Dysfunctional Sleep-Related Cognitions and Maladaptive Behaviors Perpetuating Insomnia During Pregnancy: A Cross-Sectional Study

Background: Insomnia is highly prevalent during pregnancy, but the role of modifiable cognitive and behavioral factors remains understudied. Objective: We aimed to investigate factors associated with insomnia symptoms in pregnant women, with a focus on sleep-related psychological and behavioral factors. Methods: A cross-sectional study was conducted among 545 pregnant women recruited from 2 tertiary hospitals in Eastern China (December 2023-March 2024). Participants completed self-reported questionnaires assessing insomnia severity, pregnancy-related rumination, physical discomfort, anxiety symptoms, depressive symptoms, presleep arousal, dysfunctional sleep-related cognitions, maladaptive sleep habits, and demographic information. Univariable and binary logistic regression were used to identify factors associated with insomnia symptoms. Results: Among the 545 participants (mean age = 29.1 years), 27.0% reported insomnia symptoms. In the regression model, insomnia was significantly associated with prepregnancy insomnia symptoms (OR = 2.82; 95% CI, 1.69-4.70; P < .001), increased physical discomfort (OR = 1.05; 95% CI, 1.01-1.09; P = .012), higher presleep arousal (OR = 1.13; 95% CI, 1.07-1.20; P < .001), dysfunctional sleep-related cognitions (OR = 0.95; 95% CI, 0.92-0.98; P < .001), and maladaptive sleep habits (OR = 1.03; 95% CI, 1.01-1.05; P = .005). Conclusion: Insomnia during pregnancy is associated with prepregnancy insomnia, physical discomfort, and key modifiable perpetuating factors including presleep arousal, dysfunctional sleep-related cognitions, and maladaptive sleep behaviors. Interventions targeting these modifiable factors are needed to improve insomnia symptoms in pregnant women.