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. 2024 Aug 13;15:1427255. doi: 10.3389/fpsyt.2024.1427255

Evaluating the global prevalence of insomnia during pregnancy through standardized questionnaires and diagnostic criteria: a systematic review and meta-analysis

Chengcheng Yang 1,†, Rui Fu 1,†, Huan Wang 1,†, Yanjie Jiang 2, Shipeng Zhang 1,*, Xiaoli Ji 1,*
PMCID: PMC11348333  PMID: 39193579

Abstract

Introduction

Insomnia during pregnancy presents significant medical care challenges and heightens the risk of adverse outcomes for both pregnant women and fetuses. This study undertook a meta-analysis to assess the global prevalence of insomnia during pregnancy, examining both the overall prevalence and regional variations.

Method

The aim of this study was to perform a meta-analysis of articles indexed in PubMed, Embase, and Web of Science from the inception of these databases up to February 29, 2024. The study systematically reviewed the global prevalence of gestational insomnia and explored potential moderating factors, encompassing research type, publication date, regional influences, maternal age, pregnancy status, depressive symptoms, and anxiety symptoms.

Result

Forty-four studies, encompassing a total of 47,399,513 participants, were included in the analysis. The overall prevalence of insomnia symptoms during pregnancy was 43.9%. Regional factors and depression emerged as the main factors affecting insomnia, with Europe (53.6%) surpassing North America (41.0%), followed by South America (50.6%) and Asia (40.7%). High depression rates (56.2%) correlated with increased insomnia prevalence compared to low depression rates (39.8%). The type of research and publication date showed no significant impact on the prevalence of insomnia symptoms.

Conclusion

The meta-analysis results indicated that the prevalence of insomnia symptoms was higher during pregnancy, especially among pregnant women who were in a highly depressed state or located in the European region.

Systematic review registration

PROSPERO, identifier CRD42018104460.

Keywords: insomnia, depression, geographic location, prevalence during pregnancy, global

Highlight

  • Reassess the global prevalence of insomnia during pregnancy.

  • The regional differences in insomnia disease were discussed.

  • The possible reasons for the difference in prevalence were analyzed.

Introduction

Insomnia is a common clinical disorder characterized by difficulty falling asleep or maintaining sleep, often accompanied by symptoms such as irritability or fatigue when awake. It often occurs at least three times a week and lasted for a duration of at least three months, and can’t be attributed to other diseases or substances (1).

Research indicates that the incidence rate of insomnia in adults typically ranges from 6% to 10%, whereas among pregnant women it is notably higher at 38.2% (2, 3). Insomnia during pregnancy can be attributed to a varied of factors, such as physical discomfort, hormonal fluctuations, fetal growth (4), and emotional distress. Research has shown that insomnia during pregnancy (5) not only leads to a decline in quality of life, but also is a potential cause of premature delivery, cesarean section, prolonged delivery, pregnancy induced hypertension, pregnancy induced diabetes, and postpartum depression. Lu conducted a comprehensive review of sleep disorders and their association with adverse maternal and infant outcomes. The results revealed that sleep disorders, including insomnia, were associated with an increased risk of adverse pregnancy outcomes such as preeclampsia (OR=2.80, 95% CI 2.38-3.30), hypertension during pregnancy (OR=1.74, 95% CI 1.54-1.97), diabetes during pregnancy (OR=1.59, 95% CI 1.45-1.76), cesarean section (OR=1.47, 95% CI 1.31-1.64), and premature delivery (OR=1.38, 95% CI 1.26-1.51) (6); Additionally, a study demonstrated that insomnia was associated with an increased risk of perinatal suicide (OR=4.76, 95% CI 1.83-12.34) (7). Therefore, insomnia poses a significant threat to maternal and fetal health throughout pregnancy.

In the 2020 review on the prevalence of insomnia, the authors conducted subgroup analysis on variables including maternal age, gestational age, depressive symptoms, and gestational period (8). The review found that maternal age, gestational age, and anxiety significantly impact the prevalence of insomnia. Due to the limited number of articles included, the authors did not compare regional prevalence rates. As is well known, insomnia during pregnancy is a sleep disorder caused by various confounding factors. Regional studies are important for the prevention of women’s health. In China, a cross-sectional study on insomnia in Chinese pregnant women showed that 24.3% of the pregnant women suffered from insomnia, and found that maternal age, attained education, occupation, monthly household income, insurance coverage, relationship with the mother-in-law, gestational age, and anxiety symptoms were independently risk factors for insomnia (9). A Canadian study found that good social attention and partnership can reduce the incidence of prenatal depression and thus reduce the risk of insomnia during pregnancy (10). Similarly, several studies of pregnancy insomnia in the United States have found that degree of social concern is related to differences in the risk of pregnancy insomnia (11, 12). What’s more, different countries and regions may also have significant differences in the prevalence of insomnia during pregnancy due to diet, social life pressure, cultural background, and national women’s policies.

Based on this, we conducted a comprehensive database search and compare the prevalence of insomnia during pregnancy in different countries by region. These results will provide some reference evidence for the formulation of prevention and health policies in high prevalence areas, thereby increasing social attention to women’s health.

Methods

A systematic review and meta-analysis were conducted on articles related to insomnia symptoms during pregnancy. Both systematic reviews and meta-analyses were reported in accordance with the PRISMA Declaration Guidelines (13). This review has been registered in the PROSPERO database (registration number: CRD42018104460). The PRISMA checklist could be found in Supplementary Material 1 . The PICOS method was used in formulating research questions (14).

Search strategy

A full-text search was conducted on the PubMed, Embase, and Web of Science databases, with a time limit for papers published until February 29, 2024, including articles that reported insomnia rates during pregnancy through self-report or questionnaire surveys. The search algorithm was based on terms such as ‘pregnancy’ and ‘insomnia’. Specific search strategies were in Supplementary Material 2 .

The selected titles and relevant abstracts of the articles were reviewed. Each article was categorized as ‘yes’, ‘no’, or ‘possible’, with articles marked as ‘no’ being excluded from the analysis. The entire articles with titles or abstracts marked as ‘yes’ or ‘possible’ were thoroughly reviewed to determine if they met the inclusion criteria. Please refer to Figure 1 for a detailed flowchart outlining the detection program for the study.

Figure 1.

Figure 1

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Flow chart.

Research selection

The P-population was Women with pregnancy, the I-study has no intervention, the C-compare with and without sleep problem, the O-outcome is insomnia, and S-study included Randomized controlled studies, cohort studies, cross-sectional studies, case-control studies. The study included data on the prevalence of insomnia among pregnant women, or reported the number of individuals with insomnia. Research methods involved self-reporting, questionnaire surveys, and the measurement of epidemiological data.

Exclusion criteria: The sample consisted solely of pregnant women with sleep disorders. Studies that used non-standardized measurement methods, such as evaluating insomnia with a single question, were not included. Furthermore, studies that were case reports, systematic reviews, or used data from previous studies were also excluded.

The first and second authors (FR and WH) independently reviewed these studies and conducted a full-text review based on inclusion and exclusion criteria to further exclude studies that were not qualified. Any differences were be resolved by the senior author (ZS).

Data extraction

The first (FR) and second (WH) authors independently extracted data to confirm accuracy. The third author (ZS) confirmed the accuracy of the included data. The studies selected for review are recorded using standardized tables to describe the important variables of each study. The estimated prevalence of insomnia was obtained by extracting data on the number of cases, total sample size, or percentage of samples identified as having insomnia symptoms, as well as the study type, region, maternal age (year), gestational age (week), and percentage of anxiety or depression cases (see Table 1 ).

Table 1.

Basic information included in the literature.

Author Text Type Release year Country Average age Age range Number of people Case Diagnostic criteria Types of psychological problems
Mourady Cross-sectiona 2017 Lebanon 30.52±5.22 / 141 36 Insomnia Severity Index Depression
Palagini Cross-sectiona 2019 Italy 33.6 ± 3 / 62 17 Insomnia Severity Index Anxiety、Depression
David A Kalmbach Cross-sectiona 2021 America 29.76±4.72 / 267 156 Insomnia Severity Index Depression
Leslie M Swanson Cross-sectional 2011 America 31 / 114 51 Insomnia Severity Index Anxiety、Depression
Xu Chen Cross-sectional 2023 China 29.4±4.5 / 535 320 Insomnia Severity Index Anxiety
Xu Zhou case–control study 2023 China 29.7±4.2 / 456 291 Pittsburgh Sleep Quality Index /
Serap Öztürk Altınayak Cross-sectional 2023 Turkey 27.4±6.3 / 220 134 Insomnia Severity Index /
Jitka Bušková Cross-sectional 2023 Czech Republic) 30.3±5.3 / 325 213 / Anxiety、Depression
Jia-Peng Yang Cross-sectional 2023 China ≥18 / 717 174 Diagnostic and Statistical Manual of Mental Disorder Depression
Keiko Murakami MPH Cross-sectional 2022 Japan 32 29-35 17586 6560 Athens Insomnia Scale /
Juan Wang Cross-sectional 2022 China 30.3±4.2 20-43 665 179 Pittsburgh Sleep Quality Index Anxiety、Depression
Jiazhou Wang Cross-sectional 2021 China 30.25±3.99 19-47 2235 423 Insomnia Severity Index Anxiety、Depression
Wen-Jing Wang Cross-sectional 2020 China 35 20-44 436 84 DBAS Anxiety、Depression
Shiho Umeno Cross-sectional 2020 Japan 30.9 ± 4.7 / 88 37 Insomnia Severity Index /
Kızılırmak et al. Cross-sectional 2012 Turkey 25.2±5.49 15-42 486 254 Women's Health Initiative Insomnia Depression
Fernández-Alonso Cross-sectional 2012 Japan 31.0± 7.0 / 370 272 Insomnia Severity Index /
Randi Liset Cross-sectional 2021 Norway 30.6±4.0 24-43 61 23 BIS and Insomnia disry Depression
Nuworza Kugbey Cross-sectional 2021 Ghana 30.5 26-35 214 90 Insomnia Severity Index Anxiety、Depression
Magdalena Smyka Cross-sectional 2020 Poland 28.19 17-44 7207 5556 Self compiled surveys (PSQI, Insomnia Severity Index, Stanford Sleep Questionnaire, and Berlin Questionnaire) Pressure
Wołyńczyk-Gmaj Cross-sectional 2017 Poland 30.6 ± 5 / 266 106 Athens Insomnia Scale /
Dorheim Cross-sectional 2012 Norway 30.9 / 2,816 1743 Bergen Insomnia Scale Depression
Anthony M Kendle Cross-sectional 2022 America 32 15-49 47353875 24625 clinical observation /
Jennifer N. Felder, Cross-sectional 2021 America 32.32 ±5.50 / 423 356 Insomnia Severity Index /
David A. Kalmbach Cross-sectional 2021 America 30.38±4.96 / 65 35 Insomnia Severity Index /
Mindell Cross-sectional 2015 America / / 997 217 Insomnia Severity Index /
Manber Cross-sectional 2013 America 26.5 / 1,289 219 Women's Health Initiative Insomnia Rating Scale /
Rannveig S. Osnes Cohort study 2021 Norway 34 20-48 539 247 Pittsburgh Sleep Quality Index Depression
Rannveig S. Osnesa Cohort study 2020 Norway 30.5 ± 4.4 / 530 317 The Bergen Insomnia Scale Anxiety、Depression
Kiviruusu, O. Cohort study 2020 Poland 30.7 1,635 948 Basic Nordic Sleep Questionnaire Anxiety、Depression
David A Kalmbach c Cohort study 2021 America 28.21±4.32 20-39 39 24 Insomnia Severity Index Pre Sleep Awakening Scale - Cognitive Factors Depression
Hilla Peltonen Cohort study 2023 Iran 30.6±4.6 17-48 1414 491 Nordic Sleep Questionnaire Anxiety、Depression
Nacar and Tashan Cross-sectional 2019 Turkey 27.7±5.0 18-35 436 157 Women's Health Initiative Insomnia Rating Scale (WHIIRS) /
Ko Cohort study 2012 Korea 32.3 ± 3.8 20-45 642 218 Women's Health Initiative Insomnia Rating Scale /
Cristina Liebana-Presa Cohort study 2022 Spain 33.61 20-47 297 225 The General Health Questionnaire (GHQ-28) /
Dolatian Cohort study 2014 Switzerland / 18-45 231 119 Insomnia Severity Index /
Román-Gálvez Cohort study 2018 Brazil 31.24 / 486 215 Athens Insomnia Scale /
Madeleine F. Cohen Cohort study 2022 America 25.36 (5.08) 18-40 600 98 Patient-Reported Outcomes Measurement Information System (PROMIS) Depression
Ivan D. Sedov & Lianne M. Tomfohr-Madsen Cohort study 2020 Canada 31.35 >18 142 82 Insomnia Severity Index Pressure、Depression
Okun and O’Brien Cohort study 2018 America 29.8b / 439 146 Insomnia Symptom Questionnaire(ISQ) /
Facco Cohort study 2010 America 29.7 / 186 72 Women's Health Initiative Insomnia /
C. Amezcua-Prieto C. Radomized controlled trial 2020 Spain 34 18-49 265 159 Athens Insomnia Scale Pittsburgh Sleep Quality Index /
Rebeca Benito-Villena Radomized controlled trial 2022 Brazil 27 18-39 270 39 Athens Insomnia Scale /
David A Kalmbach Radomized controlled trial 2023 America 28.95±4.51 / 39 9 Pittsburgh Sleep Quality Index Insomnia Severity Index /
Jennifer N. Felder Randomized clinical trial 2020 America 33.6±3.7 / 208 110 Pittsburgh Sleep Quality Index Anxiety、Depression
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Meta-analysis was conducted using the comprehensive software STATA 16.0. A random effects model was chosen for analysis based on the level of heterogeneity, typically with I2>50%. The I2 index was used to assess heterogeneity between point estimates, indicating the proportion of variation between point estimates attributed to heterogeneity. Traditionally, I2 values below 25% suggest low heterogeneity, while values between 25% and 50% suggest moderate heterogeneity, and values above 50% suggest high heterogeneity. Subgroup comparison was then employed to further investigate the sources of heterogeneity.

Quality evaluation

The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included observational studies, and it was generally considered that 1-3 was classified as low quality, 4-6 as medium quality, and 7-9 as high quality. Randomized controlled trials were evaluated using the Cochrane risk bias assessment tool.

Results

Figure 1 illustrated the flowchart of the search and selection process. Initially, a search yielded 18,074 records, of which 10,312 were filtered based on title and abstract after removing duplicates. Following a full text review of the remaining 200 studies, 152 studies were excluded due to unclear sleep outcomes. The meta-analysis included 44 studies (9–12, 15–54), involving a total of 47,399,513 participants in the analysis. The literature included 26 cross-sectional studies (9–11, 15–18, 21–26, 28, 30–34, 39, 41, 44, 45, 47, 49, 50), 13 cohort studies (12, 19, 20, 27, 29, 35, 36, 40, 42, 46, 51–53), 4 randomized controlled studies (37, 38, 43, 48), and 1 case-control study (54).

Figures 2 and 3 displayed a summary of insomnia prevalence rates and subgroup forest plots, indicating an estimated range of 1% -77.1% for the prevalence of insomnia among 44 study patients. The overall prevalence rate was 43.9% (33.5% - 54.4%). On this basis, multiple subgroup analyses were conducted.

Figure 2.

Figure 2

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Analysis results of total prevalence of insomnia.

Figure 3.

Figure 3

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Overall prevalence and subgroup analysis of insomnia.

Subgroup analysis based on region and country

Based on regional grouping results, the prevalence of insomnia in Asia was the lowest (9, 16–18, 23, 24, 29–34, 36, 39, 45, 54), with a specific value of 40.7% (34.1% - 47.3%); Pregnant women in Europe exhibited a high insomnia rate of 53.6% (45.6% - 61.6%) (10, 15, 20–22, 26, 37, 40, 41, 51–53); The prevalence rates in North and South America were 41.0% and 50.6%, respectively (11, 12, 19, 25, 27, 28, 35, 38, 42–44, 46–50). Further analysis of the prevalence of insomnia by the country revealed that Spain has the highest insomnia rate of 67.8% (52.6% - 82.9%, I2 = 92.9%) (37, 52), while China has the lowest pregnancy insomnia rate of 35.4% (21.3% -49.6%, I2 = 99.2%) (9, 16, 32, 34, 39, 54).

Subgroup analysis based on study design

According to the analysis of article categories, it was found that the prevalence of insomnia in randomized controlled studies was the lowest at 37.7% (12% - 63.5%) (37, 38, 43, 48).The prevalence of insomnia was relatively similar between cross-sectional studies (9–11, 15–18, 21–26, 28, 30–34, 39, 41, 44, 45, 47, 49, 50) and cohort studies (12, 19, 20, 27, 29, 35, 36, 40, 42, 46, 51–53), at 42.8% and 47.4%, respectively. Based on the analysis of publication years, there was no significant difference in the prevalence of insomnia.

Subgroup analysis based on psychological depression participants

Based on classification analysis, it was discovered that in studies with a high prevalence of depression, the occurrence of gestational insomnia rose by 56.2% (49.8% - 62.6%). This indicates that depression is a contributing factor to the elevated rates of insomnia.

Quality evaluation

The overall quality of the included literature was deemed high, with 24 studies in Table 2 offering moderate evidence and 2 studies presenting low-level evidence. Only one article in the randomized controlled study indicated low quality, as shown in Figure 4 . The high quality of the papers contributes to the reliability of the analysis results.

Table 2.

The NOS scales evaluation table for observational studies was included.

Author and year Research method Representativeness of the expoaed cohort Selection of the non exposed cohort Ascertainment of exposure Demonstration that outcome of interest was not present at start of study Comparability of cohorts on the basis of the design or analysis Assesment of outcome Was follow-up lonf enough for outcomes to occur Adequacy of follow up of cohort Total points
Mourady 2017 (24) Cross-sectional ⭐ ⭐ ⭐ ⭐⭐ ⭐ ⭐ 7
Palagini 2019 (22) Cross-sectional ⭐ ⭐ ⭐ ⭐⭐ ⭐ 6
Kalmbach 2021 (46) Cross-sectional ⭐ ⭐ ⭐ ⭐ ⭐ 5
Swanson 2011 (28) Cross-sectional ⭐ ⭐ ⭐ ⭐ 4
Xu 2023 (39) Cross-sectional ⭐ ⭐ ⭐ ⭐ ⭐ ⭐ ⭐ 7
Zhou 2023 (54) case–control study ⭐ ⭐ ⭐ ⭐⭐ ⭐ ⭐ ⭐ 8
Altınayak 2023 (18) Cross-sectional ⭐ ⭐ ⭐ ⭐ ⭐ 5
Bušková 2023 (33) Cross-sectional ⭐ ⭐ ⭐ ⭐ ⭐ ⭐ 6
Yang 2023 (9) Cross-sectional ⭐ ⭐ ⭐ ⭐ ⭐ 5
Murakami 2022 (31) Cross-sectional ⭐ ⭐ ⭐ ⭐⭐ ⭐ ⭐ ⭐ 8
Wang 2022 (32) Cross-sectional ⭐ ⭐ ⭐ ⭐ ⭐⭐ ⭐ ⭐ 8
Wang 2021 (34) Cross-sectional ⭐ ⭐ ⭐ ⭐ ⭐ 5
Wang 2020 (16) Cross-sectional ⭐ ⭐ ⭐ ⭐ ⭐⭐ ⭐ ⭐ ⭐ 9
Umeno 2020 (17) Cross-sectional ⭐ ⭐ ⭐ ⭐ ⭐ ⭐ 6
Kızılırmak 2012 (30) Cross-sectional ⭐ ⭐ ⭐ ⭐ ⭐ ⭐ 6
Fernández 2012 (45) Cross-sectional ⭐ ⭐ ⭐ ⭐ ⭐ 5
Randi 2021 (21) Cross-sectional ⭐ ⭐ ⭐ ⭐⭐ ⭐ ⭐ 7
Nuworza 2021 (10) Cross-sectional ⭐ ⭐ ⭐ ⭐ ⭐ ⭐ ⭐ 7
Magdalena 2020 (26) Cross-sectional ⭐ ⭐ ⭐ ⭐⭐ ⭐ 6
Wołyńczyk 2017 (15) Cross-sectional ⭐ ⭐ ⭐ ⭐ ⭐⭐ ⭐ ⭐ ⭐ 9
Dorheim 2012 (41) Cross-sectional ⭐ ⭐ ⭐ ⭐⭐ ⭐ ⭐ ⭐ 8
Kendle 2022 (50) Cross-sectional ⭐ ⭐ ⭐ ⭐ ⭐ 5
Felder 2021 (44) Cross-sectional ⭐ ⭐ ⭐ ⭐ ⭐ 5
Kalmbach 2021 (46) Cross-sectional ⭐ ⭐ ⭐ ⭐ ⭐ 5
Mindell 2015 (25) Cross-sectional ⭐ ⭐ ⭐ ⭐ 4
Manber 2013 (11) Cross-sectional ⭐ ⭐ ⭐ ⭐ ⭐ ⭐ 6
Rannveig S 2021 (53) Cohort study ⭐ ⭐ ⭐ ⭐ ⭐ ⭐ 6
Rannveig S2020 (20) Cohort study ⭐ ⭐ ⭐ ⭐ ⭐ ⭐ 6
Kiviruusu 2020 (51) Cohort study ⭐ ⭐ ⭐ ⭐⭐ ⭐ ⭐ ⭐ 8
Kalmbach 2021 (46) Cohort study ⭐ ⭐ ⭐ ⭐ ⭐ 5
Peltonen 2023 (36) Cohort study ⭐ ⭐ ⭐ ⭐ ⭐ ⭐ ⭐ 7
Nacar and Tashan 2019 (23) Cross-sectional ⭐ ⭐ ⭐ ⭐⭐ ⭐ ⭐ 7
Ko 2012 (29) Cohort study ⭐ ⭐ ⭐ ⭐⭐ ⭐ ⭐ ⭐ 8
Rebeca 2022 (38) Cohort study ⭐ ⭐ ⭐ ⭐ ⭐ ⭐ ⭐ 7
Dolatian 2014 (40) Cohort study ⭐ ⭐ ⭐ ⭐ 4
Román 2018 (19) Cohort study ⭐ ⭐ ⭐ ⭐ ⭐ ⭐ 6
Madeleine 2022 (27) Cohort study ⭐ ⭐ ⭐ ⭐⭐ ⭐ ⭐ ⭐ 8
Sedov、Tomfohr-Madsen 2020 (35) Cohort study ⭐ ⭐ ⭐ ⭐ ⭐ ⭐ 6
Okun and O’Brien 2018 (12) Cohort study ⭐ ⭐ ⭐ ⭐ ⭐ 5
Facco 2010 (42) Cohort study ⭐ ⭐ ⭐ ⭐ ⭐ ⭐ 6
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Figure 4.

Figure 4

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Quality evaluation of 4 randomized controlled trials included.

Sensitivity analysis

After deleting each study item by item ( Figure 5 ), the overall estimates remained stable, indicating that the studies did not significantly affect the overall combined prevalence estimate.

Figure 5.

Figure 5

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Sensitivity analysis.

Discussion

An in-depth analysis was conducted on the various factors influencing insomnia during pregnancy, indicating that sleep quality can be significantly impacted by pregnancy. As the pregnancy advances, there is a noticeable decline in sleep quality, with late pregnancy being the most disruptive period (53). Studies have indicated a strong correlation between subjective sleep scores and the severity of depressive symptoms (55). Moreover, pregnancy represents a physiological state characterized by continuous hormonal, physical, and behavioral changes that may significantly alter both sleep quality and duration (56).

The study found that the total prevalence of insomnia during pregnancy was 44.0%, significantly higher than the general population. This highlights the importance of addressing insomnia as a significant health issue during pregnancy. Subgroup analysis by region revealed the highest prevalence in Europe and the lowest in Asia. Further analysis was then conducted at the country level.

Among European countries, Spain, Poland, and Norway exhibited a higher risk of insomnia compared to the overall level of insomnia in this analysis. This finding is in line with previous European studies that have shown a relatively high prevalence of insomnia in the European population (57, 58). Pregnancy events will further exacerbate the burden of female insomnia. A self-reported survey conducted by David O’Regan on individuals with insomnia in Europe identified lifestyle factors and high levels of life stress as the primary causes of insomnia (59). Numerous articles on insomnia have also highlighted the impact of lifestyle factors such as diet, exercise, smoking, and sleep habits on the development of insomnia (60). Additionally, a study on diet and insomnia revealed a positive association between dietary glycemic load and insomnia risk (OR: 1.10; 95% CI, 1.01, 1.20) (61). Spain, Poland, and Norway, being developed countries, often experience higher life burdens and pressures due to the pursuit of a high quality of life. Meanwhile, the preference for sugary foods among Europeans may contribute to the increased risk of insomnia (62–64).

In the Asian subgroup analysis, Japan, a developed country, exhibited a higher prevalence of insomnia during pregnancy, in line with expectations. The study revealed that, apart from economic pressures, the societal focus on women played a significant role in causing insomnia. Notably, China has specific support measures for pregnant women, including reduced working hours, dietary adjustments, and tailored psychological counseling, effectively alleviating psychological stress (65, 66). Moreover, within the Chinese cultural context, pregnant women receive extensive care from family members, contributing to a low insomnia rate (65). These findings offer valuable insights for designing women’s health initiatives. Conversely, the status of women in Japan is comparatively lower, hindering access to social support and contributing to the high prevalence of insomnia among pregnant women (67).

North America mainly includes the United States and Canada. In this analysis, only the United States was considered, revealing a lower insomnia rate compared to the overall level. Throughout the past century, the United States has dedicated efforts to safeguarding women’s power and status. Additionally, being the most developed country globally, the United States boasts top-tier economic and medical advancements. These factors, including a robust system and favorable economic and medical conditions, play a vital role in ensuring a safe pregnancy and reducing the risk of insomnia in pregnant women (68–70).

A correlation between insomnia and depression has been observed. In recent years, the detection rate of pregnancy complications in clinical practice has been on the rise (71), attributed to changes in the living environment, maternal neuroendocrine function, and abnormal fetal development. Studies both domestically and internationally have reported a prevalence rate of depression symptoms during pregnancy among women with pregnancy complications ranging from 29.4% to 39%, significantly surpassing that of healthy pregnant women (72, 73).

Through data analysis, it was found that individuals with high levels of depression were at a higher risk of insomnia, and depression was positively correlated with an increase in sleep latency. A study found differences in the consistency of local activity in the auxiliary motor area and insula between patients with insomnia and those without. Patients with insomnia and severe depression exhibited differences in the intensity of spontaneous activity in the middle frontal gyrus and paracentral lobules compared to those without insomnia. Previous studies have shown that the potential neurobiological mechanisms of depression and insomnia symptoms may have included: (1) abnormalities in monoamine neurotransmitters, especially changes in 5-HT concentration, which were closely related to sleep awakening and depression, such as shortened REM latency in patients with depression; (2) Overexpression of biological clock genes and stress response genes; (3) Dysfunction of the hypothalamic pituitary adrenal axis (HPA) and abnormal release of cortisol (74). According to data, there was a close relationship between insomnia during pregnancy and depression at both the symptom and disease levels. Some women’s insomnia symptoms were relatively stable in the early stages of pregnancy, but temporarily increased in the late stages of pregnancy. This is closely associated with significant physiological and psychological changes, and pregnancy can be characterized as a period of heightened biological and situational stress (75), which may activate latent vulnerabilities and magnify them. Hence, many pregnant women might experience a worsening of insomnia symptoms in the later stages of pregnancy. For instance, around 70% of individuals with depression experience symptoms of insomnia, and the prevalence of depression among pregnant women with insomnia is 3-4 times higher than in those without insomnia (76). This bidirectional and cumulative relationship necessitates greater clinical attention, as gestational insomnia and depression both pose risk factors for adverse pregnancy outcomes.

Insomnia during pregnancy is not inherently harmful, but it can contribute to an elevated risk of various health complications for women, such as stillbirth, miscarriage, perinatal depression, and other adverse outcomes. As a result, it is essential to focus on non-pharmacological methods for preventing and managing insomnia during pregnancy. Psychological and social factors play a significant role in the varying prevalence of insomnia during pregnancy, with psychological factors often being linked to some social factors. Pan Chen and Eric S Kim suggest that enhancing overall well-being can be an effective way to alleviate negative psychological symptoms (77, 78). Therefore, enhancing the focus on women during pregnancy is crucial for safeguarding their health (79). China, with its historical cultural background, has shown a greater emphasis on women’s health compared to other developed countries. Drawing from China’s approach, strategies such as reducing the work intensity of pregnant women, promoting increased attention from family members and social groups, providing regular psychological counseling, and encouraging appropriate exercise like relaxation training and mindfulness can help alleviate psychological issues during pregnancy and improve sleep quality to some extent (80).

Limitations

In this meta-analysis, significant heterogeneity was found, which may be attributed to population characteristics, study design, evaluation of insomnia and measurement of outcomes, as well as clinical stages of pregnancy. Secondly, insomnia mainly came from subjective reports or questionnaire surveys, and differences in diagnosis may have a certain impact on the results. Due to the fact that the summary result of single arm rate is a descriptive result and not a difference comparison result, the statistical significance of publication bias is not strong. We strictly followed the inclusion and exclusion criteria to manually screen relevant articles, without any restrictions on the language or year of the study, thus minimizing the possibility of omitting any research related to the topic; We also conducted a stratified analysis based on geographical location, publication time, literature type, and degree of depression. Therefore, compared to other small-scale studies, our research results may have more reference value and robustness. Finally, due to the limited data on insomnia across various gestational periods, a subgroup analysis based on these different periods has not yet been conducted. Further studies are anticipated to provide additional verification in the future.

Conclusion

The prevalence of insomnia during pregnancy, reaching as high as 44%, has been displaying an upward trend year by year. Urgent attention must be directed toward women’s health issues. Insomnia during pregnancy not only elevates the risk of adverse pregnancy outcomes for women but also significantly affects fetal development and postpartum well-being. As widely acknowledged, insomnia during pregnancy stems from various complex factors, with regional disparities emerging as a central aspect warranting special attention. We aim to undertake further regional research in the future to enhance clinical evidence for developing regional policies aimed at safeguarding women’s health.

Funding Statement

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. Administration of Traditional Chinese Medicine, National Famous Traditional Chinese Medicine Expert Inheritance Studio Construction Project.

Data availability statement

The original contributions presented in the study are included in the article/ Supplementary Material . Further inquiries can be directed to the corresponding authors.

Author contributions

CY: Writing – review & editing, Writing – original draft. RF: Writing – review & editing, Writing – original draft. HW: Writing – review & editing, Writing – original draft. YJ: Writing – review & editing, Writing – original draft. SZ: Writing – review & editing, Writing – original draft. XJ: Writing – review & editing, Writing – original draft.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyt.2024.1427255/full#supplementary-material

DataSheet1.zip (42.5KB, zip)

References

  • 1. Louis JM, Koch MA, Reddy UM, Silver RM, Parker CB, Facco FL, et al. Predictors of sleep-disordered breathing in pregnancy. Am J Obstet Gynecol. (2018) 218:521.e1–.e12. doi:  10.1016/j.ajog.2018.01.031 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2. Krystal AD, Ashbrook LH, Prather AA. What is insomnia? Jama. (2021) 326:2444. doi:  10.1001/jama.2021.19283 [DOI] [PubMed] [Google Scholar]
  • 3. Buysse DJ. Insomnia. Jama. (2013) 309:706–16. doi:  10.1001/jama.2013.193 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4. Chaudhry SK, Susser LC. Considerations in treating insomnia during pregnancy: A literature review. Psychosomatics. (2018) 59:341–8. doi:  10.1016/j.psym.2018.03.009 [DOI] [PubMed] [Google Scholar]
  • 5. 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. doi:  10.1007/s10865-018-9950-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6. Lu Q, Zhang X, Wang Y, Li J, Xu Y, Song X, et al. Sleep disturbances during pregnancy and adverse maternal and fetal outcomes: A systematic review and meta-analysis. Sleep Med Rev. (2021) 58:101436. doi:  10.1016/j.smrv.2021.101436 [DOI] [PubMed] [Google Scholar]
  • 7. Palagini L, Cipriani E, Miniati M, Bramante A, Gemignani A, Geoffroy PA, et al. Insomnia, poor sleep quality and perinatal suicidal risk: A systematic review and meta-analysis. J Sleep Res. (2024) 33:e14000. doi:  10.1111/jsr.14000 [DOI] [PubMed] [Google Scholar]
  • 8. Sedov ID, Anderson NJ, Dhillon AK, Tomfohr-Madsen LM. Insomnia symptoms during pregnancy: A meta-analysis. J Sleep Res. (2021) 30:e13207. doi:  10.1111/jsr.13207 [DOI] [PubMed] [Google Scholar]
  • 9. Yang JP, Lin RJ, Sun K, Gao LL. Incidence and correlates of insomnia and its impact on health-related quality of life among Chinese pregnant women: a cross-sectional study. J Reprod Infant Psychol. (2023) 41:391–402. doi:  10.1080/02646838.2021.2020228 [DOI] [PubMed] [Google Scholar]
  • 10. Kugbey N, Ayanore M, Doegah P, Chirwa M, Bartels SA, Davison CM, et al. Prevalence and correlates of prenatal depression, anxiety and suicidal behaviours in the Volta region of Ghana. Int J Environ Res Public Health. (2021) 18(11):5857. doi:  10.3390/ijerph18115857 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11. Manber R, Steidtmann D, Chambers AS, Ganger W, Horwitz S, Connelly CD. Factors associated with clinically significant insomnia among pregnant low-income Latinas. J Women's Health (2002). (2013) 22:694–701. doi:  10.1089/jwh.2012.4039 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12. Okun ML, O'Brien LM. Concurrent insomnia and habitual snoring are associated with adverse pregnancy outcomes. Sleep Med. (2018) 46:12–9. doi:  10.1016/j.sleep.2018.03.004 [DOI] [PubMed] [Google Scholar]
  • 13. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ (Clinical Res ed). (2021) 372:n71. doi:  10.1136/bmj.n71 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14. Morgan RL, Whaley P, Thayer KA, Schünemann HJ. Identifying the PECO: A framework for formulating good questions to explore the association of environmental and other exposures with health outcomes. Environ Int. (2018) 121:1027–31. doi:  10.1016/j.envint.2018.07.015 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15. Wołyńczyk-Gmaj D, Różańska-Walędziak A, Ziemka S, Ufnal M, Brzezicka A, Gmaj B, et al. Insomnia in pregnancy is associated with depressive symptoms and eating at night. J Clin Sleep Med: JCSM: Off Publ Am Acad Sleep Med. (2017) 13:1171–6. doi:  10.5664/jcsm.6764 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16. Wang WJ, Hou CL, Jiang YP, Han FZ, Wang XY, Wang SB, et al. Prevalence and associated risk factors of insomnia among pregnant women in China. Compr Psychiatry. (2020) 98:152168. doi:  10.1016/j.comppsych.2020.152168 [DOI] [PubMed] [Google Scholar]
  • 17. Umeno S, Kato C, Nagaura Y, Kondo H, Eto H. Characteristics of sleep/wake problems and delivery outcomes among pregnant Japanese women without gestational complications. BMC Pregnancy Childbirth. (2020) 20:179. doi:  10.1186/s12884-020-02868-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18. Altınayak S, Rüzgar Ş, Koç E. The relationship between sleep problems and sexual dysfunction among pregnant women in Turkey. Sleep Breathing Schlaf Atmung. (2024) 28:459–65. doi:  10.1007/s11325-023-02896-z [DOI] [PubMed] [Google Scholar]
  • 19. Román-Gálvez RM, Amezcua-Prieto C, Salcedo-Bellido I, Martínez-Galiano JM, Khan KS, Bueno-Cavanillas A. Factors associated with insomnia in pregnancy: A prospective Cohort Study. Eur J Obstet Gynecol Reprod Biol. (2018) 221:70–5. doi:  10.1016/j.ejogrb.2017.12.007 [DOI] [PubMed] [Google Scholar]
  • 20. Osnes RS, Eberhard-Gran M, Follestad T, Kallestad H, Morken G, Roaldset JO. Mid-pregnancy insomnia is associated with concurrent and postpartum maternal anxiety and obsessive-compulsive symptoms: A prospective cohort study. J Affect Disord. (2020) 266:319–26. doi:  10.1016/j.jad.2020.01.140 [DOI] [PubMed] [Google Scholar]
  • 21. Liset R, Grønli J, Henriksen RE, Henriksen TEG, Nilsen RM, Pallesen S. Sleep, evening light exposure and perceived stress in healthy nulliparous women in the third trimester of pregnancy. PloS One. (2021) 16:e0252285. doi:  10.1371/journal.pone.0252285 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22. 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. doi:  10.1016/j.sleep.2019.01.009 [DOI] [PubMed] [Google Scholar]
  • 23. Nacar G, Taşhan ST. Relationship between sleep characteristics and depressive symptoms in last trimester of pregnancy. Afr Health Sci. (2019) 19:2934–44. doi:  10.4314/ahs.v19i4.14 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24. Mourady D, Richa S, Karam R, Papazian T, Hajj Moussa F, El Osta N, et al. Associations between quality of life, physical activity, worry, depression and insomnia: A cross-sectional designed study in healthy pregnant women. PloS One. (2017) 12:e0178181. doi:  10.1371/journal.pone.0178181 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25. Mindell JA, Cook RA, Nikolovski J. Sleep patterns and sleep disturbances across pregnancy. Sleep Med. (2015) 16:483–8. doi:  10.1016/j.sleep.2014.12.006 [DOI] [PubMed] [Google Scholar]
  • 26. Smyka M, Kosińska-Kaczyńska K, Sochacki-Wójcicka N, Zgliczyńska M, Wielgoś M. Sleep problems in pregnancy-A cross-sectional study in over 7000 pregnant women in Poland. Int J Environ Res Public Health. (2020) 17(15):5306. doi:  10.3390/ijerph17155306 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27. Cohen MF, Corwin EJ, Johnson DA, Amore AD, Brown AL, Barbee NR, et al. Discrimination is associated with poor sleep quality in pregnant Black American women. Sleep Med. (2022) 100:39–48. doi:  10.1016/j.sleep.2022.07.015 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28. Swanson LM, Pickett SM, Flynn H, Armitage R. Relationships among depression, anxiety, and insomnia symptoms in perinatal women seeking mental health treatment. J Women's Health (2002). (2011) 20:553–8. doi:  10.1089/jwh.2010.2371 [DOI] [PubMed] [Google Scholar]
  • 29. Ko H, Shin J, Kim MY, Kim YH, Lee J, Kil KC, et al. Sleep disturbances in Korean pregnant and postpartum women. J Psychosom Obstet Gynaecol. (2012) 33:85–90. doi:  10.3109/0167482X.2012.658465 [DOI] [PubMed] [Google Scholar]
  • 30. Kızılırmak A, Timur S, Kartal B. Insomnia in pregnancy and factors related to insomnia. Sci World J. (2012) 2012:197093. doi:  10.1100/2012/197093 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31. Murakami K, Ishikuro M, Obara T, Ueno F, Noda A, Onuma T, et al. Social isolation and insomnia among pregnant women in Japan: The Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. Sleep Health. (2022) 8:714–20. doi:  10.1016/j.sleh.2022.08.007 [DOI] [PubMed] [Google Scholar]
  • 32. Wang J, Huang Y, Li Y, Wu L, Cao D, Cao F. Sleep-related attentional bias: Development and validation of a Chinese version of the brief sleep-associated monitoring index in pregnant women. J Psychosom Res. (2022) 163:111052. doi:  10.1016/j.jpsychores.2022.111052 [DOI] [PubMed] [Google Scholar]
  • 33. Bušková J, Miletínová E, Králová R, Dvořáková T, Tefr Faridová A, Heřman H, et al. Parasomnias in pregnancy. Brain Sci. (2023) 13(2):357. doi:  10.3390/brainsci13020357 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34. Wang J, Zhou Y, Qian W, Zhou Y, Han R, Liu Z. Maternal insomnia during the COVID-19 pandemic: associations with depression and anxiety. Soc Psychiatry Psychiatr Epidemiol. (2021) 56:1477–85. doi:  10.1007/s00127-021-02072-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35. Sedov ID, Tomfohr-Madsen LM. Trajectories of insomnia symptoms and associations with mood and anxiety from early pregnancy to the postpartum. Behav Sleep Med. (2021) 19:395–406. doi:  10.1080/15402002.2020.1771339 [DOI] [PubMed] [Google Scholar]
  • 36. Peltonen H, Paavonen EJ, Saarenpää-Heikkilä O, Vahlberg T, Paunio T, Polo-Kantola P. Sleep disturbances and depressive and anxiety symptoms during pregnancy: associations with delivery and newborn health. Arch Gynecol Obstet. (2023) 307:715–28. doi:  10.1007/s00404-022-06560-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37. Amezcua-Prieto C, Naveiro-Fuentes M, Arco-Jiménez N, Olmedo-Requena R, Barrios-Rodríguez R, Vico-Zúñiga I, et al. Walking in pregnancy and prevention of insomnia in third trimester using pedometers: study protocol of Walking_Preg project (WPP). A randomized Controlled trial. BMC Pregnancy Childbirth. (2020) 20:521. doi:  10.1186/s12884-020-03225-y [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38. Benito-Villena R, Guerrero-Martínez I, Naveiro-Fuentes M, Cano-Ibánez N, Femia-Marzo P, Gallo-Vallejo JL, et al. Walking promotion in pregnancy and its effects on insomnia: results of walking_Preg project (WPP) clinical trial. Int J Environ Res Public Health. (2022) 19(16):10012. doi:  10.3390/ijerph191610012 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39. Chen X, Liu Y, Liu M, Min F, Tong J, Wei W, et al. Prevalence and associated factors of insomnia symptoms among pregnant women in the third trimester in a moderately developing region of China. BMC Public Health. (2023) 23:2319. doi:  10.1186/s12889-023-17269-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40. Dolatian M, Mehraban Z, Sadeghniat K. The effect of impaired sleep on preterm labour. West Indian Med J. (2014) 63:62–7. doi:  10.7727/wimj.2012.305 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41. Dørheim SK, Bjorvatn B, Eberhard-Gran M. Insomnia and depressive symptoms in late pregnancy: a population-based study. Behav Sleep Med. (2012) 10:152–66. doi:  10.1080/15402002.2012.660588 [DOI] [PubMed] [Google Scholar]
  • 42. Facco FL, Kramer J, Ho KH, Zee PC, Grobman WA. Sleep disturbances in pregnancy. Obstet Gynecol. (2010) 115:77–83. doi:  10.1097/AOG.0b013e3181c4f8ec [DOI] [PubMed] [Google Scholar]
  • 43. Felder JN, Epel ES, Neuhaus J, Krystal AD, Prather AA. Efficacy of digital cognitive behavioral therapy for the treatment of insomnia symptoms among pregnant women: A randomized clinical trial. JAMA Psychiatry. (2020) 77:484–92. doi:  10.1001/jamapsychiatry.2019.4491 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44. Felder JN, Hartman AR, Epel ES, Prather AA. Pregnant patient perceptions of provider detection and treatment of insomnia. Behav Sleep Med. (2020) 18:787–96. doi:  10.1080/15402002.2019.1688153 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 45. Fernández-Alonso AM, Trabalón-Pastor M, Chedraui P, Pérez-López FR. Factors related to insomnia and sleepiness in the late third trimester of pregnancy. Arch Gynecol Obstet. (2012) 286:55–61. doi:  10.1007/s00404-012-2248-z [DOI] [PubMed] [Google Scholar]
  • 46. Kalmbach DA, Ahmedani BK, Gelaye B, Cheng P, Drake CL. Nocturnal cognitive hyperarousal, perinatal-focused rumination, and insomnia are associated with suicidal ideation in perinatal women with mild to moderate depression. Sleep Med. (2021) 81:439–42. doi:  10.1016/j.sleep.2021.03.004 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47. Kalmbach DA, Cheng P, Ong JC, Ciesla JA, Kingsberg SA, Sangha R, et al. Depression and suicidal ideation in pregnancy: exploring relationships with insomnia, short sleep, and nocturnal rumination. Sleep Med. (2020) 65:62–73. doi:  10.1016/j.sleep.2019.07.010 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 48. Kalmbach DA, Cheng P, Reffi AN, Seymour GM, Ruprich MK, Bazan LF, et al. Racial disparities in treatment engagement and outcomes in digital cognitive behavioral therapy for insomnia among pregnant women. Sleep Health. (2023) 9:18–25. doi:  10.1016/j.sleh.2022.10.010 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49. Kalmbach DA, Roth T, Cheng P, Ong JC, Rosenbaum E, Drake CL. Mindfulness and nocturnal rumination are independently associated with symptoms of insomnia and depression during pregnancy. Sleep Health. (2020) 6:185–91. doi:  10.1016/j.sleh.2019.11.011 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 50. Kendle AM, Salemi JL, Jackson CL, Buysse DJ, Louis JM. Insomnia during pregnancy and severe maternal morbidity in the United States: nationally representative data from 2006 to 2017. Sleep. (2022) 45(10):zsac175. doi:  10.1093/sleep/zsac175 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 51. Kiviruusu O, Pietikäinen JT, Kylliäinen A, Pölkki P, Saarenpää-Heikkilä O, Marttunen M, et al. Trajectories of mothers' and fathers' depressive symptoms from pregnancy to 24 months postpartum. J Affect Disord. (2020) 260:629–37. doi:  10.1016/j.jad.2019.09.038 [DOI] [PubMed] [Google Scholar]
  • 52. Liebana-Presa C, Martínez-Fernández MC, García-Fernández R, Martín-Vázquez C, Fernández-Martínez E, Hidalgo-Lopezosa P. Self perceived health and stress in the pregnancy during the COVID-19 pandemic. Front Psychiatry. (2023) 14:1166882. doi:  10.3389/fpsyt.2023.1166882 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 53. Osnes RS, Eberhard-Gran M, Follestad T, Kallestad H, Morken G, Roaldset JO. Mid-pregnancy insomnia and its association with perinatal depressive symptoms: A prospective cohort study. Behav Sleep Med. (2021) 19:285–302. doi:  10.1080/15402002.2020.1743705 [DOI] [PubMed] [Google Scholar]
  • 54. Zhou X, Hong X, Huang K, Ding X, Yu H, Zhao J, et al. Poor sleep quality in early pregnancy increases the risk of developing gestational diabetes mellitus: a propensity score matching analysis. Sleep Breathing Schlaf Atmung. (2023) 27:1557–65. doi:  10.1007/s11325-022-02748-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 55. Bjornsdottir E, Lindberg E, Benediktsdottir B, Gislason T, Garcia Larsen V, Franklin K, et al. Are symptoms of insomnia related to respiratory symptoms? Cross-sectional results from 10 European countries and Australia. BMJ Open. (2020) 10:e032511. doi:  10.1136/bmjopen-2019-032511 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 56. Schmidhuber J, Traill WB. The changing structure of diets in the European Union in relation to healthy eating guidelines. Public Health Nutr. (2006) 9:584–95. doi:  10.1079/PHN2005844 [DOI] [PubMed] [Google Scholar]
  • 57. Palagini L, Manni R, Liguori C, De Gennaro L, Gemignani A, Fanfulla F, et al. Evaluation and management of insomnia in the clinical practice in Italy: a 2023 update from the Insomnia Expert Consensus Group. J Neurol. (2024) 271:1668–79. doi:  10.1007/s00415-023-12112-3 [DOI] [PubMed] [Google Scholar]
  • 58. Bjornsdottir E, Thorarinsdottir EH, Lindberg E, Benediktsdottir B, Franklin K, Jarvis D, et al. Association between physical activity over a 10-year period and current insomnia symptoms, sleep duration and daytime sleepiness: a European population-based study. BMJ Open. (2024) 14:e067197. doi:  10.1136/bmjopen-2022-067197 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 59. O'Regan D, Garcia-Borreguero D, Gloggner F, Wild I, Leontiou C, Ferini-Strambi L. Mapping the insomnia patient journey in Europe and Canada. Front Public Health. (2023) 11:1233201. doi:  10.3389/fpubh.2023.1233201 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 60. Höglund P, Hakelind C, Nordin M, Nordin S. Risk factors for insomnia and burnout: A longitudinal population-based cohort study. Stress Health: J Int Soc Invest Stress. (2023) 39:798–812. doi:  10.1002/smi.3218 [DOI] [PubMed] [Google Scholar]
  • 61. Arab A, Karimi E, Garaulet M, Scheer F. Dietary patterns and insomnia symptoms: A systematic review and meta-analysis. Sleep Med Rev. (2024) 75:101936. doi:  10.1016/j.smrv.2024.101936 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 62. Poličnik R, Hristov H, Lavriša Ž, Farkaš J, Smole Možina S, Koroušić Seljak B, et al. Dietary intake of adolescents and alignment with recommendations for healthy and sustainable diets: results of the SI.Menu study. Nutrients. (2024) 16(12):1912. doi:  10.3390/nu16121912 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 63. Sonestedt E, Lukic M. Beverages - a scoping review for Nordic Nutrition Recommendations 2023. Food Nutr Res. (2024) 68. doi:  10.29219/fnr.v68.10458 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 64. Yusta-Boyo MJ, González EG, García-Solano M, Rollán Gordo A, Peña-Rey I, Rodríguez-Artalejo F. Reduction of sugar, salt and fat content in foods over the period 2016-2021 in Spain: the National Food Reformulation Plan. Eur J Clin Nutr. (2024) 78:149–54. doi:  10.1038/s41430-023-01357-w [DOI] [PubMed] [Google Scholar]
  • 65. Zheng G, Lyu X, Pan L, Chen A. The role conflict-burnout-depression link among Chinese female health care and social service providers: the moderating effect of marriage and motherhood. BMC Public Health. (2022) 22:230. doi:  10.1186/s12889-022-12641-y [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 66. Yan HWM. Hotspots and Prospects of fertility Support Policy Research in China: A Visual econometric Analysis based on CNKI Database Literature (2013-2023). Jianghan Acad. (2024) 2024:46–57. doi:  10.16388/j.cnki.cn42-1843/c.2024.04.005 [DOI] [Google Scholar]
  • 67. Sakurai K, Kawakami N, Yamaoka K, Ishikawa H, Hashimoto H. The impact of subjective and objective social status on psychological distress among men and women in Japan. Soc Sci Med (1982). (2010) 70:1832–9. doi:  10.1016/j.socscimed.2010.01.019 [DOI] [PubMed] [Google Scholar]
  • 68. Davis KC, Fortino BR, O'Shea NG. Potential consequences of the Dobbs v. Jackson Women's Health Organization decision. Psychol Addictive Behav: J Soc Psychol Addictive Behav. (2024) 38:161–6. doi:  10.1037/adb0000986 [DOI] [PubMed] [Google Scholar]
  • 69. Ickovics JR, Lewis JB, Cunningham SD, Thomas J, Magriples U. Transforming prenatal care: Multidisciplinary team science improves a broad range of maternal-child outcomes. Am Psychol. (2019) 74:343–55. doi:  10.1037/amp0000435 [DOI] [PubMed] [Google Scholar]
  • 70. Pirkle JRA. Protecting and advancing women's health and rights post-roe era through policy. Health Educ Behav: Off Publ Soc Public Health Educ. (2023) 50:538–42. doi:  10.1177/10901981231164578 [DOI] [PubMed] [Google Scholar]
  • 71. Wu D, Chen S, Zhong X, Zhang J, Zhao G, Jiang L. Prevalence and factors associated with antenatal depressive symptoms across trimesters: a study of 110,584 pregnant women covered by a mobile app-based screening programme in Shenzhen, China. BMC Pregnancy Childbirth. (2024) 24:480. doi:  10.1186/s12884-024-06680-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 72. Vargas I, Perlis ML. Insomnia and depression: clinical associations and possible mechanistic links. Curr Opin Psychol. (2020) 34:95–9. doi:  10.1016/j.copsyc.2019.11.004 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 73. Zhang Jihui LY, Jiyang P. Research progress and existing problems on the relationship between insomnia and depression from 2008 to 2013. Chin J Ment Health. (2015) 2015:29. [Google Scholar]
  • 74. Grigoriadis S, Graves L, Peer M, Mamisashvili L, Tomlinson G, Vigod SN, et al. Maternal anxiety during pregnancy and the association with adverse perinatal outcomes: systematic review and meta-analysis. J Clin Psychiatry. (2018) 79(5):17r12011. doi:  10.4088/JCP.17r12011 [DOI] [PubMed] [Google Scholar]
  • 75. Wan EY, Moyer CA, Harlow SD, Fan Z, Jie Y, Yang H. Postpartum depression and traditional postpartum care in China: role of zuoyuezi. Int J Gynaecol Obstet: Off Organ Int Fed Gynaecol Obstet. (2009) 104:209–13. doi:  10.1016/j.ijgo.2008.10.016 [DOI] [PubMed] [Google Scholar]
  • 76. Dunkel Schetter C, Rahal D, Ponting C, Julian M, Ramos I, Hobel CJ, et al. Anxiety in pregnancy and length of gestation: Findings from the healthy babies before birth study. Health Psychol: Off J Division Health Psychol Am psychol Assoc. (2022) 41:894–903. doi:  10.1037/hea0001210 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 77. Chen P, Sun HL, Zhang L, Feng Y, Sha S, Su Z, et al. Inter-relationships of depression and insomnia symptoms with life satisfaction in stroke and stroke-free older adults: Findings from the Health and Retirement Study based on network analysis and propensity score matching. J Affect Disord. (2024) 356:568–76. doi:  10.1016/j.jad.2024.04.036 [DOI] [PubMed] [Google Scholar]
  • 78. Kim ES, Wilkinson R, Case BW, Cowden RG, Okuzono SS, VanderWeele TJ. Connected communities: Perceived neighborhood social cohesion during adolescence and subsequent health and well-being in young adulthood-An outcome-wide longitudinal approach. J Community Psychol. (2024) 52:774–91. doi:  10.1002/jcop.23130 [DOI] [PubMed] [Google Scholar]
  • 79. Li Q, Kanduma E, Ramiro I, Xu DR, Cuco RMM, Chaquisse E, et al. Spatial access to continuous maternal and perinatal health care services in low-resource settings: cross-sectional study. JMIR Public Health Surveil. (2024) 10:e49367. doi:  10.2196/49367 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 80. Riedel A, Benz F, Deibert P, Barsch F, Frase L, Johann AF, et al. The effect of physical exercise interventions on insomnia: A systematic review and meta-analysis. Sleep Med Rev. (2024) 76:101948. doi:  10.1016/j.smrv.2024.101948 [DOI] [PubMed] [Google Scholar]

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Data Availability Statement

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