Prenatal insomnia and childbirth-related PTSD symptoms: a prospective population-based cohort study
1Institute of Higher Education and Research in Healthcare, University of Lausanne, Switzerland; 2LP3C - EA 1285, Univ Rennes, Rennes, France; 3Institute of Clinical Medicine, University of Oslo, Oslo, Norway; 4Norwegian National Advisory Unit on Women’s Health, Women and Children’s Division, Oslo University Hospital, Oslo, Norway; 5Department of Medicine, Medical School Hamburg, Hamburg, Germany; 6Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway; 7Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany; 8Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland; 9These authors share joint last authorship.
Four to six percent of women develop childbirth-related posttraumatic stress disorder (CB-PTSD). Primary prevention interventions against CB-PTSD are lacking; identifying prenatal risk factors is thus crucial. Prenatal insomnia could be an important risk factor because sleep deprivation may increase distress during childbirth and hinder postpartum recovery. This study aimed to examine the relationship between prenatal insomnia symptoms and CB-PTSD symptoms, whilst taking postnatal insomnia into account.
Methods: In this prospective population-based cohort study of 1,610 pregnant women, insomnia symptoms were measured at 32 weeks of pregnancy with the Bergen Insomnia Scale. CB-PTSD symptoms were measured at eight weeks postpartum, with the Impact of Event Scale. Postnatal insomnia symptoms, prenatal psychological symptoms (PTSD, depression, anxiety, fear of childbirth), as well as mode of childbirth and subjective birth experience (SBE) were included as covariates in the analyses, which were based on a Piecewise Structural Equation Modelling approach.
Results: Prenatal psychological symptoms were all associated with prenatal insomnia symptoms. Prenatal insomnia predicted CB-PTSD symptoms, and this relationship was mediated by postnatal insomnia symptoms and negative SBE.
Discussion: Prenatal insomnia symptoms may put mothers at risk of a negative SBE, thus suggesting a deleterious impact of prenatal insomnia on the ability to cope with a difficult birth. They also predicted postnatal insomnia, which contributes to CB-PTSD maintenance. Studies investigating the relationship between prenatal insomnia and postnatal mental health should therefore consider postnatal insomnia symptoms, which had not been addressed so far. Both prenatal and postnatal insomnia may be relevant targets for CB-PTSD interventions.