Association between trajectories of sleep quality and postpartum depression: a group-based trajectory model and computer-simulated network analysis.

Study aim

To examine how different patterns of sleep quality from early pregnancy through 42 days postpartum relate to postpartum depression, and to identify which specific depressive symptoms are most central within each sleep trajectory.

Design and methods

• – Prospective cohort of 372 pregnant individuals from the “Be Resilient to Postpartum Depression” study.
• – Four assessment time points: early pregnancy through 42 days after delivery.
• – Validated tools were used to measure sleep quality and postpartum depression.
• – Group-based trajectory modeling identified distinct sleep-quality patterns over time.
• – Computer-simulated network analysis explored how individual depressive symptoms interacted and which were central (“core” and aggravating) versus potentially symptom-relieving.

Key findings

• – Two sleep trajectories were found:
  • 1. “Increasingly poor” sleep (41.4% of participants)
  • 2. “Stably good” sleep (58.6%)
• – The “increasingly poor” trajectory was associated with a substantially higher risk of postpartum depression (OR 2.75, P < 0.001) compared with the “stably good” group.

Symptom network results

• – In the “increasingly poor” sleep group:
  • – Core/aggravating depressive symptom: “Things have been getting on top of me.”
  • – A key symptom linked to alleviating depression: “I have been anxious or worried for no good reason.”
• – In the “stably good” sleep group:
  • – Core/aggravating symptom: “I have felt scared or panicky for no very good reason.”
  • – A key symptom linked to alleviating depression: “I have been so unhappy that I have had difficulty sleeping.”

Conclusions and implications

• – Sleep quality during pregnancy and early postpartum follows heterogeneous trajectories that are differentially associated with risk and structure of postpartum depressive symptoms.
• – Different core and modifiable symptoms across trajectories support the need for tailored mental health interventions, potentially targeting specific anxiety and overwhelm-related symptoms in relation to sleep patterns.