School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910, Hengshan Rd., Shanghai, 200030, China.
Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China.
BMC Psychiatry. 2022 Aug 2;22(1):521. doi: 10.1186/s12888-022-04164-y.
Poor sleep quality and maternal mood disturbances are common during pregnancy and may play pivotal roles in the development of postpartum depression. We aim to examine the trajectories of sleep quality and mental health in women from early pregnancy to delivery and explore the mediating effects of sleep quality and mental status on the link between antepartum depressive symptoms and postpartum depressive symptoms.
In an ongoing prospective birth cohort, 1301 women completed questionnaires in the first, second and third trimesters and at 6 weeks postpartum. In each trimester, sleep quality was measured utilizing the Pittsburgh Sleep Quality Index (PSQI), and mental health was assessed with the Center for Epidemiologic Studies Depression Scale (CES-D), the Self-Rating Anxiety Scale (SAS) and the Perceived Stress Scale (PSS). Postpartum depressive symptoms were evaluated by the Edinburgh Postnatal Depression Scale (EPDS). The bootstrap method was used to test the mediation effect.
The PSQI, CES-D, and SAS scores presented U-shaped curves across the antenatal period while the PSS score followed a descending trend. Antenatal sleep quality, depressive symptoms, anxiety symptoms and perceived stress all predicted depressive symptoms at 6 weeks postpartum. The influence of antepartum depressive symptoms on postpartum depressive symptoms was mediated by antepartum sleep quality and anxiety symptoms, which accounted for 32.14%, 39.25% and 31.25% in the first, second and third trimesters (P = 0.002, P = 0.001, P = 0.001, respectively).
Poor sleep quality and anxiety symptoms in pregnancy mediated the relationship between antepartum depressive symptoms and postpartum depressive symptoms. Interventions aimed at detecting and managing sleep quality and elevated anxiety among depressed women in pregnancy warrant further investigation as preventative strategies for postpartum depression.
妊娠期间睡眠质量差和情绪障碍较为常见，这可能在产后抑郁症的发展中起关键作用。我们旨在研究女性从早孕到分娩期间的睡眠质量和心理健康轨迹，并探讨睡眠质量和精神状态对产前抑郁症状与产后抑郁症状之间关联的中介作用。
在一项正在进行的前瞻性出生队列研究中，1301 名女性在孕早期、孕中期和孕晚期以及产后 6 周完成了问卷调查。在每个孕期，均采用匹兹堡睡眠质量指数（PSQI）评估睡眠质量，采用抑郁量表（CES-D）、焦虑自评量表（SAS）和压力知觉量表（PSS）评估心理健康状况。产后抑郁症状采用爱丁堡产后抑郁量表（EPDS）评估。采用 bootstrap 方法检验中介效应。
PSQI、CES-D 和 SAS 评分在整个产前期间呈 U 形曲线，而 PSS 评分呈下降趋势。产前睡眠质量、抑郁症状、焦虑症状和压力知觉均预测产后 6 周时的抑郁症状。产前抑郁症状对产后抑郁症状的影响通过产前睡眠质量和焦虑症状进行中介，在孕早期、孕中期和孕晚期，分别占 32.14%、39.25%和 31.25%（P=0.002，P=0.001，P=0.001）。
妊娠期间睡眠质量差和焦虑症状中介了产前抑郁症状与产后抑郁症状之间的关系。针对妊娠期间抑郁女性进行睡眠质量和焦虑升高的检测和管理的干预措施，作为产后抑郁的预防策略，值得进一步研究。
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