Department of Bio-statistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Nutrition, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
Int J Dev Neurosci. 2021 Oct;81(6):469-478. doi: 10.1002/jdn.10118. Epub 2021 Jun 21.
Postpartum depression (PPD) is one of the most important mental disorders in recent years. However, the effects of prenatal sleep disorders on the development of PPD among pregnant women have not been elucidated. This review aims to provide a summary of the literature evaluating the relation between sleep disorders during pregnancy and PPD.
A systematic literature search was conducted in PubMed, Web of Science, Scopus, Google Scholar, and Embase up to September 2020. All observational studies (cross-sectional, case-control, and cohort) and studies that assessed the association between sleep disorders during pregnancy and PPD were included. Total sample of 36,873 women from 13 studies was entered to meta-analysis. An aggregate effect size estimate (odds ratio) was generated using the comprehensive meta-analysis software. A random effects model was set a priori. Heterogeneity and publication bias were examined using the standard meta-analytic approaches.
We found maternal sleep disorder increased odds of PPD (point estimate, 3.300; 95% confidence interval [CI], 2.136-5.098; p < .001; n = 13). However, there was significant heterogeneity (Q, 131.250; df, 12; p < .001; I , 90.857%). The estimated effect size was significant for all categorical studies. According to meta-regression, no moderating factor (age and publication year) significantly mediated the estimated effect size.
We found a significant relationship between sleep disturbances during pregnancy and PPD. Women with sleep disorders are at an increased risk of developing PPD, which warrants screening pregnant mothers for sleep disturbances. Also, we found that the increasing age in pregnancy was associated with increased risk of PPD.
产后抑郁症（PPD）是近年来最重要的精神障碍之一。然而，产前睡眠障碍对孕妇 PPD 发展的影响尚未阐明。本综述旨在总结评估妊娠期间睡眠障碍与 PPD 之间关系的文献。
系统检索 PubMed、Web of Science、Scopus、Google Scholar 和 Embase 数据库，检索时间截至 2020 年 9 月。纳入所有观察性研究（横断面研究、病例对照研究和队列研究）和评估妊娠期间睡眠障碍与 PPD 之间相关性的研究。13 项研究共纳入 36873 名女性，进行荟萃分析。使用综合荟萃分析软件生成汇总效应大小估计值（优势比）。预设采用随机效应模型。使用标准荟萃分析方法检查异质性和发表偏倚。
我们发现母体睡眠障碍增加了 PPD 的发生风险（点估计值 3.300；95%置信区间 [CI]，2.136-5.098；p<0.001；n=13）。然而，存在显著的异质性（Q，131.250；df，12；p<0.001；I, 90.857%）。所有分类研究的估计效应量均有统计学意义。根据元回归，没有调节因素（年龄和发表年份）显著调节估计效应量。
我们发现妊娠期间睡眠障碍与 PPD 之间存在显著关系。患有睡眠障碍的女性发生 PPD 的风险增加，这需要对孕妇进行睡眠障碍筛查。此外，我们发现妊娠年龄的增加与 PPD 风险的增加相关。
