Objective  To investigate the prevalence of depressive symptoms in pregnant couples in Anhui province and analyze the dose-response relationships of insufficient sleep and late bedtime with depressive symptoms, thus providing evidence for family-centered perinatal health interventions.

Methods This multicenter cross-sectional study was conducted from November 2023 to June 2024. Through convenience sampling, 2 460 pregnant couples were recruited from five regions across southern, central, and northern Anhui province. Depressive symptoms in both partners were assessed via the Edinburgh Postnatal Depression Scale (EPDS). A self-designed questionnaire was employed to collect sociodemographic information, sleep duration, and bedtime. Generalized additive models (GAMs) were adopted to explore the associations between sleep and depression, while multivariable logistic regression was performed to examine the independent and interactive effects of sleep duration and bedtime on depression risk.

Results Depressive symptoms were detected in 16.4% of pregnant women and 14.6% of husbands, with a 3.3% co-occurrence rate. The symptom prevalence followed a U-shaped trend across trimesters, peaking at 19.4% in women during the third trimester. GAMs revealed nonlinear dose-response relationships of sleep duration and bedtime with depression. Insufficient sleep (<7 h) and late bedtime (>23:00) were independent risk factors for both wives (OR = 1.72, 95%CI: 1.35–2.16; OR = 2.46, 95%CI: 1.75–3.46) and husbands (OR = 1.69, 95%CI: 1.33–2.14; OR = 1.41, 95%CI: 1.27–2.24). Combined insufficient sleep and late bedtime further increased the risk (wives: OR = 3.75, 95%CI: 2.29–6.14; husbands: OR = 1.63, 95%CI: 1.09–2.43). A statistically significant interactive effect between partners′ sleep duration was observed on maternal depressive symptoms (OR = 1.38, 95%CI: 1.10–1.77).

Conclusions Pregnant women exhibit higher depression prevalence than spouses, particularly during late pregnancy. Insufficient sleep and late bedtime are critical risk factors. Family-centered interventions targeting couple-based sleep health are recommended for perinatal depression prevention.