Prioritizing maternal sleep reduces risk of postpartum anxiety disorders

Postpartum and perinatal depression are known challenges for those going through pregnancy, but there has been less focus on the more prevalent disorder of anxiety.

Roughly 15% of people experience an anxiety-related disorder during pregnancy and during the postpartum period, or weeks after childbirth, along with heightened risk for obsessive-compulsive disorder (OCD) symptoms. Researchers at Washington University in St. Louis wanted to understand how sleep disruption factors into all of this.

In a study published recently in Sleep, the researchers, including senior author and psychiatrist Mary Kimmel, MD, PhD, at WashU Medicine, and psychologist Rebecca Cox, PhD, in Arts & Sciences, surveyed about 230 women during early and late pregnancy and the early and later postpartum period to see how sleep disruption correlates with anxiety and OCD symptoms. 

Getting a full night's sleep can be difficult during this time, said Cox, an assistant professor of psychological and brain sciences and first author on the paper. The perinatal period, which covers pregnancy through the child's first year or two, is marked with sleep disruption, which can be caused by a variety of factors such as hormonal and physical changes, as well as stressors associated with pregnancy.

In the new study, results reflected prior research suggesting that sleep problems during pregnancy are especially pronounced in the third trimester, increase during the early postpartum period, and stabilize thereafter. But the downstream effects of that sleep disruption on anxiety required more investigation.

Survey participants completed several measures of sleep habits and anxiety, which included questions related to "worrying about the baby" or "fear of harm coming to the baby," along with questions related to OCD traits, such as exhibiting thoughts like "harmful events will happen unless I'm very careful" or "things are not right if they're not perfect."

The team also investigated how a pregnant person's confidence in their ability "to cope" affects that sleep and anxiety. Coping measurements look at an individual's sense that they have a situation "under control," or their perceived ability to flexibly respond to changing demands, Cox said.

In general, shorter sleep duration was associated with increases in perinatal anxiety and obsessive beliefs over time, study authors found. Mothers who had more disturbed sleep, on average, had heightened perinatal anxiety, and the effect was worse for those who had lower levels of coping ability.

In contrast, coping did not influence the association between sleep and obsessive beliefs. The reverse direction, anxiety and obsessive beliefs predicting less sleep, was not supported in this study, meaning that sleep loss generally precedes the arrival of anxiety-related symptoms.

The main finding suggests that shorter sleep duration is a more "robust longitudinal predictor of perinatal anxiety," according to study authors, and disrupted sleep might be a good target for perinatal mental health intervention.

The bottom line, Cox said, is "trying to prioritize mom's sleep may have benefits for her mental health."