Sleep quality during pregnancy: the role of anxiety, fear of childbirth, and obstetric factors – a multicenter cross-sectional study

Abstract

Background: Pregnancy is a vulnerable period for poor sleep quality, and sleep disturbances might increase the risk of adverse pregnancy outcomes. Therefore, the present study aimed to identify the prevalence of poor sleep quality and examine the association of pregnancy-related anxiety, fear of childbirth, sociodemographic and obstetric factors with sleep quality among Iranian pregnant women. Methods: A multicenter cross-sectional study was conducted using multi-stage cluster sampling among 424 pregnant women attending health centers in Bandar Abbas, Iran, from 2023 to 2024. Data collection tools included a demographic and obstetric questionnaire, a checklist of pregnancy complications, the Pittsburgh Sleep Quality Index (PSQI), the Pregnancy-Related Anxiety Questionnaire (PRAQ), and the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). Data were analyzed using both univariate and multivariate linear regression in SPSS version 25 and quantile regression in R software version 4.3.0 with the quantreg package. Results: The mean age and gestational age of the participants were 29.10 ± 6.81 years and 22.35 ± 9.28 weeks, respectively. Poor sleep quality was observed in 70.8% of the participants, with rates of 69.7%, 65.6%, and 79.1% in the first, second, and third trimesters, respectively. Pregnancy-related anxiety (B = 0.053, P < 0.001), fear of childbirth (B = 0.019, P = 0.006), occupation (B=-0.898, P = 0.026), unwanted pregnancy (B = 1.364, P < 0.001), hospitalization during pregnancy (B = 1.379, P < 0.001), and intrauterine growth restriction (IUGR) (B = 1.114, P = 0.033) were associated with sleep quality in pregnant women. The results of the quantile regression confirmed the significant association of these factors with the median PSQI score. Conclusions: Poor sleep quality was common among pregnant women in this study. Housewives and those reporting higher levels of pregnancy-related anxiety and fear of childbirth, unwanted pregnancies, hospitalization, and IUGR during pregnancy, were more likely to experience poorer sleep quality. Given the adverse effects of sleep disorders on maternal and fetal health, screening and managing sleep disturbances during pregnancy are essential.