0423 Risk Factors Associated with Development of Insomnia Disorder up to 12 Months Postpartum

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Abstract Introduction Peripartum sleep disorders are linked to adverse maternal health outcomes and impaired infant bonding. Although higher incidences of sleep disorders have been reported during the peripartum period, risk factors for new postpartum sleep disorders remain under explored. We aimed to identify risk factors associated with new sleep disorders in the first year following childbirth. Methods We conducted a retrospective cohort analysis of a US commercial insurance claims database(MerativeTM Marketscan® Research Database). Women aged 18–55 with continuous insurance coverage from 90 days before estimated last menstrual period to 1 year after delivery were included. Exclusions were fetal demise, unknown delivery mode, and preexisting sleep disorders 3 months before delivery. Primary outcome was to identify demographic, medical, obstetric, and infant variables associated with new sleep disorder diagnoses between 1 and 12 months postpartum. Secondary outcomes included incidence of insomnia, sleep-related breathing disorders(SRBD) and sleep-related movement disorders(SRMD), and the monthly incidence of sleep disorders in the first year postpartum. Descriptive statistics were used and associations were assessed using univariate odds ratios and 95% confidence intervals (CIs), and multivariable logistic regression analysis was performed to identify independent predictors. Results 1,534,840 patients from 2007-2022 (vaginal delivery 68.5%; cesarean delivery: 31.6%) were included. Mean maternal age at delivery was 31.6±4.6 years; mean gestational age 38.4±2 weeks. Medical risk factors for new sleep disorders were major mental health disorder (adjusted odds ratios (aOR) 2.98, 95%CI [2.88, 3.09]), delivery BMI >40 (aOR 2.08, [1.95, 2.23]), substance use disorder (aOR 1.79 [1.65, 1.94]) and maternal age ≥35 (aOR 1.67 [1.29, 2.16]) (p< 0.001). Obstetric factors associated with sleep disorder diagnoses included pre-eclampsia(aOR 1.33 [1.26, 1.39]), severe maternal morbidity(aOR 1.25 [1.14, 1.37)), neglected maternal morbidity (aOR 1.22 [1.18, 1.26]), caesarean delivery(aOR 1.16 [1.12, 1.20]), and gestational age < 32 weeks(aOR 1.12 [1.07, 1.16]) (p < 0.001). Incidences of insomnia, SRBD, and SRMD were 0.77%, 0.12%, and 0.09%, respectively in the first year postpartum. Monthly incidences increased by 34% from months 1 to 6 postpartum (1,393 to 1,867 cases per month). Conclusion We identify clinical and obstetric risk factors for new postpartum sleep disorders. Screening these high-risk groups may facilitate timely referral and treatment. Support (if any)

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