<p>Reliability of study scales.</p>

Background
Poor sleep quality during pregnancy has been increasingly associated with adverse neonatal outcomes and heightened maternal psychological distress. However, evidence from Middle Eastern populations remains limited, particularly in Saudi Arabia where cultural and environmental factors may influence sleep during pregnancy.
Aim
To examine the association between maternal sleep quality during pregnancy and adverse neonatal outcomes (ANO), including preterm birth, low Apgar scores, and neonatal intensive care unit (NICU) admission, among postpartum women in Riyadh, Saudi Arabia.
Methods
This cross-sectional study recruited 223 postpartum women via online platforms; 145 met inclusion criteria and were included in the final analysis. Sleep quality was assessed using a culturally adapted 10-item Arabic Maternal Sleep Quality (MSQ) scale, a culturally adapted 10-item Arabic Maternal Sleep Quality (MSQ) scale that underwent expert review and demonstrated strong internal consistency (Cronbach’s α = 0.88). Maternal psychological well-being and neonatal outcomes were self-reported. Multivariate logistic regression was conducted to identify predictors of ANO, adjusting for confounders.
Results
Approximately 38.1% of women reported poor sleep quality, and 18.0% experienced at least one adverse neonatal outcome. Poor maternal sleep quality was associated with higher odds of ANO (adjusted OR = 1.75, 95% CI: 1.18–2.59, p = 0.005). A strong positive correlation was found between poor sleep and postpartum psychological distress (r = 0.52, p < .001).
Conclusions
Poor maternal sleep quality is significantly associated with adverse neonatal outcomes and increased maternal psychological burden. These findings support consideration of routine sleep screening and culturally sensitive sleep-health counseling within antenatal nursing care in Saudi Arabia.