Natural vs. Assisted Conception: Sleep and Emotional Health from Pregnancy to Postpartum-An Exploratory Study

Background/Objectives: Sleep plays a key role in female fertility. Sleep disturbances (SDis) during pregnancy are common and may negatively affect maternal health, contributing to an increased risk of perinatal depression and anxiety. Aim: The present prospective study aimed to examine the interplay of sleep, anxiety, and depression during the pregnancy and postpartum stages, comparing women who conceived naturally (NC) with those who conceived through assisted reproductive treatment (ART). Methods: The study included five timepoints: pre-pregnancy (t0), the end of each trimester (t1-t3), and the postpartum period (t4). SDis were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Athens Insomnia Scale (AIS), the Epworth Sleepiness Scale (ESS), the Fatigue Severity Scale (FFS); perinatal depressive and anxiety symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Demographic and clinical characteristics were also collected. Given the imbalance in group size and the dispersion of values, a negative binomial regression model with robust variances and Satterthwaite approximation for the degrees of freedom was applied. Results: Compared to women with NC (N = 37), those undergoing ART (N = 57) were more likely to be older (p < 0.001), married (p < 0.001), unemployed (p < 0.001), and have a history of thyroid disease (p = 0.008). Significant differences between different time points were observed in both NC (N = 37) and successfully conceived ART groups (N = 9) in all sleep, fatigue, and well-being parameters. Notably, at the end of the first trimester (t1), the ART group reported more severe insomnia symptoms (p = 0.02). Conclusions: SDis are common in pregnancy, but more pronounced during the first trimester among women on ART. These findings highlight the need for early screening and targeted psychological support during perinatal care.