36% of women follow a poor sleep path from pregnancy through the first year

Pregnancy and the first year with a baby are notorious for disrupted sleep, but not every woman experiences it the same way. Some sleep badly throughout, some deteriorate as time goes on, and some start poorly and recover, and lumping everyone together hides who actually needs help. Sleep in this window matters beyond tiredness, because it is tied to the health of both mother and infant. This review set out to map the distinct paths sleep takes from pregnancy to one year postpartum, how common the problematic ones are, and what predicts landing on them.

The authors searched eight databases from inception to 13 August 2024 for studies that followed pregnant or postpartum women over time. To qualify, a study had to recruit at least 100 women, measure sleep on at least three occasions between pregnancy and one year postpartum, and model distinct sleep trajectories statistically. The team then pooled the prevalence of nonoptimal trajectories for sleep quality, duration, efficiency, timing and insomnia symptoms, compared prevalence across geographical regions, and reanalysed available data with group-based trajectory modelling to identify clusters of sleep quality over time.

Five studies modelled a single trajectory, while the other 12 identified two to four distinct paths. Pooled across studies, 36% of women followed a nonoptimal sleep quality trajectory and 22% a nonoptimal duration trajectory, with nonoptimal sleep efficiency at 15%, delayed bedtime at 51%, late wake-up time at 17% and clinical insomnia at 13%. When the data were reclustered, three sleep quality groups emerged: consistently good (38.9%), increasingly poor (37.6%) and decreasingly poor (23.5%). Across the evidence, nonoptimal trajectories were associated with higher risks of adverse outcomes for both mothers and infants.

The review confirms that perinatal sleep problems are common, but adds the more useful point that they are not uniform: distinct groups follow distinct paths, and a substantial share of women never develop serious problems at all. It also assembles a consistent set of early markers, including low socioeconomic status, higher pre-pregnancy body mass index, poor baseline sleep quality and self-rated health, and high initial levels of fatigue, anxiety and depressive symptoms. What it cannot establish is cause and effect, and the authors call for work on spotting at-risk women early and testing targeted interventions.

If you are pregnant or planning to be, this is a reason to take early sleep problems seriously rather than write them off as an inevitable part of the territory. The paths appear to diverge early, and the factors linked to a worse one, such as poor sleep, fatigue and anxiety at the outset, are visible from the beginning. It is equally a reason for reassurance: one large group of women slept consistently well through the whole period, and another started poorly and improved. Knowing these patterns exist is useful context for conversations about perinatal care.