Psychological state during pregnancy is associated with sleep quality: preliminary findings from MY-CARE cohort study

ABSTRACT

Psychological distress during pregnancy may increase the risk of adverse maternal and infant outcomes. Past studies have demonstrated the association between circadian disturbances with psychological health. However, the roles of chronotype and social jetlag on psychological state during pregnancy are yet to be identified. We aimed to examine the psychological state in pregnant women and its relations to chronotype, social jetlag (SJL), sleep quality and cortisol rhythm. The current study included a subsample of participants from an ongoing cohort study. A total of 179 primigravidas (mean age 28.4 ± 4.0 years) were recruited. Chronotype and sleep quality during the second trimester were assessed using the Morning-Eveningness Questionnaire (MEQ) and Pittsburgh Sleep Quality Index (PSQI), respectively. SJL was calculated based on the difference between mid-sleep on workdays and free days. Psychological state of participants was evaluated using the Depression, Anxiety, and Stress Scale-21 (DASS-21). Subsamples (n = 70) provided salivary samples at 5 time points over a 24 h period during the second trimester for cortisol assay. A higher proportion of pregnant women experienced moderate to severe anxiety symptoms (n = 77, 43.0%), followed by depressive (n = 17, 9.5%) and stress (n = 14, 7.8%) symptoms. No association was observed between chronotype and psychological distress during pregnancy. There was no significant difference in cortisol rhythms in relation to psychological distress. SJL and sleep quality were significantly associated with stress symptoms among pregnant women in the second trimester. Poor sleep quality, particularly daytime dysfunction (β = 0.37, p = .006) and sleep disturbances (β = 0.23, p = .047), were significantly associated with psychological distress (depressive, anxiety and stress symptoms) during the second trimester. The findings suggest that sleep is a potential modifiable lifestyle factor that can be targeted to improve psychological health among pregnant women.

KEYWORDS:

• Sleep
• chronotype
• social jetlag
• cortisol rhythm
• mental health
• pregnancy

Author contributions

T.A.N was responsible for data analysis and writing the manuscript. S.K, N.H.S and S.R.S were responsible for the conception of the study, provided input to data analysis and reviewed the manuscript. N.A.B, M.T, L.P.J and S.S guided in lab analysis results and reviewed the manuscript with substantial contribution to the interpretation of the results. All authors approved the final version of the manuscript.

Acknowledgements

We are grateful to the pregnant women who provided the data and samples.

Disclosure of interest

The authors report no conflict of interest.

Additional information

Funding

This study is financially supported by the Ministry of Education Malaysia under Fundamental Research Grant Scheme [FRGS/1/2018/SKK06/UCSI/02/2].