Trajectories of sleep health during the perinatal period: A systematic review and meta-analysis.

Abstract

Study objectives: This review aims to summarize trajectories of sleep quality, duration, efficiency, timing and insomnia symptoms from pregnancy to one year postpartum, with a specific focus on identifying the number, proportion, shape, associated factors and outcomes of these trajectories.

Methods: We conducted a systematic search across eight databases from inception to August 13, 2024. Longitudinal studies who recruited 100 or more pregnant or postpartum women with at least three sleep assessments during pregnancy and one year postpartum, and modeled independent sleep health trajectories using trajectory analysis methods were included. Meta-analyses were performed to assess the pooled prevalence of nonoptimal sleep health trajectories. The prevalence was compared across geographical regions by subgroup meta-analysis. Group-based trajectory model (GBTM) was used to reidentify clusters of sleep health trajectories if available.

Results: Five studies modeled a single trajectory, and the other 12 studies identified two to four distinct trajectories. The pooled prevalence of nonoptimal sleep quality and duration trajectories was 36% and 22%, respectively. The mean prevalence of the nonoptimal sleep efficiency trajectory was 15%, while the prevalence of delayed bedtime, late wake-up time, and clinical insomnia trajectories was reported as 51%, 17%, and 13%, respectively. Nonoptimal sleep trajectories were associated with higher risks of adverse maternal and infant outcomes. Low socioeconomic status, high pre-pregnancy body mass index, poor baseline sleep quality and self-reported health, and high initial levels of fatigue, anxiety and depressive symptoms were key factors associated with these trajectories. Additionally, GBTM identified three trajectory groups of perinatal sleep quality: consistently good (38.9%), increasingly poor (37.6%) and decreasingly poor (23.5%).

Conclusions: Perinatal sleep health trajectories demonstrate significant heterogeneity, with a notable proportion of women following high-risk trajectories. Further research should focus on identifying key risk factors for sleep health trajectories early in the perinatal period, and developing targeted public health strategies and interventions to address these factors.