Sleep‐specific repetitive negative thinking processes and prenatal insomnia symptoms: A naturalistic follow‐up study from mid‐ to late‐pregnancy

Summary Insomnia symptoms are highly prevalent during pregnancy; therefore, identifying modifiable risk markers is important for risk prediction and early intervention. This study aimed to examine the role of sleep‐specific rumination and sleep‐specific worry in prenatal insomnia symptoms. A total of 859 married pregnant women without history of psychiatric illnesses (mean standard deviation age, 30.15 3.86 years; 593 69.0% with a bachelor's degree or above) were enrolled from the obstetrical outpatient departments of two tertiary comprehensive hospitals in Shandong, China, who completed assessments of sleep‐specific rumination, sleep‐specific worry, and insomnia symptoms at baseline (mid‐pregnancy) and follow‐up (late‐pregnancy). Measures included Daytime Insomnia Symptom Response Scale, Anxiety and Preoccupation about Sleep Questionnaire, and Insomnia Severity Index. Our results showed that after controlling for covariates, both sleep‐specific rumination and sleep‐specific worry showed significant concurrent and prospective associations with insomnia symptoms, and the increases in scores of sleep‐specific rumination and sleep‐specific worry over time were significantly associated with the increased likelihood of insomnia symptoms at follow‐up. Moreover, the increases in sleep‐specific rumination and sleep‐specific worry over time were significantly associated with the increased likelihood of reporting newly developed insomnia symptoms rather than persistent normal sleep. However, the changes in sleep‐specific rumination and sleep‐specific worry were not significantly associated with the likelihood of reporting persistent or remitted insomnia symptoms rather than persistent normal sleep. In conclusion, sleep‐specific rumination and sleep‐specific worry were significantly associated with concurrent or subsequent insomnia symptoms; thus, they may be promising cognitive risk markers and intervention targets.