Prevalence and associated factors of insomnia disorder among women attending antenatal care

Abstract

Background: Insomnia disorder is a modifiable risk factor for maternal and offspring psychopathology, yet it remains overlooked in low-resource settings like Malawi, where maternal mental health services are underprioritised.
Aim: To assess the prevalence and associated psychiatric factors for insomnia disorder among pregnant women at Kamuzu Central Hospital (KCH).
Setting: Antenatal care unit (ANC) at KCH, Lilongwe.
Methods: A cross-sectional design was employed. Systematic random sampling was used to select 110 pregnant women. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate insomnia. Descriptive and logistic regression established the association between socio-demographic, obstetric, sleep arrangement and biometric factors and sleep quality.
Results: The prevalence of insomnia disorder was found to be 79.1% (mean PSQI = 8.77 ± 3.79), indicating significant sleep disturbances. Logistic regression revealed a significant association with gestation, participants in the second trimester (adjusted odds ratio [AOR] = 5.21, 95% confidence interval [CI]: 1.49–18.26, p = 0.010) being at higher risk and increased odds among married women (odds ratio [OR] = 0.14, 95% CI: 0.13–0.48, p = 0.038) and those sharing bed (OR = 5.28, 95% CI: 1.14–24.55, p = 0.034) at higher risk of poor sleep quality.
Conclusion: Poor sleep quality is common among pregnant women in Malawi, with trimester-specific and psychosocial predictors elevating psychiatric risks.
Contribution: Integration of sleep screening and perinatal mental health interventions into antenatal care is urgently needed in the second trimester to mitigate adverse maternal and offspring outcomes.