Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, MD, FRCOG, Joachim W.

Ed. by Bancalari, Eduardo / Chappelle, Joseph / Chervenak, Frank A. / D'Addario , Vincenzo / Genc, Mehmet R. / Greenough, Anne / Grunebaum, Amos / Konje, Justin C. / Kurjak M.D., Asim / Romero, Roberto / Zalud, MD PhD, Ivica

IMPACT FACTOR 2018: 1.361
5-year IMPACT FACTOR: 1.578

CiteScore 2018: 1.29

SCImago Journal Rank (SJR) 2018: 0.522
Source Normalized Impact per Paper (SNIP) 2018: 0.602

See all formats and pricing
More options …
Volume 47, Issue 7


Poor sleep quality is associated with perinatal depression. A systematic review of last decade scientific literature and meta-analysis

Ernesto González-MesaORCID iD: https://orcid.org/0000-0002-7106-092X
  • Corresponding author
  • Surgical Specialties, Biochemistry and Immunology Department, Malaga University School of Medicine, 32, Boulevard Louis Pasteur, 29071 Málaga, Spain
  • Obstetrics and Gynecology at Malaga University Hospital, Málaga, Spain
  • orcid.org/0000-0002-7106-092X
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Celia Cuenca-Marín / María Suarez-Arana / Beatriz Tripiana-Serrano / Nadia Ibrahim-Díez / Ana Gonzalez-Cazorla
  • Surgical Specialties, Biochemistry and Immunology Department, Malaga University School of Medicine, 32, Boulevard Louis Pasteur, 29071 Málaga, Spain
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Marta Blasco-Alonso
Published Online: 2019-08-06 | DOI: https://doi.org/10.1515/jpm-2019-0214



Although pregnancy is frequently associated with mental states of happiness, hope and well-being, some physical and psychological changes can contribute to increased sleep disturbances and worsened sleep quality. Sleep quality has been linked to negative emotions, anxiety and depression. The main objective of this paper was to systematically review the impact of sleep during pregnancy on maternal mood, studying the association between objective and subjective measures of sleep quality and perinatal depression.


We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, which included studies published between January 2008 and April 2019, and met the following criteria: (i) studies on pregnant women assessing the effects of sleep quality variables on perinatal mood disorders, (ii) studies published in English and (iii) full paper published in a peer-reviewed scientific journal with full-text format available.


A total of 36 studies published in the last decade met the inclusion criteria for qualitative review and eight of them were suitable for meta-analysis. Both confirmed the negative effects of poor sleep on perinatal mood. However, qualitative analysis showed that unrepresentative samples and low participation rates falling below 80% biased some of the studies. The standard random-effects meta-analysis showed a pooled size effect [ln odds ratio (OR) 1.49 (95% confidence interval [CI] 1.19, 1.79)] for perinatal depression in cases of poor prenatal sleep quality, although heterogeneity was moderate to high [Q 16.05, P ≤ 0.025, H2 2.45 (95% CI 1.01, 13.70)].


Poor sleep quality was associated with perinatal mood disturbances. The assessment of sleep quality along the pregnancy could be advisable with a view to offering preventative or therapeutic interventions when necessary.

Keywords: mood disorder; perinatal depression; sleep disturbance; sleep quality


  • 1.

    Otchet F, Carey MS, Adam L. General health and psychological symptom status in pregnancy and the puerperium: what is normal? Obstet Gynecol 1999;94:935–41.PubMedGoogle Scholar

  • 2.

    Hertz G, Fast A, Feinsilver SH, Albertario CL, Schulman H, Fein AM. Sleep in normal late pregnancy. Sleep 1992;15:246–51.PubMedCrossrefGoogle Scholar

  • 3.

    Lee KA, Zaffke ME, McEnany G. Parity and sleep patterns during and after pregnancy. Obstet Gynecol 2000;95:14–8.PubMedGoogle Scholar

  • 4.

    Sedov ID, Cameron EE, Madigan S, Tomfohr-Madsen LM. Sleep quality during pregnancy: a meta-analysis. Sleep Med Rev 2018;38:168–76.CrossrefPubMedGoogle Scholar

  • 5.

    Neau JP, Texier B, Ingrand P. Sleep and vigilance disorders in pregnancy. Eur Neurol 2009;62:23–9.CrossrefGoogle Scholar

  • 6.

    Anafi RC, Kayser MS, Raizen DM. Exploring phylogeny to find the function of sleep. Nat Rev Neurosci 2019;20:109–16.CrossrefPubMedGoogle Scholar

  • 7.

    Vandekerckhove M, Wang Y. Emotion, emotion regulation and sleep: an intimate relationship. AIMS Neurosci 2017;5:1–17.CrossrefGoogle Scholar

  • 8.

    Tochikubo O, Ikeda A, Miyajima E, Ishii M. Effects of insufficient sleep on blood pressure monitored by a new multibiomedical recorder. Hypertension 1996;27:1318–24.CrossrefPubMedGoogle Scholar

  • 9.

    Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet 1999;354:1435–9.CrossrefGoogle Scholar

  • 10.

    Baglioni C, Spiegelhalder K, Lombardo C, Riemann D. Sleep and emotions: a focus on insomnia. Sleep Med Rev 2010;14:227–38.PubMedCrossrefGoogle Scholar

  • 11.

    Ohayon M, Wickwire EM, Hirshkowitz M, Albert SM, Avidan A, Daly FJ, et al. National Sleep Foundation’s sleep quality recommendations: first report. Sleep Health 2017;3:6–19.PubMedCrossrefGoogle Scholar

  • 12.

    Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev [Internet] 2015;4:1.CrossrefGoogle Scholar

  • 13.

    Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e1000097.CrossrefPubMedGoogle Scholar

  • 14.

    McMaster University. Quality assessment tool for quantitative studies. Eff Public Health Pract Proj 2010. https://www.nccmt.ca/knowledge-repositories/search/14.

  • 15.

    Lawson A, Murphy KE, Sloan E, Uleryk E, Dalfen A. The relationship between sleep and postpartum mental disorders: a systematic review. J Affect Disord 2015;176:65–77.PubMedCrossrefGoogle Scholar

  • 16.

    DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177–88.PubMedCrossrefGoogle Scholar

  • 17.

    O’Brien LM, Owusu JT, Swanson LM. Habitual snoring and depressive symptoms during pregnancy. BMC Pregnancy Childbirth 2013;13:113.PubMedCrossrefGoogle Scholar

  • 18.

    Chung T-C, Chung C-H, Peng H-J, Tsao C-H, Chien W-C, Sun H-F. An analysis of whether sleep disorder will result in postpartum depression. Oncotarget 2018;9:25304–14.PubMedGoogle Scholar

  • 19.

    Gelaye B, Addae G, Neway B, Larrabure-Torrealva GT, Qiu C, Stoner L, et al. Poor sleep quality, antepartum depression and suicidal ideation among pregnant women. J Affect Disord 2017;209:195–200.PubMedCrossrefGoogle Scholar

  • 20.

    Mellor R, Chua SC, Boyce P. Antenatal depression: an artefact of sleep disturbance? Arch Womens Ment Health 2014;17:291–302.PubMedCrossrefGoogle Scholar

  • 21.

    Tham EK, Tan J, Chong YS, Kwek K, Saw SM, Teoh OH, et al. Associations between poor subjective prenatal sleep quality and postnatal depression and anxiety symptoms. J Affect Disord 2016;202:91–4.PubMedCrossrefGoogle Scholar

  • 22.

    Yu Y, Li M, Pu L, Wang S, Wu J, Ruan L, et al. Sleep was associated with depression and anxiety status during pregnancy: a prospective longitudinal study. Arch Womens Ment Health 2017;20:695–701.PubMedCrossrefGoogle Scholar

  • 23.

    Pietikainen JT, Polo-Kantola P, Polkki P, Saarenpaa-Heikkila O, Paunio T, Paavonen EJ. Sleeping problems during pregnancy-a risk factor for postnatal depressiveness. Arch Womens Ment Health 2019;22:327–37.PubMedCrossrefGoogle Scholar

  • 24.

    Swanson LM, Pickett SM, Flynn H, Armitage R. Relationships among depression, anxiety, and insomnia symptoms in perinatal women seeking mental health treatment. J Womens Health (Larchmt) 2011;20:553–8.CrossrefPubMedGoogle Scholar

  • 25.

    Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Br Med J 2003;327:557–60.CrossrefGoogle Scholar

  • 26.

    Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. Br Med J 1997;315:629–34.CrossrefGoogle Scholar

  • 27.

    Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000;56:455–63.CrossrefPubMedGoogle Scholar

  • 28.

    Rosenthal R. The file drawer problem and tolerance for null results. Psychol Bull 1979;86:638.CrossrefGoogle Scholar

  • 29.

    JASP Team. JASP (Version [Computer software]. 2018. https://jasp-stats.org.

  • 30.

    Chang HC, Chen SY, Chen CH. Predictors of antenatal psychosocial stress in Taiwanese women. J Nurs Res 2016;24:193–200.CrossrefPubMedGoogle Scholar

  • 31.

    Dorheim SK, Bondevik GT, Eberhard-Gran M, Bjorvatn B. Sleep and depression in postpartum women: a population-based study. Sleep 2009;32:847–55.CrossrefPubMedGoogle Scholar

  • 32.

    Palagini L, Cipollone G, Masci I, Novi M, Caruso D, Kalmbach DA, et al. Stress-related sleep reactivity is associated with insomnia, psychopathology and suicidality in pregnant women: preliminary results. Sleep Med 2019;56:145–50.CrossrefPubMedGoogle Scholar

  • 33.

    Sattler MC, Jelsma JG, Bogaerts A, Simmons D, Desoye G, Corcoy R, et al. Correlates of poor mental health in early pregnancy in obese European women. BMC Pregnancy Childbirth 2017;17:404.CrossrefPubMedGoogle Scholar

  • 34.

    Simpson W, Frey BN, Steiner M. Mild depressive symptoms during the third trimester of pregnancy are associated with disruptions in daily rhythms but not subjective sleep quality. J Womens Health 2016;25:594–8.CrossrefGoogle Scholar

  • 35.

    Volkovich E, Tikotzky L, Manber R. Objective and subjective sleep during pregnancy: links with depressive and anxiety symptoms. Arch Womens Ment Health 2016;19:173–81.PubMedCrossrefGoogle Scholar

  • 36.

    Hux VJ, Roberts JM, Okun ML. Allostatic load in early pregnancy is associated with poor sleep quality. Sleep Med 2017;33:85–90.CrossrefPubMedGoogle Scholar

  • 37.

    Kamysheva E, Skouteris H, Wertheim EH, Paxton SJ, Milgrom J. A prospective investigation of the relationships among sleep quality, physical symptoms, and depressive symptoms during pregnancy. J Affect Disord 2010;123:317–20.PubMedCrossrefGoogle Scholar

  • 38.

    Krawczak EM, Minuzzi L, Simpson W, Hidalgo MP, Frey BN. Sleep, daily activity rhythms and postpartum mood: a longitudinal study across the perinatal period. Chronobiol Int 2016;33:791–801.CrossrefGoogle Scholar

  • 39.

    Okun ML, Luther J, Prather AA, Perel JM, Wisniewski S, Wisner KL. Changes in sleep quality, but not hormones predict time to postpartum depression recurrence. J Affect Disord 2011;130:378–84.PubMedCrossrefGoogle Scholar

  • 40.

    Okun ML, Hanusa BH, Hall M, Wisner KL. Sleep complaints in late pregnancy and the recurrence of postpartum depression. Behav Sleep Med 2009;7:106–17.PubMedCrossrefGoogle Scholar

  • 41.

    Park EM, Meltzer-Brody S, Stickgold R. Poor sleep maintenance and subjective sleep quality are associated with postpartum maternal depression symptom severity. Arch Womens Ment Health 2013;16:539–47.PubMedCrossrefGoogle Scholar

  • 42.

    Paulson JL, Miller-Graff L. Prenatal sleep quality and mental health symptoms across the perinatal period: a longitudinal study of high-risk women. J Psychosom Res 2019;116:31–6.PubMedCrossrefGoogle Scholar

  • 43.

    Skouteris H, Wertheim EH, Germano C, Paxton SJ, Milgrom J. Assessing sleep during pregnancy. A study across two time points examining the Pittsburgh Sleep Quality Index and associations with depressive symptoms. Womens Heal Issues 2009;19:45–51.Google Scholar

  • 44.

    Wolfson AR, Crowley SJ, Anwer U, Bassett JL. Changes in sleep patterns and depressive symptoms in first-time mothers: last trimester to 1-year postpartum. Behav Sleep Med 2003;1:54–67.PubMedCrossrefGoogle Scholar

  • 45.

    Wu M, Li X, Feng B, Wu H, Qiu C, Zhang W. Poor sleep quality of third-trimester pregnancy is a risk factor for postpartum depression. Med Sci Monit 2014;20:2740–5.CrossrefPubMedGoogle Scholar

  • 46.

    MacLean JV, Faisal-Cury A, Chan YF, Menezes PR, Winters A, Joseph R, et al. The relationship between sleep disturbance in pregnancy and persistent common mental disorder in the perinatal period (sleep disturbance and persistent CMD). J Ment Health 2015;24:375–8.PubMedCrossrefGoogle Scholar

  • 47.

    Osnes RS, Roaldset JO, Follestad T, Eberhard-Gran M. Insomnia late in pregnancy is associated with perinatal anxiety: a longitudinal cohort study. J Affect Disord 2019;248:155–65.PubMedCrossrefGoogle Scholar

  • 48.

    Zhou H, Li W, Ren Y. Poor sleep quality of third trimester exacerbates the risk of experiencing postnatal depression. Psychol Health Med 2018;17:1–10.Google Scholar

  • 49.

    Bei B, Milgrom J, Ericksen J, Trinder J. Subjective perception of sleep, but not its objective quality, is associated with immediate postpartum mood disturbances in healthy women. Sleep 2010;33:531–8.CrossrefPubMedGoogle Scholar

  • 50.

    Bilszta JL, Meyer D, Buist AE. Bipolar affective disorder in the postnatal period: investigating the role of sleep. Bipolar Disord 2010;12:568–78.CrossrefPubMedGoogle Scholar

  • 51.

    Coo Calcagni S, Bei B, Milgrom J, Trinder J. The relationship between sleep and mood in first-time and experienced mothers. Behav Sleep Med 2012;10:167–79.CrossrefPubMedGoogle Scholar

  • 52.

    Coo S, Milgrom J, Kuppens P, Cox P, Trinder J. Exploring the association between maternal mood and self-reports of sleep during the perinatal period. J Obstet Gynecol Neonatal Nurs 2014;43:465–77.CrossrefPubMedGoogle Scholar

  • 53.

    Dorheim SK, Bjorvatn B, Eberhard-Gran M. Can insomnia in pregnancy predict postpartum depression? A longitudinal, population-based study. PLoS One 2014;9:e94674.CrossrefPubMedGoogle Scholar

  • 54.

    Goyal D, Gay C, Lee K. Fragmented maternal sleep is more strongly correlated with depressive symptoms than infant temperament at three months postpartum. Arch Womens Ment Health 2009;12:229–37.CrossrefPubMedGoogle Scholar

  • 55.

    Khazaie H, Ghadami MR, Knight DC, Emamian F, Tahmasian M. Insomnia treatment in the third trimester of pregnancy reduces postpartum depression symptoms: a randomized clinical trial. Psychiatry Res 2013;210:901–5.CrossrefPubMedGoogle Scholar

  • 56.

    Okun ML, Mancuso RA, Hobel CJ, Schetter CD, Coussons-Read M. Poor sleep quality increases symptoms of depression and anxiety in postpartum women. J Behav Med 2018;41: 703–10.CrossrefPubMedGoogle Scholar

  • 57.

    Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28: 193–213.CrossrefPubMedGoogle Scholar

  • 58.

    Tomfohr LM, Buliga E, Letourneau NL, Campbell TS, Giesbrecht GF. Trajectories of sleep quality and associations with mood during the perinatal period. Sleep 2015;38:1237–45.PubMedCrossrefGoogle Scholar

  • 59.

    Buysse DJ, Hall ML, Strollo PJ, Kamarck TW, Owens J, Lee L, et al. Relationships between the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and clinical/polysomnographic measures in a community sample. J Clin Sleep Med 2008;4:563–71.Google Scholar

  • 60.

    Cox J. Validation of the Edinburgh postnatal depression scale (EPDS) in non-postnatal women. J Affect Disord [Internet] 1996;39:185–9.CrossrefGoogle Scholar

  • 61.

    Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988;56:893–7.CrossrefPubMedGoogle Scholar

  • 62.

    Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.PubMedCrossrefGoogle Scholar

  • 63.

    Argyropoulos SV, Hicks JA, Nash JR, Bell CJ, Rich AS, Nutt DJ, et al. Correlation of subjective and objective sleep measurements at different stages of the treatment of depression. Psychiatry Res 2003;120:179–90.PubMedCrossrefGoogle Scholar

About the article

Corresponding author: Prof. Ernesto González-Mesa, MD, PHD, Surgical Specialties, Biochemistry and Immunology Department, Malaga University School of Medicine, 32, Boulevard Louis Pasteur, 29071 Málaga, Spain; and Obstetrics and Gynecology at Malaga University Hospital, Málaga, Spain

Received: 2019-06-12

Accepted: 2019-07-17

Published Online: 2019-08-06

Published in Print: 2019-09-25

Author contributions: All authors participated in the design of search strategy and in the review of the included articles. EGM wrote the Methods and Discussion and submitted the article. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organisation(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Citation Information: Journal of Perinatal Medicine, Volume 47, Issue 7, Pages 689–703, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/jpm-2019-0214.

Export Citation

©2019 Walter de Gruyter GmbH, Berlin/Boston.Get Permission

Comments (0)

Please log in or register to comment.
Log in