The relationship between disturbing thoughts (rumination, worry) and sleep quality of pregnant mothers referring to health centers affiliated to Isfahan University of Medical Sciences 2019

Document Type : Original Article


1 B.Sc. of Midwifery, Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.

2 Associate Professor, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.

3 M.Sc. of Midwifery, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran.

4 M.Sc. of Midwifery, School of Nursing and Midwifery, Kerman Azad University, Kerman, Iran.

5 PhD student in Reproductive Health, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.


Introduction: Hormonal changes during pregnancy affect the sleep-wake cycle and sleep structure and lead to sleep disorders. Ruminants and anxiety are two negative thoughts that can affect the quantity and quality of sleep and cause sleep disorders. Therefore, this study was conducted with aim to determine the relationship between disturbing thoughts (rumination, worry) and sleep quality of pregnant mothers.
Methods: This cross-sectional descriptive study was performed in 2019 on 190 pregnant mothers referring to the health centers in Isfahan. Data collection tools were the questionnaires of ruminant, anxiety and sleep quality. Data were analyzed by SPSS software (version 22) and Spearman and regression tests. P<0.05 was considered statistically significant.
Results: In pregnant mothers participating in the study, the mean overall score of sleep quality was 2.57±5.60, mental rumination was 9.62±1.43 and anxiety was 33.52±3.37. Based on the results of Spearman test, there is a significant inverse relationship between all dimensions of sleep quality and overall sleep quality score with the overall score of mental rumination and anxiety (p=0.001).
Conclusion: There was a significant relationship between rumination disturbing thoughts and anxiety with the quality of sleep in pregnant mothers. For this purpose, by examining the components of disturbing thoughts and their relationship with the quality of sleep in pregnant mothers, an effective step can be taken to improve the quality of sleep of pregnant women.


  1. Sadock BJ. Kaplan & Sadock's synopsis of psychiatry: behavioral sciences/clinical psychiatry. 10nd Philadelphia: Lippincott Williams and Wilkins; 2007
  2. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al. Williams Obstetrics. 23nd New York: McGraw-Hill Education; 2014.
  3. Bondad R, Abedian Z. Sleep Patterns and Factors Affecting It in the Third Trimester Pregnant Women Referred to Health Centers In Mashhad 1380. IJN 2003; 16(36):22-6.
  4. Doǧan O, Ertekin Ş, Doǧan S. Sleep quality in hospitalized patients. Journal of clinical nursing 2005; 14(1):107-13.
  5. Guastella AJ, Moulds ML. The impact of rumination on sleep quality following a stressful life event. Personality and Individual Differences 2007; 42(6):1151-62.
  6. Dzaja A, Arber S, Hislop J, Kerkhofs M, Kopp C, Pollmächer T, et al. Women's sleep in health and disease. Journal of psychiatric research 2005; 39(1):55-76.
  7. Jomeen J, Martin CR. The impact of choice of maternity care on psychological health outcomes for women during pregnancy and the postnatal period. Journal of evaluation in clinical practice 2008; 14(3):391-8.
  8. Karimi FZ, Nosrati Hadiabad SF, Abdollahi M, Karimi L. Frequency of sleep disorders and individual related factors in pregnant women referred to Mashhad health centers in 2019. Iran J Obstet Gynecol Infertil 2020; 23(1):25-32.
  9. Zaky NH. The relationship between quality of sleep during pregnancy and birth outcome among primiparae. OSR Journal of Nursing and Health Science 2015; 4(5):90-101.
  10. Okun ML, Luther JF, Wisniewski SR, Wisner KL. Disturbed sleep and inflammatory cytokines in depressed and nondepressed pregnant women: an exploratory analysis of pregnancy outcomes. Psychosomatic medicine 2013; 75(7):670-81.
  11. Tsai SY, Lin JW, Kuo LT, Thomas KA. Daily sleep and fatigue characteristics in nulliparous women during the third trimester of pregnancy. Sleep 2012; 35(2):257-62.
  12. JahanPak N, Razmjou N, RezaeiArdany A, Mazloum S, Bonakdaran S. Association between sleep duration and results of glucose challenge test in pregnant women without risk factors for diabetes. Iran J Obstet Gynecol Infertil 2013; 16(60):9-17.
  13. Seyedahmadinejad FS, Golmakani N, Asgharipour N, Shakeri MT. Investigation of Sleep quality during the third trimester of pregnancy and some related factors in primigravida women referred to health care centers in Mashhad-2014. Scientific Journal of Hamadan Nursing & Midwifery Faculty 2015; 22(4):53-60.
  14. Karami J, Momeni K, Alimoradi F. Prediction of sleep quality based on stress, depression and anxiety with role of mediator cognitive emotion regulation strategies in pregnant women. Iran J Obstet Gynecol Infertil 2016; 19(9):1-10.
  15. Pallarés ME, Bernasconi PA, Feleder C, Cutrera RA. Effects of prenatal stress on motor performance and anxiety behavior in Swiss mice. Physiology & behavior 2007; 92(5):951-6.
  16. Ko JY, Farr SL, Dietz PM, Robbins CL. Depression and treatment among US pregnant and nonpregnant women of reproductive age, 2005–2009. Journal of women's health 2012; 21(8):830-6.
  17. Sahebi A, Asghari MJ, Salari RS. Validation of depression anxiety and stress scale (DASS-21) for an Iranian population. Iran Psychol 2005; 4(1):299-313.
  18. Samani S, Sadeghi L. Psychometric properties of the cognitive emotion regulation questionnaire. Journal of Psychological Models and Methods 2010; 1(1):51-62.
  19. Pourmohseni Koluri F. The impact of rumination and worry on sleep disturbance. Daneshvar Medicine 2014; 21(108):1-12.
  20. Yadollahifar S, Sadeghi A, Shamsaei F. The relationship between rumination and sleep quality in patients with major depressive disorder. Shenakht journal of psychology & psychiatry 2020; 7(2):26-36.
  21. Zemestani M, Mehrabian T, Mosalman M. Prediction of the Amount of Worrying Based on Meta-Cognitive Beliefs and Rumination in Students. Iranian Journal of Psychiatric Nursing 2016; 4(3):51-7.
  22. Asadi Majreh S, Abedini M, Poursharifi H, Nikokar M. Relationship between intolerance of uncertainty and rumination with worry in students. Clin psychol 2012; 4(16):83-91.
  23. Querstret D, Cropley M. Assessing treatments used to reduce rumination and/or worry: A systematic review. Clinical psychology review 2013; 33(8):996-1009.
  24. Mousavi E, Alipour A, Zare H, Agah Heris M, Janbozorgi M. Effectiveness Of LEARN multifaceted intervention in modifying meta-cognition and the meta-worry beliefs. Adv Cogn Sci 2014; 16(1):39-48.
  25. Wangel AM, Molin J, Östman M, Jernström H. Emergency cesarean sections can be predicted by markers for stress, worry and sleep disturbances in first‐time mothers. Acta obstetricia et gynecologica Scandinavica 2011; 90(3):238-44.
  26. Alipour Z, Lamyian M, Hajizadeh E. Fear of childbirth, trait anxiety and quality sleep in pregnancy and birth outcomes in nulliparous woman. Iran J Obstet Gynecol Infertil 2012; 15(28):21-30.
  27. Rad P, Amir Ali Akbari S, Sadeghniiat KH, Alavi Majd H. Relationship between sleep disorder and pregnancy depression in primigravidae referring to health–treatment centers of Ahvaz Jundishapur University of Medical Sciences in 2010. SSU_Journals 2011; 19(4):454-62.
  28. Farokhi H, Seyedzadeh I, Mostafapour A. Investigating Reliability, Validity and Factor Structure of the Persian Version of the Positive and Negative Belief Rumination Scale and Rumination Response Scale. The Journal of New Advances in Behavioral Sciences 2018; 2(14):21-37.
  29. Borjali A, Sohrabi F, Dehshiri GR, Golzari M. Psychometrics particularity of farsi version of Pennsylvania state worry questionnaire for college students. Applied Psychology. 2010;4(1):67-75.
  30. Safa A, Adib-Hajbaghery M, Fazel-Darbandi AR. The relationship between sleep quality and quality of life in older adults. Iranian Journal of Psychiatric Nursing 2015; 3(3):53-62.
  31. Yan Y, Lin R, Tang X, He F, Cai W, Su Y. The relationship between worry tendency and sleep quality in Chinese adolescents and young adults: The mediating role of state–trait anxiety. Journal of health psychology 2014; 19(6):778-88.
  32. Afkham-Ebrahimi A, Rasoulian M, Taherifar Z, Zare M. The impact of anxiety on sleep quality. Medical Journal of The Islamic Republic of Iran (MJIRI) 2010; 23(4):184-8.
  33. Heydari A, Ehtesham Zadeh P, Marashi M. Relationship between insomnia severity, sleep quality, drowsiness and mental health disorders with academic performance in girls. Journal Woman and Culture 2010; 2(4):65-76.
  34. Ghofrani S. Examines the role of cognitive emotion regulation variables interpersonal problems and sleep quality among parents of middle school students. Marvdasht, Iran: Islamic Azad University of Marvdasht. 2015.
  35. Zawadzki MJ, Graham JE, Gerin W. Rumination and anxiety mediate the effect of loneliness on depressed mood and sleep quality in college students. Health Psychology 2013; 32(2):212-22.
  36. Thomsen DK, Mehlsen MY, Christensen S, Zachariae R. Rumination—relationship with negative mood and sleep quality. Personality and Individual Differences. 2003 May 1;34(7):1293-301.
  37. Ford DE, Kamerow DB. Epidemiologic study of sleep disturbances and psychiatric disorders: an opportunity for prevention?. Jama 1989; 262(11):1479-84.
  38. Gharashi Y. The relationship between brain behavioral systems and depressive symptoms with symptoms of sleep disorders (Doctoral dissertation, Master Thesis]. Tabriz, Iran: Faculty of Education and Psychology Tabriz University); 2015.
  39. Karami J, Momeni K, Alimoradi F. The Relationship Between Sleep Quality with Cognitive Emotion Regulation Strategies and Brain-Behavioral Systems in Pregnant Women. Avicenna Journal of Nursing and Midwifery Care 2018; 26(4):219-26.
  40. Tang NK, Harvey AG. Effects of cognitive arousal and physiological arousal on sleep perception. Sleep 2004; 27(1):69-78.
  41. Fernández-Mendoza J, Vela-Bueno A, Vgontzas AN, Ramos-Platón MJ, Olavarrieta-Bernardino S, Bixler EO, et al. Cognitive-emotional hyperarousal as a premorbid characteristic of individuals vulnerable to insomnia. Psychosomatic medicine 2010; 72(4):397-403.
  42. Carney CE, Edinger JD, Meyer B, Lindman L, Istre T. Symptom-focused rumination and sleep disturbance. Behavioral Sleep Medicine 2006; 4(4):228-41.
  43. Zoccola PM, Dickerson SS, Lam S. Rumination predicts longer sleep onset latency after an acute psychosocial stressor. Psychosomatic medicine 2009; 71(7):771-5.
  44. Carney CE, Harris AL, Moss TG, Edinger JD. Distinguishing rumination from worry in clinical insomnia. Behaviour research and therapy 2010; 48(6):540-6.
  45. Saeidi R, Tafazoli M, Gholami M, Mazlom R. New treatment for nipple soreness in breastfeeding mothers: A clinical trial study. Iranian Journal of Neonatology IJN 2015; 6(2):48-51.
  46. Saeidi R, Tafazoli M, Robatsangi MG. Kangaroo mother care for infantile colic: a randomized clinical trial. Tehran University Medical Journal 2010; 67(12):870-5.