The Study On Related Factors Of Insomnia In Pregnant Women And Its Influence On Delivery

Objective:Insomnia in pregnant women is a common sleep disorder during pregnancy,and its related factors and the impact on delivery are rare.The purpose of this study was to investigate the prevalence of insomnia during pregnancy,the related psychological and biological factors,the changes in the process of pregnancy and the impact on delivery.Methods:A cross-sectional study was conducted.436 pregnant women were screened by the Insomnia Severity Index(ISI>8).According to the diagnostic criteria of insomnia in 4th edition of the manual of mental disorders diagnosis and Statistics Manual(DSM-?)and the frequency standard of insomnia in 10th edition of international classification of diseases(ICD-10),the subjects were divided into insomnia group and non-insomnia group.Beck Depression Scale(BDI),State Trait Anxiety Scale(STAI)and pregnancy stress scale(PPS)were used to evaluate the psychological status.Sleep status was assessed by dysfunctional sleep belief and attitude scale(DBAs),Epworth Sleepiness Scale(ESS),Pittsburgh sleep quality index(PSQI)and Berlin questionnaire.The intensity and symptoms of physical discomfort were assessed by self-made questionnaire.Body mass index(BMI)and blood pressure were measured before and after pregnancy.At 24-28 weeks of gestation,Serum estradiol and progesterone were detected and Gestational Diabetes Mellitus(GDM)was screened.In addition,112 pregnant women were followed up in the second and third trimester of pregnancy,and sleep,psychological,biological,prenatal examination and delivery indicators were collected at two time points.Results:19.3%of pregnant women met the diagnostic criteria of insomnia.49.1%of pregnant women had ISI?8.Compared with non-insomnia group(n=352),insomnia group(n=84)had higher moderate and severe physical discomfort,moderate to severe fatigue,excessive daytime sleepiness,sleeping partner interference,the proportion of obstructive sleep apnea(OSA)and short sleep,as well as DBAS,BDI,STAI,PPS,the number of physical symptoms,current and pregnancy increased BMI and gestational age.The proportion of social support,mid pregnancy and planned natural childbirth was significantly lower.There was no significant difference in BMI,blood pressure,progesterone,estradiol and GDM between the two groups.Binary logistic regression showed that the influence of sleeping partner(or?1.90,95%CI:1.01-3.57),depressive symptoms(or=1.07,95%CI:1.00-1.15),moderate and severe physical discomfort(or=2.26,95%CI:1.11-4.61)and number of physical symptoms(or=1.14,95%CI:1.03-1.27)were a predictor factors of insomnia in pregnant women.Sensitivity analysis showed that the number of somatic symptoms(or = 1.74,95%CI:1.18-2.58)was a predictor of insomnia in early pregnancy;sleeping partner interference(or=2.37,95%CI:1.05-5.37),number of somatic symptoms(or=1.20,95%CI:1.07-5.35)and OSA(or = 4.40,95%CI:1.16-16.57)were predictors of insomnia in mid pregnancy.Moderate to severe physical discomfort(or=18.51,95%CI:2.12-161.67)was a predictor of insomnia in late pregnancy.The results of prospective study:the rate of insomnia in late pregnancy(ISI?8)was significantly higher than that in the second trimester(x2=4.31,P=0.03).32.1%of pregnant women reported insomnia at both time points,and the proportion of severe insomnia in late pregnancy was 26.8%.In second trimester,depression and pregnancy stress were independent influencing factors of cesarean section.The risk factors of persistent or aggravating insomnia in late pregnancy were advanced age(?35 years old)(OR=10.32,95%CI:1.25-84.81)and increased anxiety symptoms(OR=1.22,95%CI:1.06-1.42).Conclusion:The prevalence of insomnia in pregnant women is high,and it increases obviously with the progress of pregnancy.The risk factors of insomnia in different pregnancy are different,and the physical discomfort related to pregnancy is particularly prominent.Old age is an important risk factor of insomnia in late pregnancy.The choice of cesarean section is closely related to mid pregnancy depression and pregnancy stress.It is suggested to carry out routine screening and intervention of insomnia and psychological status of pregnant women.