Abstract
OBJECTIVE: Insomnia is prevalent among pregnant women and adversely affects maternal and fetal health. The mechanisms that underpin the relation between sleep-related cognitions and insomnia symptoms among pregnant women are unclear. This study tried to examine the mediation roles of pre-sleep arousal and maladaptive habits between dysfunctional cognitions and insomnia symptoms during pregnancy. METHODS: Pregnant women (N = 450) from two tertiary hospitals in Yangzhou, Jiangsu Province, China, were recruited. Participants completed self-report measures, including the Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16), Pre-Sleep Arousal Scale (PSAS), Sleep Hygiene Practice Scale (SHPS), and Insomnia Severity Index (ISI). Pearson correlation was tested and serial multiple mediation analysis was conducted using Hayes’ PROCESS macro. RESULTS: Dysfunctional cognition, pre-sleep arousal, maladaptive habits, and insomnia symptom scores were all significantly correlated with each other (all P < 0.01). Pre-sleep arousal (B = -0.060, 95%CI: -0.082, -0.040) and maladaptive habits (B = -0.021, 95%CI: -0.036, -0.010) significantly mediated the relation between dysfunctional cognitions and insomnia symptoms, accounting for 37.74% and 13.21% of the total effect, respectively. The serial multiple mediating effects of pre-sleep arousal and maladaptive habits (B = -0.020, 95%CI: -0.028, -0.012) in the association between dysfunctional cognitions and insomnia symptoms explained 12.58% of the total effect. These findings indicate that dysfunctional cognitions contribute to insomnia symptoms not only directly but also indirectly through elevated arousal and poor sleep practices, which operate both independently and in sequence. CONCLUSIONS: Pre-sleep arousal and maladaptive habits play serial mediating roles in the relation between dysfunctional cognitions and insomnia symptoms among pregnant women. Development of targeted interventions addressing the cognitive and behavioral factors contributing to insomnia symptoms in pregnant women is needed. CLINICAL TRIAL NUMBER: Not applicable.