Biological Rhythms Outweigh Sleep Quantity Changes in Peripartum Depressive and Anxiety Symptoms

A recent study found an association between biological rhythms affecting sleep late in pregnancy and postpartum and depressive or anxiety symptoms.

During the peripartum period—the 3-month period before and after giving birth—anxiety and depression can lead to lower quality of life for mothers. A recent study connected peripartum depression and anxiety to changes in sleep and biological rhythms in late pregnancy and postpartum.

“Our findings highlight the importance of stabilizing the internal biological clock during the peripartum period to maintain healthy mood and minimize anxiety,” Benicio Frey, senior study author of the study and professor in the department of psychiatry and behavioral neurosciences at McMaster University, said in a statement.

An estimated 15% to 18% of women experience anxiety and 7% to 13% of women experience depression during the peripartum period, according to past research, and the current study is the largest observational analysis known to date examining longitudinal trends in sleep and biological rhythms in the peripartum period.

A cohort of 100 women in their third trimester of pregnancy were recruited from obstetric and midwifery practices, family physicians’ offices, ultrasound clinics, and from an outpatient psychiatric clinic in Ontario, Canada from November 2015 to May 2018.

Researchers gathered subjective and objective measures of sleep patterns and biological rhythms, including 2 weeks of actigraphy (wearable technology for sleep monitoring) at each visit. In total, 73 participants returned for follow-ups at 1 to 3 weeks postpartum, a common time for “postpartum blues” onset; and 6 to 12 weeks postpartum, when there is a higher incidence of postpartum depression.

The Epworth Sleepiness Scale (ESS) for daytime sleepiness and the Pittsburgh Sleep Quality Index (PSQI) were used to measure sleep quality, and the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) evaluated subjective disruptions in biological rhythms. Participants were interviewed using the Mini-International Neuropsychiatric Interview (MINI) Version 6 to assess current psychological mood state and diagnosis. Further assessments were done to determine each patient’s risk for postpartum depression, manic symptoms, and anxiety.

Researchers identified several variables that are linked to depression and anxiety. A higher circadian quotient, a measure of biological rhythm strength, and higher mean activity counts during rest states at night were both strongly associated with increased depressive symptoms.

A higher probability of transitioning from rest to active states (pRA)—meaning more fragmentation of sleep—was associated with less depressive symptoms at 1 to 3 weeks and 6 to 12 weeks postpartum, the latter being a time when risk of developing postpartum depression is higher.

“While these results might sound counterintuitive at first, they may indicate that mothers with lower depressive symptoms were more actively responsive to the babies’ needs overnight, since these same variables were not predictive of depressive symptoms in late pregnancy,” the authors wrote. Higher pRA peripartum was also predictive of lower anxiety postpartum.

Overall, the findings suggest that subjective biological rhythm disruptions are associated with increased depressive and anxiety symptoms peripartum, which aligns with findings that objective biological rhythm disturbances are linked to these symptoms.

Changes in sleep patterns were also observed in the study cohort, but biological rhythm changes were most significantly associated with depressive and anxiety symptoms.

“Given the findings, future efforts should be made to standardize evidence-based interventions targeting these biological rhythms variables identified by our team, either as treatment or prevention strategies,” Frey said.


Slyepchenko A, Minuzzi L, Reilly JP, Frey BN. Longitudinal changes in sleep, biological rhythms, and light exposure from late pregnancy to postpartum and their impact on peripartum mood and anxiety. J Clin Psychiatry. Published online January 18, 2022. doi:10.4088/JCP.21m13991

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