Adverse Maternal and Fetal Outcomes Associated with Insomnia During Pregnancy: a Systematic Review and Meta-Analysis

Insomnia affects most pregnant women. This systematic review aims to examine regarding gestational insomnia and its consequences on pregnant women and neonates. We performed a systematic search of seven databases for English and Chinese language articles about the association between insomnia and maternal complications and adverse fetal outcomes from inception to July 2022 then updated the search date to April 2024. We included observational studies concerning gestational insomnia and one or more adverse maternal, delivery, or neonatal outcomes. Data extraction was completed independently by two reviewers. The quality assessment was analyzed with the Newcastle-Ottawa quality assessment scale and an 11-item checklist recommended by Agency for Healthcare Research and Quality for observational cohort and cross-sectional studies. Data analysis was carried out through meta-analysis and narrative synthesis. Twenty-three identified studies (fifteen cohort studies, six cross-sectional studies and two case-control studies) examined the associations of gestational insomnia with adverse maternal and infant outcomes. The most consistent associations were observed between gestational insomnia and increased risks of perinatal depression (OR = 2.30, 95%CI:1.77,2.96, P = 0.002), perinatal anxiety and postpartum pain. There were mixed findings for post-traumatic stress disorder and low birth weight. Gestational insomnia was not associated with cesarean delivery (OR = 0.92, 95%CI: 0.61,1.38, P = 0.328), gestational hypertension (OR = 1.06, 95%CI: 0.90,1.25, P = 0.526), pre-eclampsia (OR = 1.67, 95%CI:0.21,13.44, P = 0.01), gestational diabetes (OR = 0.77, 95%CI: 0.48,1.24, P = 0.78), preterm birth (OR = 1.09, 95%CI:0.75,1.58, P = 0.073), high birth weight or low Apgar scores. There is an association between insomnia and some adverse maternal and infant outcomes, but larger samples and well-designed prospective studies are still needed to determine their relationship in the future.