Sleep trajectories in pregnancy: associations with trauma exposure, PTSD, and postpartum depression

Sleep during the perinatal period is often highly disrupted due to maternal biopsychosocial changes that accompany pregnancy. Poor sleep quality is a symptom of PTSD, while insomnia often emerges after a traumatic event and commonly co-occurs with PTSD. Trauma exposure as well as insomnia have been linked to increased risk for postpartum depression (PPD). The current study examined sleep trajectories across pregnancy and into the postpartum period, the impact of trauma exposure and PTSD on these sleep trajectories, and associations between these sleep trajectories and PPD. Participants completed psychiatric diagnostic evaluations for PTSD and other mental health conditions, as well as validated self-ratings of insomnia and depressive symptoms at four time points across pregnancy and at 6 weeks postpartum. Participants were categorized into one of four groups: (a) trauma exposure with PTSD, (b) trauma exposure with another mental health condition, (c) trauma exposure with no mental health conditions, or (d) no reported trauma exposure or current mental health conditions. Longitudinal growth mixture modeling revealed two distinct sleep trajectories across pregnancy: poor sleep (28.5%) and normative sleep (71.5%). Trauma-exposed participants with PTSD or other mental health conditions were more likely to have poor sleep profiles. Participants with poor sleep profiles had significantly higher depressive symptoms. These findings support the need for targeted interventions addressing insomnia in trauma-exposed pregnant women with psychiatric sequelae to improve outcomes during and after pregnancy.