OBJECTIVE: To estimate the sleep problems among pregnant women during the COVID-19 pandemic.

ELIGIBILITY CRITERIA: English, peer-reviewed, observational studies published between December 2019 and July 2021 which assessed and reported sleep problem prevalence using a valid and reliable measure were included.

INFORMATION SOURCES: Scopus, Medline/PubMed Central, ProQuest, ISI Web of Knowledge and Embase.

RISK OF BIAS ASSESSMENT TOOL: The Newcastle-Ottawa Scale checklist.

SYNTHESIS OF RESULTS: Prevalence of sleep problems was synthesised using STATA software V.14 using a random effects model. To assess moderator analysis, meta-regression was carried out. Funnel plot and Egger's test were used to assess publication bias. Meta-trim was used to correct probable publication bias. The jackknife method was used for sensitivity analysis.

INCLUDED STUDIES: A total of seven cross-sectional studies with 2808 participants from four countries were included.

SYNTHESIS OF RESULTS: The pooled estimated prevalence of sleep problems was 56% (95% CI 23% to 88%, I²=99.81%, Tau²=0.19). Due to the probability of publication bias, the fill-and-trim method was used to correct the estimated pooled measure, which imputed four studies. The corrected results based on this method showed that pooled prevalence of sleep problems was 13% (95% CI 0% to 45%; p<0.001). Based on meta-regression, age was the only significant predictor of prevalence of sleep problems among pregnant women.

LIMITATIONS OF EVIDENCE: All studies were cross-sectional absence of assessment of sleep problems prior to COVID-19, and the outcomes of the pregnancies among those with and without sleep problems in a consistent manner are among the limitation of the current review.

INTERPRETATION: Pregnant women have experienced significant declines in sleep quality when faced with the COVID-19 pandemic. The short-term and long-term implications of such alterations in sleep on gestational and offspring outcomes are unclear and warrant further studies.

PROSPERO REGISTRATION NUMBER: CRD42020181644.