Sleep and mental health in pregnancy during COVID-19: A parallel process growth model

Abstract

Objectives: Pregnancy is associated with elevated risk for poor sleep quality, which increases the risk for poor obstetrical outcomes and parent mental health problems. The COVID-19 pandemic has seen increased reports of disturbed sleep worldwide; however, the degree this extends to pregnancy or influences pregnancy mental health outcomes has not been examined. The goal of this study was to examine changes in pregnant individuals' sleep, anxiety, and depression during the pandemic, and to understand how sleep was associated with symptoms of anxiety and depression over time.

Methods: The Pregnancy During the COVID-19 Pandemic (PdP) study is a prospective longitudinal cohort of pregnant individuals (at enrollment) with repeated follow-ups during pregnancy and the postpartum period. About 3747 pregnant individuals participated between April and July 2020. The present analysis was restricted to participants who completed at least 2 assessments, yielding a final sample of 1842 pregnant individuals.

Results: Depression symptoms were elevated at baseline, compared to prepandemic estimates of prevalence, but declined gradually over time. Shorter sleep duration, higher sleep disturbance, and more sleep-related impairments at baseline predicted a slower decline in depression symptoms over time. More sleep disturbances at baseline also predicted slower decline in anxiety symptoms over time. In contrast, rates of depression and anxiety symptoms at baseline were not predictive of changes in any of the 3 sleep variables over time.

Conclusions: These findings highlight the importance of early intervention for sleep problems in pregnancy, in order to optimize mental health throughout pregnancy and mitigate long-term negative outcomes.

Keywords: Anxiety; COVID-19; Depression; Longitudinal; Pandemic; Pregnancy; Sleep.

Fig. 1

Associations tested in the bivariate (parallel) latent growth models (LGMs). Mental health refers to depression or anxiety. Sleep refers to sleep duration, sleep disturbance, or sleep-related impairments.