Study of the relationship between sleep disorders and post-traumatic stress after perinatal trauma in pregnant women

Rashidi, Farzaneh; Shakeri, Marzieh; Shariatnia, Sahar; Mahzoon, Bita; Hesari, Nazanin

Volume 13, Issue 3 (9-2025) jmsthums 2025, 13(3): 26-36 | Back to browse issues page

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Rashidi F, Shakeri M, Shariatnia S, Mahzoon B, Hesari N. Study of the relationship between sleep disorders and post-traumatic stress after perinatal trauma in pregnant women. jmsthums 2025; 13 (3) :26-36
URL: http://jms.thums.ac.ir/article-1-1364-en.html

Study of the relationship between sleep disorders and post-traumatic stress after perinatal trauma in pregnant women

Farzaneh Rashidi¹

, Marzieh Shakeri²

, Sahar Shariatnia³

, Bita Mahzoon⁴

, Nazanin Hesari⁵

1- Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran & Department of Midwifery, School of Nursing and Midwifery, North Khorasan University of Medical Sciences, Bojnurd, Iran
2- Student Research Committee, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
3- Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
4- Bentol-Hoda Hospital, North Khorasan University of Medical Sciences, Bojnord, Iran
5- Department of Midwifery, School of Nursing and Midwifery, North Khorasan University of Medical Sciences, Bojnurd, Iran & Student Research Committee, North Khorasan University of Medical Sciences, Bojnurd, Iran

Abstract: (24 Views)

Background & Aim: Despite the high importance of post-traumatic stress disorder and sleep disorders during pregnancy, these conditions are rarely addressed among pregnant women. Therefore, this study aimed to determine the relationship between sleep disorders and post-traumatic stress following perinatal trauma in pregnant women.
Methods: This cross-sectional study was conducted in 2022 on 131 pregnant women who referred to health centers in Bojnurd City, using a multistage probability sampling method. Data collection tools included questionnaires on demographic and obstetric characteristics, the Post-Traumatic Stress Disorder Scale, the Pittsburgh Sleep Quality Index, and the Maureen Insomnia Severity Index. Data were analyzed using descriptive statistics and multiple regression analysis in SPSS version 26.
Results: The mean age and gestational age (in weeks) were 28.76 ± 4.48 and 30.98 ± 9.62, respectively. The mean total scores for insomnia severity and sleep quality were 10.1 ± 5.41 and 9.62 ± 3.92, while the mean total score for post-traumatic stress disorder after perinatal trauma was 25.41 ± 16.22. Among participants, 73.6% reported difficulty initiating sleep, 80% had trouble maintaining sleep, 14.5% experienced early-morning awakening, and 89.1% reported daytime dysfunction. The variables of insomnia severity (B = 0.23), gestational age (B = 0.10), and husband’s desire for the current pregnancy (B = 2.5) had a statistically significant relationship with post-traumatic stress disorder (P < 0.05).
Conclusion: Based on the findings, the relationship between sleep disorders and post-traumatic stress after perinatal trauma highlights the importance of increasing healthcare providers’ awareness regarding the necessity of screening pregnant women for sleep disturbances and implementing psychological interventions to prevent adverse outcomes.

Keywords: Sleep disorders, Pregnancy, Trauma, Post-traumatic stress, Perinatal

Full-Text [PDF 329 kb] (38 Downloads)

Type of Study: Research | Subject: Special
Received: 2024/08/24 | Accepted: 2025/01/29 | Published: 2025/11/17

References

1. Gamble J, Creedy D, Moyle W, Webster J, McAllister M, Dickson P. Effectiveness of a counseling intervention after a traumatic childbirth: a randomized controlled trial. Birth. 2005;32(1):11-9. [DOI:10.1111/j.0730-7659.2005.00340.x]

2. Malak SM, Crowley MJ, Mayes LC, Rutherford HJ. Maternal anxiety and neural responses to infant faces. Journal of affective disorders. 2015;172:324-30. [DOI:10.1016/j.jad.2014.10.013]

3. Yildiz PD, Ayers S, Phillips L. The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis. Journal of affective disorders. 2017;208:634-45. [DOI:10.1016/j.jad.2016.10.009]

4. Logsdon MC, Koniak-Griffin D. Social support in postpartum adolescents: guidelines for nursing assessments and interventions. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2005;34(6):761-8. [DOI:10.1177/0884217505281855]

5. Shaw JG, Asch SM, Kimerling R, Frayne SM, Shaw KA, Phibbs CS. Posttraumatic stress disorder and risk of spontaneous preterm birth. Obstetrics & Gynecology. 2014;124(6):1111-9. [DOI:10.1097/AOG.0000000000000542]

6. Lev-Wiesel R, Chen R, Daphna-Tekoah S, Hod M. Past traumatic events: are they a risk factor for high-risk pregnancy, delivery complications, and postpartum posttraumatic symptoms? Journal of Women's Health. 2009;18(1):119-25. [DOI:10.1089/jwh.2008.0774]

7. Rosen D, Seng JS, Tolman RM, Mallinger G. Intimate partner violence, depression, and posttraumatic stress disorder as additional predictors of low birth weight infants among low-income mothers. Journal of Interpersonal Violence. 2007;22(10):1305-14. [DOI:10.1177/0886260507304551]

8. Sedov ID, Anderson NJ, Dhillon AK, Tomfohr‐Madsen LM. Insomnia symptoms during pregnancy: A meta‐analysis. Journal of sleep research. 2021;30(1):e13207. [DOI:10.1111/jsr.13207]

9. Lucchini M, Kyle MH, Sania A, Pini N, Babineau V, Firestein MR, et al. Postpartum sleep health in a multiethnic cohort of women during the COVID-19 pandemic in New York City. Sleep Health. 2022;8(2):175-82. [DOI:10.1016/j.sleh.2021.10.009]

10. Geng F, Wang J, Wen C, Shao Y, Wu J, Fan F. Prevalence and correlates of sleep problems among Chinese prisoners. Social psychiatry and psychiatric epidemiology. 2021;56:671-8. [DOI:10.1007/s00127-020-01882-0]

11. McCall CA, Turkheimer E, Tsang S, Avery A, Duncan GE, Watson NF. Sleep duration and post-traumatic stress disorder symptoms: a twin study. Sleep. 2019;42(12):zsz179. [DOI:10.1093/sleep/zsz179]

12. Wenz-Gross M, Weinreb L, Upshur C. Screening for post-traumatic stress disorder in prenatal care: prevalence and characteristics in a low-income population. Maternal and child health journal. 2016;20(10):1995-2002. [DOI:10.1007/s10995-016-2073-2]

13. FARAMARZI M, RANJBAR TA, ZAKARIAII Z, NAEIMIRAD M. Role of psycho-social factors in pregnant women with nausea and vomiting. 2015.

14. Callahan J, Borja S, Hynan M. Modification of the Perinatal PTSD Questionnaire to enhance clinical utility. Journal of Perinatology. 2006;26(9):533-9. [DOI:10.1038/sj.jp.7211562]

15. Hernández-Martínez A, Martínez-Vázquez S, Rodríguez-Almagro J, Khan KS, Delgado-Rodríguez M, Martínez-Galiano JM. Validation of perinatal post-traumatic stress disorder questionnaire for Spanish women during the postpartum period. Scientific Reports. 2021;11(1):5567. [DOI:10.1038/s41598-021-85144-2]

16. Morin CM, Belleville G, Bélanger L, Ivers H. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011;34(5):601-8. [DOI:10.1093/sleep/34.5.601]

17. Heidari A, Ehteshamzadeh P, Marashi M. The relationship between insomnia severity, sleep quality, sleepiness and mental health disorders with academic performance in girls. Woman Cult. 2010;2(4):76-65.

18. Taheri Tanjani P, Khodabakhshi H, Etemad K, Mohammadi M. Effect of sleep hygiene education on sleep quality and general health of elderly women with sleep disorders living in Birjand City, Iran, in 2016. Iranian Journal of Ageing. 2019;14(2):248-59.

19. Zhang S, Zhou Y, Ge L-k, Zeng L, Liu Z, Qian W, et al. Interaction of insomnia and somatization with post-traumatic stress disorder in pregnant women during the COVID-19 pandemic. Neuropsychiatric Disease and Treatment. 2021:2539-47. [DOI:10.2147/NDT.S310300]

20. Rubio E, Levey EJ, Rondon MB, Friedman L, Sanchez SE, Williams MA, et al. Poor sleep quality and obstructive sleep apnea are associated with maternal mood, and anxiety disorders in pregnancy. Maternal and child health journal. 2022;26(7):1540-8. [DOI:10.1007/s10995-022-03449-8]

21. Wang Z, Zhu H, Yuan M, Li Y, Qiu C, Ren Z, et al. The resting-state functional connectivity of amygdala subregions associated with post-traumatic stress symptom and sleep quality in trauma survivors. European archives of psychiatry and clinical neuroscience. 2021;271:1053-64. [DOI:10.1007/s00406-020-01104-3]

22. Orovou E, Dagla M, Iatrakis G, Lykeridou A, Tzavara C, Antoniou E. Correlation between kind of cesarean section and posttraumatic stress disorder in Greek women. International journal of environmental research and public health. 2020;17(5):1592. [DOI:10.3390/ijerph17051592]

23. Ayers S, Jessop D, Pike A, Parfitt Y, Ford E. The role of adult attachment style, birth intervention and support in posttraumatic stress after childbirth: A prospective study. Journal of affective disorders. 2014;155:295-8. [DOI:10.1016/j.jad.2013.10.022]

24. Beck CT, Gable RK, Sakala C, Declercq ER. Posttraumatic stress disorder in new mothers: Results from a two‐stage US national survey. Birth. 2011;38(3):216-27. [DOI:10.1111/j.1523-536X.2011.00475.x]

25. Ahmadinejad GS, Nosrati Hadiabad SF, Sadrzadeh SM, Karimi FZ. Assessment of Psychological Birth Trauma and Related Factors in Primiparous Women in Hospitals of Mashhad University of Medical Sciences. Avicenna Journal of Nursing and Midwifery Care. 2024;32(2):80-7. [DOI:10.32592/ajnmc.32.2.80]

26. Nakić Radoš S, Matijaš M, Kuhar L, Anđelinović M, Ayers S. Measuring and conceptualizing PTSD following childbirth: Validation of the City Birth Trauma Scale. Psychological Trauma: Theory, Research, Practice, and Policy. 2020;12(2):147. [DOI:10.1037/tra0000501]

27. Mahmoodi Z, Dolatian M, Shaban Z, Shams J, Alavi‑Majd H, Mirabzadeh A. Correlation between kind of delivery and posttraumatic stress disorder. Annals of medical and health sciences research. 2016;6(6):356-61. [DOI:10.4103/amhsr.amhsr_397_15]

28. Soderquist J, Wijma K, Wijma B. Traumatic stress after childbirth: the role of obstetric variables. Journal of Psychosomatic Obstetrics & Gynecology. 2002;23(1):31-9. [DOI:10.3109/01674820209093413]

29. Vizeh M, Kazemnejaz A, Afrasiabi S, Rouyhi M, Hassan M, Habibzadeh S. Prevalance of post traumatic stress disorder after childbirth and its precipitating factors. Bimonthly Journal of Hormozgan University of Medical Sciences. 2012;16(4):309-16.

30. Seng JS, Oakley DJ, Sampselle CM, Killion C, Graham-Bermann S, Liberzon I. Posttraumatic stress disorder and pregnancy complications. Obstetrics & Gynecology. 2001;97(1):17-22. [DOI:10.1097/00006250-200101000-00004]