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Most of the studies addressing the connection between sleep during pregnancy and postnatal depression have been cross-sectional, have had a low number of participants, have focused on insomnia symptoms during late pregnancy versus depressive symptoms in the postnatal period, have had a high drop-out rate (for example, 75% from the baseline), or have not differentiated prenatal sleeping problems between the pregnancy trimesters. Poor sleep during pregnancy has been associated with both maternal and foetal health risks, such as maternal hypertension and gestational diabetes, poor obstetric outcomes, foetal growth restriction, and the risk of preterm delivery, as well as interpersonal distress and mood disorders. Prenatal insomnia symptoms of varying severity are very common they are reported in at least 50% of women in different stages of pregnancy, depending on the characteristics of the study population and measurement methods. According to a recent review, 42–100% of women with postnatal depression, anxiety or psychosis also suffered from concurrent insomnia. Perinatal psychiatric disorders are closely related to disturbances in sleep. Nevertheless, the effect and magnitude of increased risk with each cumulating factor have not been explored. Insomnia symptoms during late pregnancy are one of these risk factors, as summarized in several reviews and a recent meta-analysis. Several risk factors for PPD have been identified, including anxiety during pregnancy, multiparity, a low-income level, and a history of depression. PPD has potentially long-term adverse consequences for the mother, child, and entire family.
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Postpartum depression (PPD) affects approximately 8% of women in European countries, and up to 13–19% in other high-income countries. Odds ratios of risk factor combinations demonstrate the magnitude of cumulating risk of PDS when multiple risk factors are present. Screening of long sleep latency and anxiety during early pregnancy, in addition to depression screening, could be advisable. Furthermore, we found highly elevated odds ratios in early, mid-, and late pregnancy for women with multiple PDS risk factors. Our predictive models indicated that sleep latency of ≥ 20 min, anxiety in early pregnancy, and insufficient sleep during late pregnancy predicted the risk of PDS. Of the 2224 women included in the study, 7.1% scored EPDS ≥ 11 3 months postnatally. We also calculated separate and combined predictive models of PDS for each pregnancy time point and reported the odds ratios for each risk group. Using data from the FinnBrain Birth Cohort Study and logistic regression analyses, we investigated the associations of distinct insomnia symptoms at gw 14, 24, and 34 with depressive symptoms (Edinburgh Postnatal Depression Scale score ≥ 11) 3 months postnatally. Our aim was to test how various insomnia symptoms (sleep latency, duration, quality, frequent night awakenings, early morning awakenings) and other risk factors (e.g., history of depression, symptoms of depression and anxiety, as well as sociodemographic factors) in early, mid-, and late pregnancy predict PDS. However, the cumulative effect of various risk factors throughout pregnancy has not been explored. Insomnia symptoms during late pregnancy are a known risk for postnatal depressive symptoms (PDS).