservative nature of the comparisons, the true differences for Expressing emotion may be smaller, and those for Motor activity and Speaking larger, than shown in the figure. *P < 0.05; **P < 0.01; ***P < 0.001