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Aukia L, Paavonen EJ, Karlsson L, Pelto J, Perasto L, Karlsson H, Polo-Kantola P. Sleep duration and sleep loss during pregnancy: a longitudinal FinnBrain birth cohort study. Arch Gynecol Obstet 2024; 310:2541-2552. [PMID: 39299978 DOI: 10.1007/s00404-024-07727-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 09/04/2024] [Indexed: 09/22/2024]
Abstract
PURPOSE To investigate sleep duration and sleep loss during antenatal period and assess associative factors, including maternal characteristic and mood symptoms. METHODS A cohort of 3038 women was enrolled. Self-reported sleep duration and sleep loss, the latter being calculated from preferred sleep need and actual sleep duration, were measured in early, mid- and late pregnancy, and at delivery. The associations with age, BMI, parity, education, smoking, napping, and depressive and anxiety symptoms were evaluated. RESULTS Sleep duration was longest in early pregnancy and shortest at delivery (7.93 h-7.76 h, p < 0.001). The proportion of short sleepers (< 6 h) increased from 1.4% to 5.9% throughout the studied period (p < 0.001). Mean sleep loss remained stable in early- and mid-pregnancy, lowering in late pregnancy (p < 0.001) and increasing again until delivery (p = 0.003). The number of women with notable sleep loss (> 2 h) was similar during the first three measurement points (9.4%, 8.9% and 9.5%), but increased until delivery (14.1%, p < 0.001). Older, multiparous, and more-depressive women slept less (p < 0.001, p < 0.001, p = 0.017). Women with higher BMI were more likely to sleep < 6 h in late pregnancy (p = 0.012). Multiparous, more-depressive, and higher-BMI women reported more sleep loss (p < 0.001, p < 0.001, p = 0.049). CONCLUSION We confirmed earlier reported decrease in sleep duration at the end of pregnancy. As a novel finding, we showed a notable increase in sleep loss during the last month of pregnancy. Various factors were associated with both short sleep and sleep loss, especially multiparity, napping and depressive symptoms.
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Affiliation(s)
- Linda Aukia
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Savitehtaankatu 5, 20520, Turku, Finland.
| | - E Juulia Paavonen
- Pediatric Research Center, Child Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
| | - Juho Pelto
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Laura Perasto
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland
| | - Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Savitehtaankatu 5, 20520, Turku, Finland
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Wang Y, Gu J, Zhang F, Xu X. Path analysis of influencing factors for maternal antenatal depression in the third trimester. Sci Rep 2024; 14:4742. [PMID: 38413698 PMCID: PMC10899182 DOI: 10.1038/s41598-024-55355-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/22/2024] [Indexed: 02/29/2024] Open
Abstract
Maternal antenatal depression (AD) is a nonpsychotic depressive episode during pregnancy that can harm both the pregnant woman and the fetus. This study aimed to investigate the intrinsic interrelationships between AD and its influencing factors by constructing a path model. This survey-based cross-sectional study included 1071 pregnant women who underwent pregnancy examinations in three hospitals in Nantong City, China, between February and June 2023. General information and information regarding maternal AD, pregnancy stress, prenatal anxiety, social support, marital satisfaction, sleep quality, and resilience were collected. Multiple linear regression analysis using SPSS 25.0 was employed to determine the factors influencing pregnancy depression, and Amos25.0 was used to construct a structural equation model. AD incidence was 19.4% (208/1071). The independent risk factors affecting AD in pregnant women have been integrated into the established path analysis model. The model demonstrated a good fit (χ2/DF = 1.238, comparative fit index = 0.999, goodness-of-fit index = 0.998, normed fit index = 0.996, adjusted goodness-of-fit index = 0.990, incremental fit index = 0.999, and root mean square error of approximation = 0.015). While prenatal anxiety (0.230) and hyperthyroidism (0.048) only had direct effects on AD, mental resilience was the biggest factor affecting AD, followed by pregnancy stress, marital satisfaction, prenatal anxiety, sleep quality, social support, and hyperthyroidism. Improved mental resilience, social support, sleep quality, and marital satisfaction; reduced pregnancy stress and prenatal anxiety; and effective hyperthyroidism treatment might reduce AD. This study underscored the significance of delivering actionable strategies and tangible assistance to pregnant women to reduce AD.
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Affiliation(s)
- Yanchi Wang
- Affiliated Nantong Hospital of Shanghai University (The Sixth People's Hospital of Nantong), Nantong, Jiangsu, China
- Medical School of Nantong University, Nantong, Jiangsu, China
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, China
| | - Jian Gu
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Feng Zhang
- Medical School of Nantong University, Nantong, Jiangsu, China.
- Medical School (School of Nursing), Nantong University, Nantong, 226001, Jiangsu, China.
| | - Xujuan Xu
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, China.
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Okun ML, Lac A. Postpartum Insomnia and Poor Sleep Quality Are Longitudinally Predictive of Postpartum Mood Symptoms. Psychosom Med 2023; 85:736-743. [PMID: 37506301 DOI: 10.1097/psy.0000000000001234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
OBJECTIVE Insomnia and poor sleep quality are frequently reported by perinatal women. Both are noted to increase the risk of postpartum depression, with less known about their association with postpartum anxiety. This study sought to assess whether perinatal sleep disturbances predicted depression and anxiety symptoms across each month of the first 6 months postpartum in women with a history of depression. METHODS Pregnant women without active depression at enrollment ( N = 159), 18 to 45 years of age, were recruited. In late pregnancy and for up to 6 months postpartum, women completed monthly online questionnaires including the Insomnia Symptom Questionnaire, Pittsburgh Sleep Quality Index, Edinburgh Postnatal Depression Scale, and Generalized Anxiety Disorder-7. Repeated-measures multilevel models were used to predict depression and anxiety across the postpartum. RESULTS The prevalence of insomnia was 20.4%, and the prevalence of poor sleep quality was 67.8% across the first 6 months postpartum. Postpartum insomnia and poor sleep quality at the between-subject and within-subject levels tended to uniquely predict greater depressive and anxiety symptoms, even after controlling for demographic characteristics, prenatal insomnia, and prenatal poor sleep quality. CONCLUSIONS Most of the women in our sample had sleep disturbances across the perinatal period. Consistent with the extant literature, postpartum insomnia and poor sleep quality, but not prenatal measures of sleep, longitudinally predicted greater postpartum depression and anxiety symptoms. The chronic sleep deprivation of insomnia and the subjective experience of poor sleep quality are uniquely relevant risks of postpartum mood disorders. Evaluation and mitigation of perinatal sleep disturbance are ideal opportunities to reduce postpartum mood disorders and subsequent health outcomes.
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Affiliation(s)
- Michele L Okun
- From the Biofrontiers Center (Okun) and Department of Psychology (Lac), University of Colorado Colorado Springs, Colorado Springs, Colorado
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Bao C, Wang Y, Le T, Xu L, Tang W, Zou W, Bao Y, Xu D, Zhao K. Relationship between depressive symptoms and sleep quality and cognitive inhibition ability in prenatal pregnant women. BMC Psychiatry 2023; 23:522. [PMID: 37474916 PMCID: PMC10357698 DOI: 10.1186/s12888-023-04976-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/22/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Sleep problems and cognitive changes are typical in pregnant women with depressive symptoms. However, the relationship between sleep quality and executive dysfunction remains unclear. This study aims to explore the differences in sleep quality and cognitive inhibition between pregnant women with and without depressive symptoms in the third trimester of pregnancy and investigate the correlations between sleep quality, cognitive inhibition and depressive symptoms. METHODS In the third trimester, 169 women without depressive symptoms and 88 women with depressive symptoms participated in the study. Edinburgh Postpartum Depression Questionnaire (EPDS) was used to assess depressive symptoms, and Pittsburgh Standard Sleep Quality Index Questionnaire (PSQI) was used to investigate sleep quality. The color-word Stroop task is used to evaluate cognitive inhibition. RESULTS Compared with women without depressive symptoms, pregnant women with depressive symptoms showed worse sleep quality and Stroop task performances (response speed and accuracy). In addition, the speed of cognitive inhibition plays a mediating role in the relationship between sleep quality and prenatal depressive symptoms. CONCLUSION This research emphasizes the importance of sleep quality screening and cognitive training for depression during pregnancy and childbirth in ensuring women's mental health during pregnancy and childbirth.
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Affiliation(s)
- Ciqing Bao
- Wenzhou Seventh People's Hospital, Wenzhou, 325000, China
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210000, China
| | - Yali Wang
- Wenzhou Seventh People's Hospital, Wenzhou, 325000, China
| | - Tao Le
- School of Mental Health, Wenzhou Medical University , Wenzhou, China
| | - Ling Xu
- Wenzhou Seventh People's Hospital, Wenzhou, 325000, China
| | - Weina Tang
- Shaoxing 7th People's Hospital, Shaoxing, China
| | - Wanyun Zou
- Wenzhou Seventh People's Hospital, Wenzhou, 325000, China
| | - Yin Bao
- Department of Obstetrics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Dongwu Xu
- School of Mental Health, Wenzhou Medical University , Wenzhou, China.
| | - Ke Zhao
- Lishui Second People's Hospital Afliated to Wenzhou Medical University, Lishui, 323000, China.
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center For Mental Disorder, Wenzhou, China.
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Sharma V, Sharkey KM, Palagini L, Mazmanian D, Thomson M. Preventing recurrence of postpartum depression by regulating sleep. Expert Rev Neurother 2023; 23:1-9. [PMID: 37462620 PMCID: PMC10527998 DOI: 10.1080/14737175.2023.2237194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 07/12/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Women are at a high risk of recurrence of depression in the postpartum period. Given the circumscribed duration of the risk period and knowledge of its triggers, postpartum depression should be easily preventable. However, prophylactic drug studies have reported contradictory findings partly due to the heterogeneity of the disorder. Currently, there are no studies on the efficacy of psychotherapy in the prevention of postpartum depression in women with major depressive or bipolar disorder. AREAS COVERED This review evaluates the results of controlled medication and psychotherapeutic studies in the prevention of depression in women with major depressive disorder or bipolar disorder; it further suggests that the management of sleep loss/insomnia may be an effective strategy in the prevention of postpartum depression. EXPERT OPINION A thorough understanding of the clinical course of the antecedent mood disorder and historical treatment response is necessary before the implementation of strategies for the prevention of postpartum depression. Targeting disturbed and/or insufficient sleep - a common and early transdiagnostic symptom of peripartum psychiatric disorders - may be a more effective intervention for the prevention of postpartum depression and psychiatric comorbidities in some individuals than the traditional approach of antidepressant use.
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Affiliation(s)
- Verinder Sharma
- Department of Psychiatry, Western University, London, Ontario, Canada
- Department of Obstetrics & Gynecology, Western University, London, Ontario, Canada
- Parkwood Institute Mental Health, St. Joseph’s Health Care, London, Ontario, Canada
| | - Katherine M. Sharkey
- Department of Medicine, Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University Providence, Rhode Island
| | - Laura Palagini
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Via Roma 67, 56100, Pisa, Italy
| | - Dwight Mazmanian
- Department of Psychology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Michael Thomson
- Department of Psychiatry, Western University, London, Ontario, Canada
- Parkwood Institute Mental Health, St. Joseph’s Health Care, London, Ontario, Canada
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Bušková J, Miletínová E, Králová R, Dvořáková T, Tefr Faridová A, Heřman H, Hrdličková K, Šebela A. Parasomnias in Pregnancy. Brain Sci 2023; 13:brainsci13020357. [PMID: 36831900 PMCID: PMC9954207 DOI: 10.3390/brainsci13020357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVES Pregnancy is often associated with reduced sleep quality and an increase in sleep disorders, such as restless leg syndrome, obstructive sleep apnea, and insomnia. There are few studies investigating the prevalence of parasomnias in pregnancy, although they may be expected to be a significant problem, as disturbed sleep in this time period in addition to these sleep disorders may trigger parasomnia episodes. METHODS We conducted a survey using an online questionnaire focusing on a comparison of the prevalence of parasomnias in three time periods: 3 months before pregnancy, during pregnancy, and 3 months after delivery. We also inquired about psychiatric and neurological comorbidities, current anxiety and depression symptoms, and pregnancy complications. RESULTS A total of 325 women (mean age 30.3 ± 5.3 years) participated in the online survey. The overall number of reported parasomnias increased during pregnancy compared to the 3 months before pregnancy (p < 0.001) and decreased after childbirth (p < 0.001). Specifically, we found a significant increase in sleepwalking (p = 0.02) and night terrors (p < 0.001), as well as in vivid dreams (p < 0.001) and nightmares (p < 0.001) during pregnancy. A similar significant increase during pregnancy was reported for head explosion (p < 0.011). In contrast, the number of episodes of sleep paralysis increased after delivery (p = 0.008). At the individual level, an increase in the severity/frequency of individual parasomnia episodes was also observed during pregnancy. Participants whose vivid dreams/nightmares persisted after delivery had higher BDI-II and STAI-T scores. Our data also suggest a significant impact of migraines and other chronic pain, as well as complications during pregnancy, on the presence of parasomnia episodes in our cohort. CONCLUSIONS We have shown that the prevalence of parasomnias increases during pregnancy and needs to be targeted, especially by non-pharmacological approaches. At the same time, it is necessary to inquire about psychiatric and neurological comorbidities and keep in mind that more sleep disorders may be experienced by mothers who have medical complications during pregnancy.
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Affiliation(s)
- Jitka Bušková
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, 100 00 Prague, Czech Republic
- Correspondence: ; Tel.: +420-732325637
| | - Eva Miletínová
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, 100 00 Prague, Czech Republic
| | - Radana Králová
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic
| | - Tereza Dvořáková
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic
| | - Adéla Tefr Faridová
- The Institute for the Care of Mother and Child, 147 10 Prague, Czech Republic
- Second Faculty of Medicine, Charles University, 150 06 Prague, Czech Republic
| | - Hynek Heřman
- The Institute for the Care of Mother and Child, 147 10 Prague, Czech Republic
| | - Kristýna Hrdličková
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic
- Faculty of Arts, Charles University, 116 38 Prague, Czech Republic
| | - Antonín Šebela
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, 100 00 Prague, Czech Republic
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Epperson CN, Rubinow DR, Meltzer-Brody S, Deligiannidis KM, Riesenberg R, Krystal AD, Bankole K, Huang MY, Li H, Brown C, Kanes SJ, Lasser R. Effect of brexanolone on depressive symptoms, anxiety, and insomnia in women with postpartum depression: Pooled analyses from 3 double-blind, randomized, placebo-controlled clinical trials in the HUMMINGBIRD clinical program. J Affect Disord 2023; 320:353-359. [PMID: 36191643 DOI: 10.1016/j.jad.2022.09.143] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/26/2022] [Accepted: 09/27/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Brexanolone is currently the only treatment specifically approved for postpartum depression (PPD) in the United States, based on the results from one Phase 2 and two Phase 3 double-blind, randomized, controlled trials in the HUMMINGBIRD program. METHODS Adults with PPD randomized to a 60-h infusion of brexanolone 90 μg/kg/h (BRX90) or placebo from the 3 trials were included in these post hoc analyses. Data on change from baseline (CFB) in the 17-item Hamilton Rating Scale for Depression (HAMD-17) total score, HAMD-17 Anxiety/Somatization and Insomnia subscales, and Clinical Global Impression of Improvement (CGI-I) scale were pooled. Response rates for HAMD-17 (≥50 % reduction from baseline) and CGI-I (score of 1 or 2) scales and time to response were analyzed. RESULTS Patients receiving BRX90 (n = 102) versus placebo (n = 107) achieved a more rapid HAMD-17 response (median, 24 vs 36 h; p = 0.0265), with an Hour-60 cumulative response rate of 81.4 % versus 67.3 %; results were similar for time to CGI-I response (median, 24 vs 36 h; p = 0.0058), with an Hour-60 cumulative response rate of 81.4 % versus 61.7 %. CFB in HAMD-17 Anxiety/Somatization and Insomnia subscales also favored BRX90 versus placebo, starting at Hour 24 through Day 30 (all p < 0.05), and response rates for both subscales were higher with BRX90. LIMITATIONS The study was not powered to assess exploratory outcomes. CONCLUSIONS Brexanolone was associated with rapid improvement in depressive symptoms and symptoms of anxiety and insomnia compared with placebo in women with PPD. These data continue to support the use of brexanolone to treat adults with PPD.
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Affiliation(s)
- C Neill Epperson
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, United States of America.
| | - David R Rubinow
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Kristina M Deligiannidis
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States of America; Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America
| | - Robert Riesenberg
- Atlanta Center for Medical Research, Atlanta, GA, United States of America
| | - Andrew D Krystal
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States of America
| | - Kemi Bankole
- Sage Therapeutics, Inc., Cambridge, MA, United States of America
| | - Ming-Yi Huang
- Sage Therapeutics, Inc., Cambridge, MA, United States of America
| | - Haihong Li
- Sage Therapeutics, Inc., Cambridge, MA, United States of America
| | - Colville Brown
- Sage Therapeutics, Inc., Cambridge, MA, United States of America
| | - Stephen J Kanes
- Sage Therapeutics, Inc., Cambridge, MA, United States of America
| | - Robert Lasser
- Sage Therapeutics, Inc., Cambridge, MA, United States of America
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Maternal Sleep Problems in the Periconceptional Period and the Impact on Health of Mother and Offspring: A Systematic Review. Clocks Sleep 2022; 4:688-713. [PMID: 36547103 PMCID: PMC9777334 DOI: 10.3390/clockssleep4040052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/06/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022] Open
Abstract
Knowledge of the impact of sleep problems in the periconceptional period is scarce. Since this period is the most sensitive time window for embryonic and placental development, we aim to study the impact of maternal sleep problems in the periconceptional period on both mother and offspring. We systematically searched various databases up until September 2021 for studies reporting on maternal sleep in the periconceptional period and any outcome in mother and offspring. We included observational studies describing maternal sleep problems in the periconceptional period and associations with either maternal and/or offspring outcomes. The search produced 8596 articles, of which we selected 27 studies. Some associations were found between sleep problems and lower fertility, more hypertensive disorders, more mood disorders in mothers, higher risk of preterm birth and low birth weight, and more sleep and behavior problems in offspring, with associations with maternal mood disorders being most consistent. This systematic review shows that maternal sleep problems in the periconceptional period are associated with a higher risk of various adverse outcomes in both mother and offspring, although not consistently. It shows that good sleep during pregnancy is crucial, starting as early as before conception, especially for maternal mood. Therefore, it is important for clinicians to pay attention to sleep problems in the periconceptional period and provide adequate treatment for potential sleep problems, even before pregnancy.
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Associations between childhood maltreatment, poor sleep, and prenatal distress in pregnant adolescents. Dev Psychopathol 2022; 34:764-773. [PMID: 33551015 PMCID: PMC8349382 DOI: 10.1017/s0954579420002163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Childhood maltreatment (CM) is a known risk factor for adolescent pregnancy. Sleep disturbances and psychological distress, both common negative sequelae of CM, often co-occur during pregnancy, although directionality remains unclear. Furthermore, little is known about how CM affects sleep-distress associations during pregnancy. In pregnant adolescents, we examined: (a) whether there are significant predictive associations from CM to sleep quality and distress and (b) bidirectional influences of distress and sleep quality. Healthy pregnant adolescents (n = 204) were recruited before or during the 2nd trimester. CM was assessed at enrollment; sleep quality and distress were assessed in the 2nd and 3rd trimesters. Hypotheses were tested using path analysis. Findings revealed that CM was associated with worse 2nd trimester sleep quality and distress (β = .19, p < .05 for sleep; β = .30, p < .001 for distress). Higher levels of 2nd trimester distress were associated with lower 3rd trimester sleep quality (β = .19, p < .05). Findings provide novel information about (a) associations from CM to prenatal mood and sleep in pregnant adolescents, and (b) sleep-distress directionality over the course of pregnancy. These results have implications for better understanding the ways in which CM potentially exerts influences later in life, and for targeting interventions to address physical and mental health during pregnancy.
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Mohammadi F, Moradi M, Niazi A, Jamali J. The Impact of Aromatherapy with Citrus Aurantium Essential Oil on Sleep Quality in Pregnant Women with Sleep Disorders: A Randomized Controlled Clinical Trial. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2022; 10:160-171. [PMID: 35855386 PMCID: PMC9287566 DOI: 10.30476/ijcbnm.2022.92696.1900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 04/10/2022] [Accepted: 04/16/2022] [Indexed: 11/19/2022]
Abstract
Background Sleep disorders are so prevalent during pregnancy. The present study was conducted to investigate the impact of aromatherapy with Citrus aurantium essential oil on sleep quality in pregnant women with sleep disorders. Methods This randomized clinical trial study was conducted on 68 pregnant women in their 28-34 weeks of pregnancy who sufferred sleep disorders and referred to Jiroft health centers in 2021 (January-June). Those meeting the inclusion criteria were divided into the intervention and placebo groups, using random sequence generated through the randomization website. They were given five drops of Citrus aurantium essential oil and the placebo twice a day, every day for one month in the form of facemasks which they inhaled through normal breathing for 20 minutes. Sleep quality was assessed before the intervention and one month after the start of the intervention. The demographic questionnaire and Pittsburgh Sleep Quality Index (PSQI) were used for collecting the data. Data analysis was performed using SPSS 24 software. The Mann-Whitney-U, Wilcoxon and fisher exact tests were carried out. P-value<0.05 was considered statistically significant. Results Before the intervention, the mean and standard deviation scores of pregnant women's sleep quality in the intervention (9.89±3.00) and placebo (8.12±2.53) groups were not significantly different (P=0.10). One month after the intervention, the score was significantly lower in the intervention group (4.37±1.85) than the placebo group (8.48±2.62) (P<0.001). Conclusion Based on the results of the present study, it seems that aromatherapy with Citrus aurantium essential oil enhances the sleep quality in pregnant women with sleep disorders, so it can be used to diminish sleep disorders in these women.Trial Registration Number: IRCT20200512047414N1.
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Affiliation(s)
- Freshteh Mohammadi
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Moradi
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran,
Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Azin Niazi
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Jamshid Jamali
- Department of Epidemiology and Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
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Broberg L, Damm P, Frokjaer VG, Rosthøj S, de Wolff MG, Høgh S, Tabor A, Hegaard HK. Evaluation of the Effect of Supervised Group Exercise on Self-Reported Sleep Quality in Pregnant Women with or at High Risk of Depression: A Secondary Analysis of a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105954. [PMID: 35627496 PMCID: PMC9140477 DOI: 10.3390/ijerph19105954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/05/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022]
Abstract
Poor sleep quality is common during pregnancy. Our objective was to evaluate the effect of supervised group physical exercise on self-reported sleep quality in pregnant women with or at high risk of depression, and secondly, to describe the association between sleep quality and psychological well-being during pregnancy and postpartum. This was a secondary analysis of a randomized controlled trial (n = 282) (NCT02833519) at Rigshospitalet, Denmark. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), psychological well-being by the five-item WHO Well-Being Index (WHO-5). The intention-to-treat analysis showed no difference in mean global PSQI score neither at 29−34 weeks, 6.56 (95% CI: 6.05−7.07) in the intervention group and 7.00 (95% CI: 6.47−7.53) in the control group, p = 0.2, nor at eight weeks postpartum. Women with WHO-5 ≤ 50 reported higher mean global PSQI scores at baseline, 7.82 (95% CI: 7.26−8.38), than women with WHO-5 score > 50, mean 5.42 (95% CI: 5.02−5.82), p < 0.0001. A significant difference was also present post-intervention and eight weeks postpartum. No significant effect of group exercise regarding self-reported sleep quality was seen at 29−34 weeks of gestation or postpartum. Low psychological well-being was associated with poor sleep quality during pregnancy and postpartum.
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Affiliation(s)
- Lotte Broberg
- Department of Obstetrics, Copenhagen University Hospital–Rigshospitalet, 2100 Copenhagen, Denmark; (P.D.); (S.H.); (H.K.H.)
- The Interdisciplinary Research Unit of Women’s, Children’s and Families’ Health, Copenhagen University Hospital–Rigshospitalet, 2100 Copenhagen, Denmark
- Center for Clinical Research and Prevention, Frederiksberg Hospital, 2000 Frederiksberg, Denmark
- Correspondence: ; Tel.: +45-21908188
| | - Peter Damm
- Department of Obstetrics, Copenhagen University Hospital–Rigshospitalet, 2100 Copenhagen, Denmark; (P.D.); (S.H.); (H.K.H.)
- Department Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
| | - Vibe G. Frokjaer
- Neurobiology Research Unit, Department of Neurology, Copenhagen University Hospital–Rigshospitalet, 2100 Copenhagen, Denmark;
- Mental Health Services, Capital Region of Copenhagen, 2605 Brondby, Denmark
| | - Susanne Rosthøj
- Danish Cancer Society Research Center, 2100 Copenhagen, Denmark;
| | - Mie Gaarskjaer de Wolff
- Department of Obstetrics and Gynecology, Copenhagen University Hospital–Hvidovre, 2650 Hvidovre, Denmark;
| | - Stinne Høgh
- Department of Obstetrics, Copenhagen University Hospital–Rigshospitalet, 2100 Copenhagen, Denmark; (P.D.); (S.H.); (H.K.H.)
- Neurobiology Research Unit, Department of Neurology, Copenhagen University Hospital–Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Ann Tabor
- Department Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark
| | - Hanne Kristine Hegaard
- Department of Obstetrics, Copenhagen University Hospital–Rigshospitalet, 2100 Copenhagen, Denmark; (P.D.); (S.H.); (H.K.H.)
- The Interdisciplinary Research Unit of Women’s, Children’s and Families’ Health, Copenhagen University Hospital–Rigshospitalet, 2100 Copenhagen, Denmark
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12
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Abujilban S, Mrayan L, Al-Obeisat S, Tanash M, Sinclair M, Kernohan WG. Factors associated with antenatal depression in the Kingdom of Jordan during the COVID-19 pandemic. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000194. [PMID: 36962288 PMCID: PMC10021866 DOI: 10.1371/journal.pgph.0000194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/19/2022] [Indexed: 11/19/2022]
Abstract
Fear of infection and measures taken to mitigate infection, such as social distancing, lockdown and isolation can lead to anxiety and depression across the life course, but especially in pregnancy. We set out to identify the prevalence of depression in pregnancy, using Edinburgh Postnatal Depression Scale (EPDS) during national quarantine and to examine women's knowledge, attitude, and practices (KAP) in regard to potential COVID-19-related depression. Following ethical approval, an observational design, with an online questionnaire and snowball sampling was used to recruit 546 pregnant women (231 primi and 315 multiparous) in Jordan via common social media platforms (facebook, WhatsApp). Over one third (36.7%) reported depressive symptoms. There were significantly lower depression scores among pregnant women who exhibited more knowledge about COVID-19 (in high [vs low] knowledge groups, mean EPDS = 10.8 [vs 12.2]; p = 0.007). Depression scores were not significantly associated with attitude nor with practice. This suggests that enhanced knowledge levels may protect pregnant women against depression. Our findings contribute to understanding of the experience of pregnant women in developing countries during the COVID-19 pandemic. Healthcare Professionals should provide health education to all pregnant women and timely services to pregnant women with depressive symptoms. This may lead to the prevention of serious symptoms and reduce negative consequences on the next generation, not only in Jordan, but worldwide.
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Affiliation(s)
- Sanaa Abujilban
- Department of Maternal, Child and Family Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - Lina Mrayan
- Department of Maternal, Child and Family Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - Salwa Al-Obeisat
- Department of Maternal and Child Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Mu'ath Tanash
- Department of Adult Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - Marlene Sinclair
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, County Antrim, Northern Ireland, United Kingdom
| | - W George Kernohan
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, County Antrim, Northern Ireland, United Kingdom
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13
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Okun ML, Kohl V, Feliciano L. Comparison of longitudinal diary and actigraphy-assessed sleep in pregnant women. Sleep Med 2021; 88:149-156. [PMID: 34753041 DOI: 10.1016/j.sleep.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/31/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVES Various methods are employed to assess sleep in pregnant women, including self-report, sleep diary, and actigraphy. Unfortunately, the data are often contradictory, and interpretations are often inconsistent. The current aims are to compare subjective and objective sleep data in pregnant women collected longitudinally in early pregnancy. METHODS In this secondary analysis of 104 pregnant women, sleep was collected via diary and actigraphy for 14 days during three separate occasions (10-12 weeks; 14-16 weeks; and 18-20 weeks). Sleep variables included wake after sleep onset (WASO), sleep efficiency (SE), bedtime/lights out, sleep onset latency (SL), and total sleep duration (TST). Repeated measures ANOVAs compared each sleep variable across Time and by Method of data collection, while controlling for parity and daytime naps. RESULTS Significant differences were noted for only the method of data collection for sleep component studied for WASO, F (1, 98) = 147.20, p < 0.001; SE, F (1, 98) = 129.41, p < 0.001); bedtime/lights out, F (1, 103) = 5.33, p < 0.05); and sleep duration, F (1, 104) = 182.75, p < 0.001). Significant variation was not seen in any variable across time-period. CONCLUSIONS There are substantial discrepancies between diary- and actigraphy-assessed sleep measures in pregnant women which is in alignment with previous literature. These data highlight that these methodologies assess different constructs. We contend that these data may be useful as a reference to compare high-risk women or those with sleep disorders. Using a multi-modal approach to identify sleep disturbance in pregnancy is likely a more clinically useful option.
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Affiliation(s)
- Michele L Okun
- BioFrontiers Center, University of Colorado, Colorado Springs, CO, USA; Department of Psychology, University of Colorado, Colorado Springs, CO, USA.
| | - Vanessa Kohl
- Department of Psychology, University of Colorado, Colorado Springs, CO, USA
| | - Leilani Feliciano
- Department of Psychology, University of Colorado, Colorado Springs, CO, USA
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14
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Overlooking Insomnia in Sleep Disorders of Pregnancy. ATS Sch 2021; 2:287-288. [PMID: 34409422 PMCID: PMC8357061 DOI: 10.34197/ats-scholar.2021-0008le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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15
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Pauley AM, Moore GA, Mama SK, Molenaar P, Symons Downs D. Associations between prenatal sleep and psychological health: a systematic review. J Clin Sleep Med 2021; 16:619-630. [PMID: 32003734 DOI: 10.5664/jcsm.8248] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
STUDY OBJECTIVES This systematic review aimed to examine the: (1) strength of associations between prenatal sleep (ie, duration, quality, and insomnia) and psychological health (ie, depression, anxiety, and stress); and (2) moderating influence of sociodemographic characteristics (ie, maternal age, gestational age/trimester, parity, marital and socioeconomic status [SES]), body mass index (BMI), and meeting sleep recommendations. METHODS A systematic search was conducted using PubMed, PsycINFO, Web of Science, and CINHAL to identify studies with at least one sleep measure and a psychological health outcome. Effect sizes (ES) were calculated by associations between individual components of sleep and psychological health (eg, sleep quality-depression). RESULTS Reviewed studies (n = 32) included 14,648 participants and yielded 219 ES. ES for anxiety/stress were combined due to insufficient data to analyze individually. Average strengths of associations for sleep duration-depression (ES = .52) and sleep duration-anxiety/stress (ES = .48), sleep quality-depression (ES = .55) and sleep quality-anxiety/stress (ES = .58), and insomnia-depression (ES = .67) ranged from medium to large. Marital status, parity, BMI, and meeting sleep recommendations moderated sleep duration-depression and sleep duration-anxiety/stress. SES, gestational age/trimester, parity, and BMI moderated sleep quality-depression and sleep quality-anxiety/stress associations. CONCLUSIONS Poor sleep quality and depression are prevalent during pregnancy and may negatively impact maternal and fetal outcomes. Moderating effects suggest that pregnant women of different BMI status and gestational age differ in their sleep habits and depression and anxiety/stress levels. Findings highlight the need to better understand the impact of these associations on maternal-fetal outcomes to inform interventions to improve sleep and psychological health.
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Affiliation(s)
- Abigail M Pauley
- Exercise Psychology Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania
| | - Ginger A Moore
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania
| | - Scherezade K Mama
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania
| | - Peter Molenaar
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania
| | - Danielle Symons Downs
- Exercise Psychology Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania.,Department of OBGYN, College of Medicine, Hershey, Pennsylvania
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Lin J, Sun W, Song Y, Dong S, Lin Q, Deng Y, Meng M, Zhu Q, Jiang Y, Wang G, Tong S, Liu S, Mei H, Jiang F. Cohort Profile: The Shanghai Sleep Birth Cohort Study. Paediatr Perinat Epidemiol 2021; 35:257-268. [PMID: 33337549 DOI: 10.1111/ppe.12738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/07/2020] [Accepted: 10/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sleep disturbances in women occur frequently throughout pregnancy. Previous studies have demonstrated that the increasing incidence of physiological and psychological illness is concurrent with increasing sleep deprivation and poor sleep quality in adults and children. OBJECTIVES The Shanghai Sleep Birth Cohort Study (SSBCS) was established to examine the effect of sleep disturbances during the third trimester on emotional regulation of mothers; to assess the effect of maternal sleep during pregnancy on the growth and development of children; and to explore the influence of children's sleep characteristics on physical and social-emotional development. POPULATION The study was conducted in the Renji Hospital in Pudong New District, Shanghai from May 2012 to July 2013. Women and their newborns who met the inclusion criteria and agreed to participate in this study were recruited to the SSBCS. METHODS The follow-up visits for children were conducted at the age of 42 days, 3, 6, 9, 12, 18, and 24 months, and 3, 4, and 6 years. Data on demographic factors, physical examination, sleep assessment, developmental and psychiatric assessment, diet records, and biological samples were collected throughout the study. PRELIMINARY RESULTS A total of 277 pregnant women were recruited to the study; the response rate was 64.3%. 37.9% of the pregnant women had poor sleep quality and 12.0% suffered from depression. Infant sleep patterns changed during the first year of life, but most sleep characteristics showed little variation from 6 to 12 months. CONCLUSIONS The SSBCS is an on-going prospective cohort study with follow-up to 6 years. The detailed data on demographic factors, sleep assessment, physical examinations, neurodevelopmental and psychiatric assessment, diet records, and biological samples make this research platform an important resource for examining the potential effects of sleep characteristics on both maternal and child health.
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Affiliation(s)
- Jianfei Lin
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wanqi Sun
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuanjin Song
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shumei Dong
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingmin Lin
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yujiao Deng
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Meng
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi Zhu
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanrui Jiang
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guanghai Wang
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shilu Tong
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,School of Public Health and Institute of Environment and Population Health, Anhui Medical University, Hefei, China.,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Shijian Liu
- Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Mei
- Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Data Science, School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Fan Jiang
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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17
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Laitinen L, Nurmi M, Rautava P, Koivisto M, Polo-Kantola P. Sleep quality in women with nausea and vomiting of pregnancy: a cross-sectional study. BMC Pregnancy Childbirth 2021; 21:152. [PMID: 33607953 PMCID: PMC7893929 DOI: 10.1186/s12884-021-03639-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/09/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Nausea and vomiting of pregnancy (NVP) deteriorates many aspects of daily lives of women. However, little is known about associations between NVP and sleep quality. METHODS Women attending to routine mid-pregnancy visits in maternity health care clinics in Turku city area and surrounding municipalities, Finland, during 2011-2014, were invited to participate. A cohort of 1203 volunteers (mean age 30 years, mean gestational week 16.6, mean BMI 24.4 kg/m2, nulliparous 46%) was recruited. The severity of NVP in the worst 12-h period of current pregnancy was assessed with Pregnancy Unique Quantification of Emesis Questionnaire (PUQE) and categorized accordingly into no/mild/moderate and severe NVP. Sleep disturbances during the past 3 months were assessed with selected questions (difficulty falling asleep, night awakenings, too early morning awakenings and sleepiness during the day) from Basic Nordic Sleep Questionnaire (BNSQ). In addition, general sleep quality, as well as physical and mental quality of life (QoL) were rated with three visual analog scales (VAS). Associations between PUQE categories (severity of NVP) and sleep disturbances, general sleep quality, physical QoL and mental QoL were evaluated with multinomial regression analysis. RESULTS According to PUQE, NVP was most frequently moderate (n = 629, 52.3%), followed by mild (n = 361, 30.0%) and severe (n = 77, 6.4%). Only 11.3% had no NVP (n = 136). The most frequent sleep disturbance was night awakenings (69.9%, n = 837), followed by sleepiness during the day (35.7%, n = 427), too early morning awakenings (12.0%, n = 143) and difficulty falling asleep (7.1%, n = 81). In adjusted analysis (age, parity, body mass index, smoking, employment), more severe NVP was associated with night awakenings (AOR 3.9, 95% CI 1.79-8.47, P < 0.0001) and sleepiness during the day (AOR 4.7, 95% CI 2.20-9.94, P < 0.0001). In VAS, women with more severe NVP rated worse general sleep quality and worse physical and mental QoL. However, in multivariable analysis, the association between the severity of NVP and physical and mental QoL was stronger than that of sleep . CONCLUSIONS More severe NVP is associated with sleep disturbances and in close relation to lower physical and mental QoL. Thus, in comprehensive care of women with NVP, also sleep quality should be evaluated.
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Affiliation(s)
- Linda Laitinen
- Department of Obstetrics and Gynecology, Central Finland Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland.
- University of Turku, Turku, Finland.
| | - Miina Nurmi
- Department of Public Health, University of Turku, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland
- Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Mari Koivisto
- Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Päivi Polo-Kantola
- University of Turku, Turku, Finland
- Department of Obstetrics and Gynecology, Turku University Hospital, Turku, Finland
- Sleep Research Center, University of Turku, Turku, Finland
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18
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Dachew BA, Ayano G, Betts K, Alati R. The impact of pre-pregnancy BMI on maternal depressive and anxiety symptoms during pregnancy and the postpartum period: A systematic review and meta-analysis. J Affect Disord 2021; 281:321-330. [PMID: 33341015 DOI: 10.1016/j.jad.2020.12.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/13/2020] [Accepted: 12/05/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Studies have reported conflicting results on the association between maternal pre-pregnancy weight and adverse mental health outcomes during pregnancy and the postpartum period. This systematic review and meta-analysis aim to provide the current state of evidence concerning the association between maternal pre-pregnancy BMI and the risk of antenatal and postnatal depressive and anxiety symptoms. METHODS PubMed, EMBASE, Web of Science and Scopus databases were searched from their inception through August 31, 2020. Observational studies assessing the association between maternal pre-pregnancy BMI and risk of depression and/anxiety during pregnancy and the postpartum period were included. We used random-and quality-effects meta-analyses to estimate risks. Subgroup, sensitivity and meta-regression analyses were performed. RESULTS Pre-pregnancy obesity was associated with a 33% increased risk of antenatal depressive symptoms (pooled OR = 1.33 [95% CI; 1.20-1.48]). The pooled ORs for the association between underweight, overweight and obesity and postnatal depressive symptoms were 1.71 [95% CI; 1.27 - 2.31], 1.14 [95% CI; 1.0 - 1.30] and 1.39 [95% CI; 1.23 - 1.57], respectively. Low to moderate level of between-study heterogeneity was noted. The association between pre-pregnancy BMI and perinatal anxiety symptoms remain uncertain. CONCLUSIONS Pre-pregnancy obesity was associated with an increased risk of maternal depressive symptoms both in pregnancy and the postpartum period. The findings suggest that women with both high and low pre-pregnancy weight may benefit from receiving mental health screening and interventions during prenatal care.
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Affiliation(s)
- Berihun Assefa Dachew
- School of Public health, Curtin University, Perth, Australia; Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
| | - Getinet Ayano
- School of Public health, Curtin University, Perth, Australia; Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Kim Betts
- School of Public health, Curtin University, Perth, Australia
| | - Rosa Alati
- School of Public health, Curtin University, Perth, Australia; Institute for Social Science Research, The University of Queensland, Brisbane, Australia
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19
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Da Costa D, Lai JK, Zelkowitz P. A prospective study on the course of sleep disturbances in first-time fathers during the transition to parenthood. Infant Ment Health J 2021; 42:222-232. [PMID: 33491788 DOI: 10.1002/imhj.21911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION This study examined sleep disturbances in first-time fathers from the third trimester of their partner's pregnancy to 2 months postpartum to determine prevalence, incidence, and persistence of sleep disturbances and identify associated determinants. METHODS Men expecting their first child were recruited from local prenatal classes and university-affiliated obstetric clinics. During their partner's third trimester of pregnancy and 2 months postpartum, 459 men completed standardized online self-report questionnaires measuring sociodemographics, lifestyle, and psychosocial variables and sleep quality. RESULTS Disturbed sleep (Pittsburgh Sleep Quality Index [PSQI] global score >5) increased from 29.6% during the third trimester to 44.7% at 2 months postpartum. The incidence of poor sleep at 2 months postpartum was 33.7%. Among men with disturbed sleep at the antenatal assessment, 70.6% continued to have sleep disturbances at 2 months postpartum. An increase in depressive symptoms and higher parenting stress was independently associated with onset and persistence of disturbed sleep at 2 months postpartum. CONCLUSIONS Sleep is compromised in expectant and new fathers. Strategies aimed at improving sleep, depressed mood, and managing the challenges of parenting may be important components to include in prenatal interventions aimed at enhancing the transition to parenthood and infant development.
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Affiliation(s)
- Deborah Da Costa
- Department of Medicine, McGill University, Montreal, Quebec, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Jonathan K Lai
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Phyllis Zelkowitz
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Department of Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada
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20
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Bais B, Hoogendijk WJG, Lambregtse-van den Berg MP. Light therapy for mood disorders. HANDBOOK OF CLINICAL NEUROLOGY 2021; 182:49-61. [PMID: 34266611 DOI: 10.1016/b978-0-12-819973-2.00004-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In this chapter, light therapy for mood disorders is discussed, including mood disorders during and after pregnancy. In the introduction, we discuss the symptomatology, etiology, and treatment of a specific type of mood disorder, seasonal affective disorder, since it kick-started the first clinical trials with light therapy. Second, we elaborate on the pathophysiology of mood disorders, in particular in the peripartum period. Next, we present an overview of the proposed working mechanisms of light therapy, followed by a discussion of the clinical trials that have followed after the initial research in seasonal affective disorder. Finally, we also focus on the limitations of these trials, such as considerable heterogeneity among studies and many methodological shortcomings. This is complemented by a number of suggestions for future research. Further studies are needed, which stems from the fact that the results have not always been consistent. Despite this, light therapy may be a promising treatment option for various types of mood disorders, since it shows a significant reduction in symptoms in many patients with few adverse effects.
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Affiliation(s)
- Babette Bais
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Witte J G Hoogendijk
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mijke P Lambregtse-van den Berg
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands.
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21
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Wang J, Zhou Y, Qian W, Zhou Y, Han R, Liu Z. Maternal insomnia during the COVID-19 pandemic: associations with depression and anxiety. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1477-1485. [PMID: 33891160 PMCID: PMC8063170 DOI: 10.1007/s00127-021-02072-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/29/2021] [Indexed: 12/04/2022]
Abstract
BACKGROUND The COVID-19 outbreak has made people more prone to depression, anxiety and insomnia, and females are at a high risk of developing these conditions. As a special group, pregnant and lying-in women must pay close attention to their physical and mental health, as both have consequences for the mother and the fetus. However, knowledge regarding the status of depression, anxiety and insomnia among these women is limited. AIM This study aimed to examine insomnia and psychological factors among pregnant and lying-in women during the COVID-19 pandemic and provide theoretical support for intervention research. METHODS In total, 2235 pregnant and lying-in women from 12 provinces in China were surveyed; their average age was 30.25 years (SD = 3.99, range = 19-47 years). PARTICIPANTS AND SETTING The participants completed electronic questionnaires designed to collect demographic information and assess levels of depression, anxiety and insomnia. RESULTS The prevalence of insomnia in the sample was 18.9%. Depression and anxiety were significant predictors of insomnia. Participants in high-risk areas, those with a disease history, those with economic losses due to the outbreak, and those in the postpartum period had significantly higher insomnia scores. DISCUSSION The incidence of insomnia among pregnant and lying-in women is not serious in the context of the epidemic, which may be related to the sociocultural background and current epidemic situation in China. CONCLUSION Depression and anxiety are more indicative of insomnia than demographic variables.
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Affiliation(s)
- Jiazhou Wang
- grid.9227.e0000000119573309Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101 China ,grid.410726.60000 0004 1797 8419Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049 China
| | - Yongjie Zhou
- grid.452897.50000 0004 6091 8446Department of Psychiatric Rehabilitation, Shenzhen Kangning Hospital, Shenzhen, 518020 China
| | - Wei Qian
- grid.9227.e0000000119573309Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101 China
| | - Yueyue Zhou
- grid.9227.e0000000119573309Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101 China ,grid.410726.60000 0004 1797 8419Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049 China
| | - Ru Han
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China. .,Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Zhengkui Liu
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China. .,Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, China.
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Sokunbi G, Takai IU, Nwosu IB, Balarabe R. Effects of Acupressure and Acupuncture-Like Transcutaneous Electrical Nerve Stimulation on Sleep Quality Among Pregnant Women. J Acupunct Meridian Stud 2020; 13:180-186. [PMID: 33137517 DOI: 10.1016/j.jams.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 10/12/2020] [Accepted: 10/18/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite the adverse consequences of poor sleep during pregnancy, relatively few safe interventions exist for improving sleep among pregnant women. Nonpharmacological interventions are increasingly gaining acceptance. However, the effects of acupressure and acupuncture-like transcutaneous electrical nerve stimulation (ACUTENS) have not been widely reported. OBJECTIVES The purpose of this study is to investigate the effects of low-frequency transcutaneous electrical nerve stimulation, otherwise known as ACUTENS, and acupressure on sleep quality among pregnant women. METHODS Purposive sampling of 42 pregnant women with sleep disorders was conducted, and the participants were randomized into 3 groups, i.e., acupressure, ACUTENS, and usual care. interventions, which were carried out twice weekly for six weeks. The Pittsburgh Sleep Quality index was used to determine the overall sleep quality. RESULTS The preintervention scores of sleep quality were 12.5 (3.75), 12.5 (4.0), and 13.0 (3.5) in the ACUTENS, acupressure, and usual care groups, respectively. The Kruskal-Wallis test did not show any significant difference in the preintervention sleep quality scores (H = 0.379, p = 0.827). Participants in the usual care group recorded the least improvement, with a score of 5.0 (2.25), the ACUTENS group recorded a score of 4.5 (3.0), and the greatest improvement was recorded in the acupressure group, with a score of 4.0 (2.2) after 6 weeks of intervention. The Kruskal-Wallis test did not show any significant difference in the postintervention sleep quality scores among the 3 groups (H = 0.666, p = 0.717). CONCLUSION This study showed that ACUTENS and acupressure as an adjunct to usual care are not more effective than usual care alone in improving sleep quality among pregnant women.
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Affiliation(s)
- Ganiyu Sokunbi
- Physiotherapy Department, Faculty of Allied Health WSciences, Bayero University Kano, Nigeria.
| | - Ibrahim U Takai
- Obstrtrics and Gynaecology Department, Faculty of Clinical Sciences, Bayero University Kano, Kano, Nigeria.
| | - Ifeoma B Nwosu
- Department of Medical Rehabilitation, Nnamdi Azikwe University, Nigeria.
| | - Rasheedat Balarabe
- Physiotherapy Department, Faculty of Allied Health WSciences, Bayero University Kano, Nigeria.
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Sleep Problems in Pregnancy-A Cross-Sectional Study in over 7000 Pregnant Women in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155306. [PMID: 32717974 PMCID: PMC7432323 DOI: 10.3390/ijerph17155306] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 12/25/2022]
Abstract
The aim was to characterize sleep patterns in pregnant women in Poland and to analyze the relation between sociodemographic factors, pregnancy-related physical symptoms and sleep problems. A self-composed questionnaire, containing questions in Polish language, was distributed online via web pages and Facebook groups designed for pregnant women. The questionnaire included questions regarding sociodemographic data and information on the current pregnancy and sleep patterns over the past four weeks. Exactly 7207 respondents were included to the study. 77.09% reported sleep problems: nocturnal awakening (52.77%), sleep onset insomnia (20.23%), awakening too early (18.56%) and believed their sleep was too shallow (9.82%). Sleep onset insomnia (26.38%) and frequent awakening (62.88%) were most often reported in 3rd trimester, while daytime drowsiness (86.35%) and naps impeding daytime function (27.18%) in the 1st trimester of pregnancy. The analyzed demographic, socioeconomic and psychological issues had a small but significant influence on sleep problems occurrence (aOR 0.81–1.24). Time to conceive from 6 to 12 months of trying increased the risk of developing sleep problems during pregnancy (aOR 1.31). Pregnancy ailments increased the risk of sleep disturbances (aOR 1.53–2.59). Sleep disorders are prevalent among pregnant women in Poland. The evaluation of risk factors is essential in proper screening for sleep disorders in pregnant women.
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Ladyman C, Signal TL, Sweeney B, Gander P, Paine SJ, Huthwaite M. A pilot longitudinal sleep education intervention from early pregnancy and its effect on optimizing sleep and minimizing depressive symptoms. Sleep Health 2020; 6:778-786. [PMID: 32536473 DOI: 10.1016/j.sleh.2020.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/22/2020] [Accepted: 05/01/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Investigate the efficacy of a pilot longitudinal sleep education program for optimizing sleep and minimizing depressive symptoms in nulliparous pregnant women. DESIGN Early and longitudinal sleep education intervention pilot study. SETTING Community-based convenience sample of New Zealand women. PARTICIPANTS 15 nulliparous women who were involved in a pilot of a longitudinal sleep education intervention during pregnancy (N = 15) were compared to a comparison group (n = 76) from another observational study with the same time points. Groups were matched on depression history and parity. INTERVENTION A longitudinal sleep education program was developed. Women in the intervention group participated in three individualized and trimester specific education sessions designed to increase sleep knowledge and improve sleep practices. The comparison group received no sleep education. MEASUREMENTS Self-reports of depressive symptoms and five dimensions of sleep (duration, quality, continuity, latency, daytime sleepiness) were compared between groups using linear mixed model analysis of variance. RESULTS At the conclusion of the intervention, the intervention group had fewer depressive symptoms with none experiencing clinically significant depressive symptoms, while 21% of the comparison group were considered to have clinically significant depressive symptoms. The intervention group also had better sleep quality, sleep initiation and sleep continuity than the comparison group at late pregnancy. CONCLUSIONS Findings suggest that a longitudinal sleep education intervention commencing early in pregnancy may be effective in optimizing sleep and minimizing depressive symptoms for nulliparous women with a history of depression. Further investigation of sleep education interventions to improve maternal mental health in pregnancy and postnatally is warranted.
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Affiliation(s)
- Clare Ladyman
- Massey University, Sleep/Wake Research Centre, College of Health, Wellington, New Zealand.
| | - T Leigh Signal
- Massey University, Sleep/Wake Research Centre, College of Health, Wellington, New Zealand
| | - Bronwyn Sweeney
- Massey University, Sleep/Wake Research Centre, College of Health, Wellington, New Zealand
| | - Philippa Gander
- Massey University, Sleep/Wake Research Centre, College of Health, Wellington, New Zealand
| | - Sarah-Jane Paine
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Mark Huthwaite
- Department of Psychological Medicine (Wellington), University of Otago, Wellington, New Zealand
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Sleep Disturbance in Early Pregnancy, but Not Inflammatory Cytokines, May Increase Risk for Adverse Pregnancy Outcomes. Int J Behav Med 2020; 28:48-63. [PMID: 32372169 DOI: 10.1007/s12529-020-09880-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND It is unclear whether subjective or objective measures of sleep during pregnancy are more pertinent to pregnancy outcomes. Moreover, it is unclear as to whether subjective indices (i.e., those likely influenced by psychological thoughts and emotions) are more likely than objective measures to modify inflammatory cytokines. METHOD Subjective and objective measures of sleep were collected from 166 pregnant women. Sleep data, both aggregate and variability measures, from diary and actigraphy, were ascertained for three 2-week periods during early gestation (10-20 weeks). A fasting morning blood sample was assayed for the cytokines (IL-6, IFN-γ, and TNF-α). Sleep, stress, and depression questionnaires were also collected. Repeated measures ANOVAs, regression models, and independent t tests were used to analyze the data. RESULTS Diary-assessed total sleep time (p < .05) and actigraphy-assessed sleep latency (p = .05) were negatively associated with gestational age. Variability in actigraphy-assessed sleep latency (p < .01) was negatively associated with infant weight. None of the cytokines was associated with any of the outcomes. t tests revealed that those with a complication were older (p < .05) and had higher pre-pregnancy BMI (p < .05), higher self-reported stress (p < .05), and lower IFN-γ (p < .05). CONCLUSION Findings suggest that longer and more variable sleep latency, as well as shorter sleep duration, is associated with shorter gestational age or a lower birth weight infant. Overall, the findings suggest that among a low-risk, healthy sample of pregnant women, sleep disturbance does not pose a substantial risk for adverse delivery outcomes.
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Aukia L, Paavonen EJ, Jänkälä T, Tolvanen M, Korja R, Karlsson L, Karlsson H, Polo-Kantola P. Insomnia symptoms increase during pregnancy, but no increase in sleepiness - Associations with symptoms of depression and anxiety. Sleep Med 2020; 72:150-156. [PMID: 32629418 DOI: 10.1016/j.sleep.2020.03.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/26/2020] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate alteration in insomnia and sleepiness symptoms during pregnancy and assess early pregnancy risk factors for these symptoms, especially depressive and anxiety symptoms. METHODS A cohort of 1858 women was enrolled from the FinnBrain Birth Cohort Study. Insomnia and sleepiness symptoms were measured in early, mid- and late pregnancy with the Basic Nordic Sleep Questionnaire. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale and anxiety symptoms with the Symptom Checklist-90/Anxiety Scale. General linear models for repeated measures were conducted. RESULTS General sleep quality decreased (p < 0.001) and all insomnia types (p < 0.001) and sleep latencies (p < 0.001) increased as pregnancy proceeded. Snoring increased, but witnessed apneas remained rare. Nevertheless, morning (p = 0.019) and daytime (p < 0.001) sleepiness decreased from early to both mid-pregnancy and late pregnancy (p = 0.006 and p = 0.039). Women took more naps in early and late pregnancy compared to mid-pregnancy (both p < 0.001). Women with higher baseline anxiety symptoms had greater increase in sleep latency. At each pregnancy point, higher depressive and anxiety symptoms were associated with higher insomnia (p < 0.001) and sleepiness scores (p < 0.001) and higher depressive symptoms with longer sleep latencies (p < 0.001). CONCLUSION We found a marked increase in insomnia symptoms throughout pregnancy. However, sleepiness symptoms did not increase correspondingly. Both depressive and anxiety symptoms in early pregnancy were associated with higher insomnia and sleepiness symptoms in later stages of pregnancy which emphasizes the importance of their assessment in early pregnancy.
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Affiliation(s)
- Linda Aukia
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland.
| | - E Juulia Paavonen
- Pediatric Research Center, Child Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland
| | - Tuire Jänkälä
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland; Department of Psychology, University of Turku, Turku, Finland
| | - Mimmi Tolvanen
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Riikka Korja
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland; Department of Psychology, University of Turku, Turku, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland; Department of Child Psychiatry, Turku University Hospital and University of Turku, Turku, Finland; Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland; Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland
| | - Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland; Sleep Research Unit, Department of Physiology, University of Turku, Turku, Finland
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Wang WJ, Hou CL, Jiang YP, Han FZ, Wang XY, Wang SB, Ng CH, Jia FJ. Prevalence and associated risk factors of insomnia among pregnant women in China. Compr Psychiatry 2020; 98:152168. [PMID: 32105909 DOI: 10.1016/j.comppsych.2020.152168] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/10/2020] [Accepted: 02/12/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Insomnia is common during pregnancy but the prevalence and risk factors of insomnia in Chinese women during pregnancy is not well studied. This study aimed to examine the prevalence of insomnia and its risk factors in Chinese women during pregnancy. METHODS In this cross sectional study, 436 Chinese pregnant women with Insomnia Severity Index (ISI) ≥ 8 were clinically assessed using the insomnia criteria based on the combination of DSM-IV (Diagnostic and Statistical Manual-4th Edition) and ICD-10 (International Classification of Dieases, 10th Edition). Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), Pregnancy Pressure Scale (PPS), Perceived physical discomfort level and number, Epworth Sleepiness Scale (ESS), and a general socio-demographic questionnaire were administered. RESULTS The results showed that about 20% of the pregnant women met the strict diagnosis criteria of insomnia. Independent-samples t-test revealed that several risk factors were correlated with the group with insomnia (N = 84) compared to the group without insomnia (N = 352). Binary Logistic regression analysis found that more significant bed partner influence (OR = 1.92, 95% CI: 1.03-3.60), depressive symptoms (OR = 1.07, 95% CI: 1.00-1.14), daytime sleepiness (OR = 1.07, 95% CI: 1.01-1.14), subjective somatic discomfort (OR = 2.27, 95% CI: 1.11-4.65), kinds of somatic discomfort (OR = 1.14, 95% CI: 1.03-1.27) and later gestation (OR = 1.05, 95% CI: 1.01-1.09) were significantly associated with insomnia. CONCLUSION In this cohort of Chinese pregnant women, about a fifth of women suffered from clinically significant insomnia. Measures to prevent the adverse effects of insomnia should be provided to pregnant women with depressive symptoms, Sleep disturbance of the bed partner, excessive daytime sleepiness and somatic discomfort, especially late in gestation.
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Affiliation(s)
- Wen-Jing Wang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China; Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Cai-Lan Hou
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China.
| | - Yan-Ping Jiang
- Department of Obstetrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Feng-Zhen Han
- Department of Obstetrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Xiao-Yun Wang
- Department of Obstetrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Shi-Bin Wang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - C H Ng
- Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Fu-Jun Jia
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China; Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China.
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Kaartinen M, Karlsson L, Paavonen EJ, Polo-Kantola P, Pelto J, Nousiainen N, Scheinin NM, Maksimow M, Salmi M, Karlsson H. Maternal tiredness and cytokine concentrations in mid-pregnancy. J Psychosom Res 2019; 127:109843. [PMID: 31683065 DOI: 10.1016/j.jpsychores.2019.109843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Sleep disturbances relate to altered levels of inflammatory mediators in general population, but not much is known about the associations between sleep disturbances and inflammatory mediators during pregnancy. The present exploratory study investigated whether insomnia, tiredness, general sleep quality, and insufficient sleep duration during pregnancy relate to the concentrations of maternal peripheral circulating cytokines. As sleep disturbances are frequently observed in mood disorders, the results were controlled for symptoms of depression and anxiety. METHODS 137 participants were randomly drawn from a representative FinnBrain Birth Cohort. Serum concentrations of selected cytokines were analyzed using Multiplex bead arrays from blood samples drawn at the gestational week 24. The sleep disturbances were evaluated using the Basic Nordic Sleep Questionnaire. Depressive and anxiety symptoms were measured with the Edinburgh Postnatal Depression Scale and the anxiety subscale of the self-rated Symptom Checklist 90, respectively. RESULTS Enhanced tiredness was associated with cytokine concentrations of IL-2, IL-10, IL-12, IL-13, and TNF-α. The observed associations resembled a reversed U-shaped curve rather than being linear. Having a good general sleep quality was associated with higher logarithmic cytokine concentrations of IL-2, IL-4, IL-6, IL-10, IL-12, IL-13, and IFN-γ. There was no evidence for associations between insomnia or sleep loss and cytokines. CONCLUSIONS Maternal subjective tiredness and good general sleep quality were associated with altered levels of immunological markers during pregnancy. The association was independent from symptoms of depression and anxiety.
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Affiliation(s)
- Miia Kaartinen
- Department of Adolescent Psychiatry, University of Tampere and Tampere University Hospital.
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku; Centre for Population Health Research, University of Turku and Turku University Hospital; Department of Child Psychiatry, University of Turku and Turku University Hospital
| | - E Juulia Paavonen
- National Institute for Health and Welfare, Helsinki, Finland; Pediatric Research Center, Child Psychiatry, University of Helsinki and Helsinki University Hospital
| | - Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital
| | - Juho Pelto
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku
| | - Niko Nousiainen
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku
| | - Noora M Scheinin
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku; Department of Psychiatry, University of Turku and Turku University Hospital
| | | | - Marko Salmi
- MediCity Research Laboratory, University of Turku; Institute of Biomedicine, University of Turku
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku; Centre for Population Health Research, University of Turku and Turku University Hospital; Department of Psychiatry, University of Turku and Turku University Hospital
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Gao M, Hu J, Yang L, Ding N, Wei X, Li L, Liu L, Ma Y, Wen D. Association of sleep quality during pregnancy with stress and depression: a prospective birth cohort study in China. BMC Pregnancy Childbirth 2019; 19:444. [PMID: 31775666 PMCID: PMC6882237 DOI: 10.1186/s12884-019-2583-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/05/2019] [Indexed: 02/07/2023] Open
Abstract
Background The sleep quality of pregnant women in the third trimester is related to mental health. However, there is still a lack of large-scale cohort research exploring this relationship in the second trimester. Thus, we assessed the associations of sleep quality during the second trimester with antenatal stress and antenatal and postnatal depression. Methods We examined 1152 pregnant women from a prospective cohort study in China to assess the associations of sleep quality in the second trimester with antenatal stress, antenatal depression, and postnatal depression. We used linear regression models and logistic regression models to examine the associations of sleep quality (Pittsburgh Sleep Quality Index [PSQI]) during pregnancy with perinatal stress (Pregnancy Pressure Scale [PPS]) and depression (Edinburgh Postnatal Depression Scale [EPDS]) status. We further assessed the relationship in groups divided according to maternal age. Results PSQI scores were positively associated with antenatal PPS scores (β: 1.52, 95% confidence interval [CI]: 1.28, 1.76), antenatal EPDS scores (β: 0.68, 95% CI: 0.58, 0.78), and postpartum EPDS scores (β: 0.51, 95% CI: 0.38, 0.64). Poor sleep quality (PSQI scores ≥5) was associated with antenatal stress status (odds ratio [OR]: 2.60, 95% CI: 1.79, 3.77), antenatal depression status (OR: 3.42, 95% CI: 2.48, 4.72), and postpartum depression status (OR: 2.40, 95% CI: 1.58, 3.64) after adjusting maternal age, BMI, gestational age, smoking, educational level, annual household income and social support. The association of poor sleep quality (PSQI scores ≥5) in the second trimester with postnatal depression status was significant among women more than or equal to 30 years old (OR: 4.12, 95% CI: 2.18, 7.78) but not among women less than 30 years old after adjusting covariates above. Conclusion Poor sleep quality in the second trimester among Chinese pregnant women is associated with stress and depression symptoms. Strategies to boost sleep quality should be considered during prenatal health care to improve women’s mental health status.
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Affiliation(s)
- Ming Gao
- Department of Social Medicine, Institute of health sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Jiajin Hu
- Department of Social Medicine, Institute of health sciences, China Medical University, Shenyang, 110122, Liaoning, China.,Research Center of China Medical University Birth Cohort, China Medical University, Shenyang, Liaoning, China
| | - Liu Yang
- Department of Obstetrics and Gynecology, Shenyang Maternity and Child Health Hospital, Shenyang, Liaoning, China
| | - Ning Ding
- Curriculum and Teaching Research Office, Research Center of Medical Education, China Medical University, Shenyang, Liaoning, China
| | - Xiaotong Wei
- Department of Social Medicine, Institute of health sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Lin Li
- Department of Developmental Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Lei Liu
- Department of Social Medicine, Institute of health sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Yanan Ma
- Department of Epidemiology and Health Statistics, School of Public Health, China Medical University, Shenyang, 110122, Liaoning, China
| | - Deliang Wen
- Department of Social Medicine, Institute of health sciences, China Medical University, Shenyang, 110122, Liaoning, China.
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Kalmbach DA, Cheng P, Sangha R, O’Brien LM, Swanson LM, Palagini L, Bazan LF, Roth T, Drake CL. Insomnia, Short Sleep, And Snoring In Mid-To-Late Pregnancy: Disparities Related To Poverty, Race, And Obesity. Nat Sci Sleep 2019; 11:301-315. [PMID: 31807103 PMCID: PMC6839586 DOI: 10.2147/nss.s226291] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/05/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To characterize sleep habits and parameters among women in mid-to-late pregnancy and to identify disparities associated with poverty, race, and obesity. DESIGN Cross-sectional. SETTING Large multi-site health system in Metro Detroit. PARTICIPANTS A total of 267 pregnant women (27.3% non-Hispanic black; gestational age: 27.99±1.20 weeks) completed online surveys on sleep quality, insomnia symptoms, sleep aid use, signs/symptoms of sleep-disordered breathing, and sociodemographics. Body mass index (BMI) and patient insurance were derived from medical records. RESULTS As high as 76.2% of the women reported global sleep disturbance, 30.6% endorsed snoring, 24.3% sleep <6 hrs/night, and over half screened positive for clinical insomnia. Yet, only 3.4% of the women reported an insomnia diagnosis and 3.0% reported a sleep apnea diagnosis. In unadjusted models, poverty, Medicaid coverage, self-identifying as black, and obesity before and during pregnancy (BMI ≥ 35) were associated with a wide range of sleep problems. However, adjusted models revealed specificity. Poverty was uniquely related to increased insomnia symptoms and trouble sleeping due to bad dreams. Obesity before pregnancy was related to poor sleep quality, snoring, sleep aids, and short sleep. Black women reported shorter sleep duration than white women but differed on no other sleep parameters. CONCLUSION Clinical signs of insomnia and sleep-disordered breathing are common in mid-to-late pregnancy, but most cases go undetected. Problematic sleep disproportionately affects women in poverty, who self-identify as black, and who are obese before pregnancy. Poverty-related sleep issues are linked to insomnia, obesity-related disparities center on sleep-related breathing and medication use, and racial disparities relate to short sleep.
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Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Novi, MI, USA
| | - Philip Cheng
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Novi, MI, USA
| | - Roopina Sangha
- Department of Obstetrics and Gynecology, Henry Ford Health System, Detroit, MI, USA
| | - Louise M O’Brien
- Departments of Obstetrics &Gynecology and Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Leslie M Swanson
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Laura Palagini
- Departments of Neuroscience and Psychiatry, University of Pisa, Pisa, Italy
| | - Luisa F Bazan
- Division of Sleep Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Thomas Roth
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Novi, MI, USA
| | - Christopher L Drake
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Novi, MI, USA
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Bennett CJ, Cain SW, Blumfield ML. Monounsaturated fat intake is associated with improved sleep quality in pregnancy. Midwifery 2019; 78:64-70. [DOI: 10.1016/j.midw.2019.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/19/2019] [Accepted: 07/24/2019] [Indexed: 11/29/2022]
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McEvoy KM, Rayapati D, Washington Cole KO, Erdly C, Payne JL, Osborne LM. Poor Postpartum Sleep Quality Predicts Subsequent Postpartum Depressive Symptoms in a High-Risk Sample. J Clin Sleep Med 2019; 15:1303-1310. [PMID: 31538601 PMCID: PMC6760397 DOI: 10.5664/jcsm.7924] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/10/2019] [Accepted: 05/10/2019] [Indexed: 12/26/2022]
Abstract
STUDY OBJECTIVES Postpartum depression (PPD) occurs in 15% to 20% of mothers worldwide and is associated with adverse outcomes for mother and child. Prior research has established a relationship between concurrent sleep quality and PPD. We conducted a secondary analysis in 45 women with mood disorders to study overall sleep quality (and individual components of sleep), measured in the early postpartum period, as a predictor of subsequent PPD. METHODS We measured sleep quality using the Pittsburgh Sleep Quality Index (PSQI; subscale and total scores) at 1 month postpartum (and during the third trimester). We measured depressive symptoms using the Inventory of Depressive Symptoms, Self-Report (IDS-SR) at 3 months postpartum. We used bivariate and multivariate linear regression models to study the association between PSQI and IDS scores. RESULTS We found that higher global PSQI scores as well as higher component scores for self-reported sleep quality, sleep latency, sleep efficiency, sleep medication usage, and daytime dysfunction, measured 1 month postpartum, were associated with increased IDS scores (at 3 months postpartum (P = .01, .01, .01, .003, < .001, respectively). We did not find an association between poor sleep quality in the third trimester and PPD. CONCLUSIONS Poor sleep quality in the early postpartum period independently predicts development of later PPD. This is clinically significant and highlights the importance of sleep interventions as an immediate postpartum therapeutic tool. CITATION McEvoy KM, Rayapati D, Washington Cole KO, Erdly C, Payne JL, Osborne LM. Poor postpartum sleep quality predicts subsequent postpartum depressive symptoms in a high-risk sample. J Clin Sleep Med. 2019;15(9):1303-1310.
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Menke RA, Swanson L, Erickson NL, Reglan G, Thompson S, Bullard KH, Rosenblum K, Lopez JP, Muzik M. Childhood adversity and sleep are associated with symptom severity in perinatal women presenting for psychiatric care. Arch Womens Ment Health 2019; 22:457-465. [PMID: 30276477 PMCID: PMC6443486 DOI: 10.1007/s00737-018-0914-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 09/17/2018] [Indexed: 01/21/2023]
Abstract
This study leverages psychiatric intake data from treatment-seeking perinatal women aiming to explore the understudied associations between childhood adversity, sleep quality, and severity of perinatal mental illness in this population. The sample is 578 perinatal women presenting for initial evaluation to a university-based perinatal psychiatry clinic. At intake, we collected demographics, adverse childhood experiences (ACEs), sleep quality, and diagnosis and symptom severity of depression, anxiety, and posttraumatic stress disorder (PTSD). Clinician-rated diagnoses showed that 65% of women met criteria for major depression, 23% for generalized anxiety disorder and 4% for PTSD; almost 30% of women had childhood adversity and 98.2% reported poor perinatal sleep quality. Regression analyses revealed differential associations between ACEs and sleep quality and perinatal mood symptoms; ACEs were significantly associated with pregnancy and postpartum PTSD, whereas sleep quality was associated with perinatal depression and generalized anxiety. Screening for ACEs and sleep quality during perinatal intake has high clinical utility, as these two factors significantly contribute to symptom severity across peripartum.
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Affiliation(s)
- Rena A Menke
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48105, USA
| | - Leslie Swanson
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48105, USA
| | - Nora L Erickson
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48105, USA
| | - Greta Reglan
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48105, USA
| | - Stephanie Thompson
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48105, USA
| | | | - Katherine Rosenblum
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48105, USA
- Center for Human Growth & Development, University of Michigan, 300 N. Ingalls St, Ann Arbor, MI, 48104, USA
| | - Juan P Lopez
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48105, USA
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48105, USA.
- Center for Human Growth & Development, University of Michigan, 300 N. Ingalls St, Ann Arbor, MI, 48104, USA.
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Bais B, Lindeboom R, van Ravesteyn L, Tulen J, Hoogendijk W, Lambregtse-van den Berg M, Kamperman A. The Impact of Objective and Subjective Sleep Parameters on Depressive Symptoms during Pregnancy in Women with a Mental Disorder: An Explorative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091587. [PMID: 31067646 PMCID: PMC6540017 DOI: 10.3390/ijerph16091587] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/02/2019] [Accepted: 05/05/2019] [Indexed: 01/08/2023]
Abstract
Poor sleep quality during pregnancy is associated with both antepartum and postpartum depression and adverse birth outcomes. This study evaluated both objective and subjective sleep quality and the effects on the subsequent course of antepartum depressive symptoms in psychiatric patients. This observational explorative study was embedded in an ongoing study focusing on pregnant women with a mental disorder and was performed in 18 patients (24–29 weeks pregnant). Depressive symptoms were assessed throughout pregnancy using the Edinburgh Postnatal Depression Scale (EPDS) with 5-week intervals. Sleep was assessed with actigraphy, the Pittsburgh Sleep Quality Index (PSQI) and sleep diaries at the start of the study. We studied correlations between sleep parameters and EPDS scores cross-sectionally using Spearman correlation. Next, we studied the course of antepartum EPDS scores over time per sleep parameter using generalized linear mixed modelling analysis. Objectively measured fragmentation index, total PSQI score and 4 PSQI subscales (sleep quality, sleep duration, sleep disturbances and daytime dysfunctions) were significantly correlated with EPDS scores when measured cross-sectionally at the start. Six objectively and subjectively measured sleep parameters had moderate to large effects on the course of depressive symptoms through the third trimester, but these effects were not statistically significant. More research is necessary to explore the causality of the direction between sleep problems and antepartum depressive symptoms we found in psychiatric patients.
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Affiliation(s)
- Babette Bais
- Department of Psychiatry, Erasmus University Medical Centre Rotterdam, 3015GD Rotterdam, The Netherlands.
| | - Robert Lindeboom
- Amsterdam UMC, Academic Medical Center, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, University of Amsterdam, 1100 DD Amsterdam, The Netherlands.
| | | | - Joke Tulen
- Department of Psychiatry, Erasmus University Medical Centre Rotterdam, 3015GD Rotterdam, The Netherlands.
| | - Witte Hoogendijk
- Department of Psychiatry, Erasmus University Medical Centre Rotterdam, 3015GD Rotterdam, The Netherlands.
| | - Mijke Lambregtse-van den Berg
- Department of Psychiatry, Erasmus University Medical Centre Rotterdam, 3015GD Rotterdam, The Netherlands.
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre Rotterdam, 3015GD Rotterdam, The Netherlands.
| | - Astrid Kamperman
- Epidemiological and Social Psychiatric Research Institute, Department of Psychiatry, Erasmus University Medical Centre Rotterdam, 3015GD Rotterdam, The Netherlands.
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Okun ML. Sleep Disturbances and Modulations in Inflammation: Implications for Pregnancy Health. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2019; 13:e12451. [PMID: 31737088 PMCID: PMC6857810 DOI: 10.1111/spc3.12451] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
When a woman becomes pregnant, there is a vast series of physiological, vascular, and psychological changes. Among the most commonly reported changes are those involving sleep. Pregnant women report that their ability to maintain sleep and acquire continuous refreshing sleep is impaired during the perinatal period as compared to the non-pregnant period. A growing literature supports the hypothesis that disturbed sleep (which comes in many forms) during the perinatal period is associated with an increased risk of adverse maternal, delivery, and infant outcomes. Among the suggested biological pathways linking sleep and adverse outcomes are disturbances in the immune and hormonal systems. The following paper will discuss (1) the various sleep processes that are commonly disturbed during the perinatal period and the methods used to collect sleep data; (2) the evidence linking sleep to adverse outcomes; and (3) how one specific biological pathway, the immune system, likely mediates these associations. The goal of this paper is to clarify the role that sleep disturbance has during pregnancy.
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Da Costa D, Danieli C, Abrahamowicz M, Dasgupta K, Sewitch M, Lowensteyn I, Zelkowitz P. A prospective study of postnatal depressive symptoms and associated risk factors in first-time fathers. J Affect Disord 2019; 249:371-377. [PMID: 30818245 DOI: 10.1016/j.jad.2019.02.033] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/11/2019] [Accepted: 02/11/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recent studies show that paternal depression negatively impacts children's behavioral and emotional development. This study determined the prevalence of depressed mood in first-time fathers at 2 and 6 months postpartum and identified associated risk factors. METHODS A prospective cohort study with 622 men who completed sociodemographic and psychosocial questionnaires during their partner's third trimester of pregnancy. Fathers completed measures again at 2 and 6 months postpartum and partners completed the depressed mood measure at all three timepoints. A cutoff of ≥10 for the Edinburgh Postnatal Depression Scale identified depressed mood status. RESULTS The prevalence of depressive symptoms in fathers was 13.76% at 2 months and 13.60% at 6 months postpartum. Men who were depressed during their partner's pregnancy were 7 times more likely to be depressed at 2 months postpartum. Depressed mood status at both the antenatal and 2 month postpartum assessment was associated with increased risk of depressed mood at 6 months postpartum. Older age, poor sleep quality at study entry, worse couple adjustment, having a partner experiencing antenatal depressive symptoms and elevated parental stress were associated with depressive symptoms at 2 months postpartum. Poor sleep quality, financial stress and a decline in couple adjustment were independently associated to depressive symptoms at 6 months postpartum. LIMITATIONS This sample was fairly well-educated and predominately middle-class. Depressive symptoms were assessed using a self-report questionnaire. CONCLUSIONS The psychosocial risk factors identified provide opportunities for early screening and targeted prevention strategies for fathers at risk for depression during the transition to parenthood.
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Affiliation(s)
- Deborah Da Costa
- Department of Medicine, McGill University, Canada; Division of Clinical Epidemiology, McGill University Health Centre - Research Institute, Canada.
| | - Coraline Danieli
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
| | - Michal Abrahamowicz
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
| | - Kaberi Dasgupta
- Department of Medicine, McGill University, Canada; Division of Clinical Epidemiology, McGill University Health Centre - Research Institute, Canada
| | - Maida Sewitch
- Department of Medicine, McGill University, Canada; Division of Clinical Epidemiology, McGill University Health Centre - Research Institute, Canada
| | - Ilka Lowensteyn
- Division of Clinical Epidemiology, McGill University Health Centre - Research Institute, Canada
| | - Phyllis Zelkowitz
- Lady Davis Institute, Department of Psychiatry, Jewish General Hospital and McGill University, Canada
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Prenatal stress and the development of psychopathology: Lifestyle behaviors as a fundamental part of the puzzle. Dev Psychopathol 2018; 30:1129-1144. [PMID: 30068418 DOI: 10.1017/s0954579418000494] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Maternal psychological stress, depression, and anxiety during pregnancy (prenatal stress; PNS) are thought to impact fetal development with long-term effects on offspring outcome. These effects would include physical and mental health, including psychopathology. Maternal sleep, diet, and exercise during pregnancy are lifestyle behaviors that are understudied and often solely included in PNS studies as confounders. However, there are indications that these lifestyle behaviors may actually constitute essential mediators between PNS and fetal programming processes. The goal of this theoretical review was to investigate this idea by looking at the evidence for associations between PNS and sleep, diet, and exercise, and by piecing together the information on potential underlying mechanisms and causal pathways through which these factors may affect the offspring. The analysis of the literature led to the conclusion that sleep, diet, and exercise during pregnancy, may have fundamental roles as mediators between PNS and maternal pregnancy physiology. By integrating these lifestyle behaviors into models of prenatal programming of development, a qualitatively higher and more comprehensive understanding of the prenatal origins of psychopathology can be obtained. The review finalizes by discussing some of the present challenges facing the field of PNS and offspring programming, and offering solutions for future research.
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Sälevaara M, Punamäki RL, Unkila-Kallio L, Vänskä M, Tulppala M, Tiitinen A. The mental health of mothers and fathers during pregnancy and early parenthood after successful oocyte donation treatment: A nested case-control study. Acta Obstet Gynecol Scand 2018; 97:1478-1485. [PMID: 29975790 DOI: 10.1111/aogs.13421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 06/28/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of this study was to compare the mental health problems between parents after oocyte donation treatment, after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) with own gametes and after naturally conceiving (NC). MATERIAL AND METHODS This is a prospective, longitudinal questionnaire study. The study group consisted of 26 oocyte donation mothers and their matched IVF/ICSI (n = 52) and NC (n = 52) controls. Matching was performed according to mother's age, parity, type of pregnancy, and number of returned questionnaires. The parents filled-in the General Health Questionnaire (GHQ-36) at gestational weeks 18-20 (T1), and at 2 months (T2) and 12 months (T3) after the childbirth. RESULTS Full response rate (T1-T3) for oocyte donation mothers was 76.9% and for oocyte donation fathers was 73.1%. At T1, no significant differences were found between groups in depression, anxiety, sleeping difficulties, or social dysfunction, but they differed at T2 and T3 in anxiety (T2, P = .02; T3, P = .01), in sleeping difficulties (T2, P = .02; T3, P = .04) and in social dysfunction (T2, P = .01; T3, P = .04). Oocyte donation mothers showed less anxiety than NC mothers (T2, T3), and fewer sleeping difficulties and less social dysfunction than IVF/ICSI (T2, T3) and NC mothers (T2). Mental health problems of oocyte donation fathers did not differ from those of IVF/ICSI and NC control fathers at T1-T3. CONCLUSIONS Oocyte donation mothers showed fewer mental health symptoms in early parenthood compared with IVF/ICSI and NC mothers. No differences were found among mothers during pregnancy and among fathers at any time point.
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Affiliation(s)
- Mari Sälevaara
- Väestöliitto Fertility Clinic Helsinki, Helsinki, Finland
| | | | - Leila Unkila-Kallio
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
| | - Mervi Vänskä
- Faculty of Social Sciences/Psychology, University of Tampere, Tampere, Finland
| | - Maija Tulppala
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
| | - Aila Tiitinen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
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Okun ML, O'Brien LM. Concurrent insomnia and habitual snoring are associated with adverse pregnancy outcomes. Sleep Med 2018; 46:12-19. [DOI: 10.1016/j.sleep.2018.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/01/2018] [Accepted: 03/06/2018] [Indexed: 11/25/2022]
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Christian LM, Kowalsky JM, Mitchell AM, Porter K. Associations of postpartum sleep, stress, and depressive symptoms with LPS-stimulated cytokine production among African American and White women. J Neuroimmunol 2018; 316:98-106. [PMID: 29406850 PMCID: PMC5806133 DOI: 10.1016/j.jneuroim.2017.12.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Postpartum is a period of unique psychosocial stress characterized by sleep disturbance, risk for depressed mood, and heightened parenting stress. However, data on effects of these exposures on inflammatory immune function are limited. METHODS This study examined associations among sleep, psychosocial stress (i.e., parenting stress, general perceived stress), mood (i.e., depressive symptoms), serum cytokine levels, and LPS-stimulated proinflammatory cytokine production among 69 women (32 African American, 37 White) assessed at 7-10weeks postpartum. RESULTS No associations between behavioral measures and serum cytokine levels were observed among women of either race. In African American women, but not Whites, poorer sleep quality, greater parenting stress, and greater depressive symptoms were associated with greater LPS-stimulated IL-6 and IL-8 production (ps≤0.05). Also in African Americans, greater general perceived stress was associated with greater IL-8 production, and greater depressive symptoms with greater stimulated TNF-α production (ps≤0.05). Simple mediation models highlighted the bidirectional relationship between stress and sleep in relation to inflammation among African American women. CONCLUSIONS Significant effects of both stress/distress and poor sleep quality on proinflammatory cytokine production during postpartum were observed uniquely among African American women. These data are consistent with an allostatic load model which predicts that conditions of chronic stress impart vulnerability to dysregulated responses to novel stressor exposures. The bidirectional nature of the stress-sleep relationship has clinical relevance. Studies examining whether interventions focused on one or both of these psychological factors during postpartum is beneficial for inflammatory profiles would be informative. In addition, examination of these models in relation to maternal health at postpartum, including delivery related wounds and other infections, is warranted.
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Affiliation(s)
- Lisa M Christian
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, United States; The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
| | | | - Amanda M Mitchell
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, United States; The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Kyle Porter
- Center for Biostatistics, The Ohio State University, Columbus, OH, United States
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Pregnancy and postpartum antidepressant use moderates the effects of sleep on depression. Arch Womens Ment Health 2017; 20:621-632. [PMID: 28488099 PMCID: PMC6940595 DOI: 10.1007/s00737-017-0726-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 04/25/2017] [Indexed: 10/19/2022]
Abstract
This study examined the course of antidepressant use, sleep quality, and depression severity from pregnancy through 6-month postpartum in women with and without a depressive disorder during pregnancy. Women (N = 215) were interviewed during pregnancy, 1- and 6-month postpartum. Mixed linear models were used to examine the longitudinal course and inter-relationships for the time-varying variables of antidepressant use, subjective sleep quality, and depression severity. Pregnant women with a depressive disorder who did not use antidepressants had more variable depression severity over time with improvements in depression severity by 6-month postpartum. In contrast, the depression severity of their medicated counterparts remained stable and high throughout. Pregnant women without a depressive disorder had worse sleep quality when using antidepressants compared with when they were not. Antidepressant use significantly strengthened the magnitude of the effect of sleep quality on depression severity in women with a depressive disorder during pregnancy. When prenatally depressed women use antidepressants, their sleep disturbance is more highly linked to depression severity than when they do not. Furthermore, antidepressants are not adequately treating the sleep disturbance of these women or their remitted counterparts, leaving both groups vulnerable to significant negative mental and physical health outcomes.
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Yang Y, Mao J, Ye Z, Zeng X, Zhao H, Liu Y, Li J. Determinants of sleep quality among pregnant women in China: a cross-sectional survey. J Matern Fetal Neonatal Med 2017; 31:2980-2985. [PMID: 28738757 DOI: 10.1080/14767058.2017.1359831] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Sleep disturbances are common during pregnancy, yet few studies are currently available regarding the determinants of sleep quality among pregnant women in China. This study aimed to: (a) calculate the prevalence of sleep disorder during pregnancy, (b) examine the difference in sleep quality among three trimesters, and (c) identify determinants of sleep quality in pregnant women. MATERIALS AND METHODS This study was designed as a cross-sectional survey. Five hundred pregnant women were recruited at the outpatient department of obstetrics and gynecology of two teaching hospitals in central China. Five selfreport questionnaires were used for gathering data, including information of sample characteristics, sleep quality (Pittsburgh Sleep Quality Index (PSQI)), prenatal depression (the Edinburgh Postnatal Depression Scale (EPDS)), perceived stress (Perceived Stress Scale (PSS)), and perceived social support (Multidimensional Scale of Perceived Social Support (MSPSS)). RESULTS A total of 454 pregnant women participated in the study between September 2016 and April 2017. Eighty-seven percent pregnant women experienced sleep disorder (PSQI score >5). Poorer global sleep quality, subjective sleep quality, lower sleep efficiency and sleep disturbances were most prevalent during third trimester. The significant contributors to sleep quality for pregnant women were prenatal depression, maternal age, and gestational age. CONCLUSIONS Sleep disorder is very common in pregnant women from China. Depressive symptoms, increased maternal age, and gestational age are determinants of sleep quality. These determinants can assist healthcare professionals in preventative intervention.
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Affiliation(s)
- Ying Yang
- a School of Nursing , Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Jing Mao
- a School of Nursing , Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Zhiying Ye
- b Huazhong University of Science and Technology Hospital , Wuhan , China
| | - Xiaoli Zeng
- c Department of Women's Health , Shiyan Maternal and Child Health Care Hospital , Shiyan , China
| | - Huimin Zhao
- a School of Nursing , Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Yueting Liu
- a School of Nursing , Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Jie Li
- a School of Nursing , Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
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Polo-Kantola P, Aukia L, Karlsson H, Karlsson L, Paavonen EJ. Sleep quality during pregnancy: associations with depressive and anxiety symptoms. Acta Obstet Gynecol Scand 2016; 96:198-206. [PMID: 27861713 DOI: 10.1111/aogs.13056] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 11/05/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Sleep disturbances are common during pregnancy, yet underdiagnosed and under-investigated. We evaluated sleep quality during pregnancy and assessed associated factors, especially depressive and anxiety symptoms. MATERIAL AND METHODS A total of 78 healthy pregnant women from the FinnBrain Birth Cohort Study were studied twice prospectively during pregnancy (in mid-pregnancy and late pregnancy). Sleep quality was evaluated by the Basic Nordic Sleep Questionnaire, depressive symptoms by the Edinburgh Postnatal Depression Scale, and anxiety symptoms by the State-Trait Anxiety Inventory. RESULTS Poor general sleep quality, difficulty falling asleep, the number of nocturnal awakenings per night, and too-early morning awakenings increased in late pregnancy compared with mid-pregnancy (all p-values < 0.020). The total insomnia score (p < 0.001) and sleep latency increased (p = 0.005), but sleep duration and preferred sleep duration did not change. Women tended to snore more often in late pregnancy, but apneas remained rare. Almost one-fourth of the women reported both morning and daytime sleepiness, but the frequencies did not increase during the follow up. In late pregnancy, depressive and anxiety symptoms were cross-sectionally related to sleep disturbances, but depressive or anxiety symptoms in mid-pregnancy were not associated with sleep disturbances in late pregnancy. CONCLUSIONS We found deterioration in sleep quality across pregnancy. However, no increase in negative daytime consequences was found, presumably indicating a compensatory capacity against sleep impairment. Additionally, depressive and anxiety symptoms and sleep disturbances were only cross-sectionally associated. Our study calls for further research on the factors that influence sleep disturbances during pregnancy.
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Affiliation(s)
- Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland.,Sleep Research Unit, University of Turku, Turku, Finland
| | - Linda Aukia
- Department of Obstetrics and Gynecology, Central Hospital of Seinäjoki, Seinäjoki, Finland
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Insitute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Insitute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital and University of Turku, Turku, Finland
| | - E Juulia Paavonen
- National Institute for Health and Welfare, Helsinki, Finland.,Department of Child Psychiatry, University of Helsinki, Helsinki, Finland
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Hashmi AM, Bhatia SK, Bhatia SK, Khawaja IS. Insomnia during pregnancy: Diagnosis and Rational Interventions. Pak J Med Sci 2016; 32:1030-7. [PMID: 27648062 PMCID: PMC5017073 DOI: 10.12669/pjms.324.10421] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Sleep disturbances are common in pregnancy. Insomnia is a frequent sleep disturbance experienced by pregnant women which can be primary or due to co-morbid conditions. The differential diagnosis of insomnia in pregnancy includes anxiety disorders, mood disorders, breathing related sleep disorders and restless legs syndrome. Early interventions to treat the sleep disturbance are recommended to avoid adverse pregnancy outcomes. Management strategies include improving sleep hygiene, behavioral therapies, and pharmacotherapy. The risks of pharmacotherapy must be weighed against their benefits due to the possible risk of teratogenicity associated with some medications.
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Affiliation(s)
- Ali M Hashmi
- Ali M. Hashmi, MBBS, MD. Diplomate American Board of Psychiatry and Neurology, Associate Professor of Psychiatry, King Edward Medical University/Mayo Hospital, Lahore, Pakistan
| | - Shashi K Bhatia
- Shashi K. Bhatia, MD; FACPSYCH; FAACAP Diplomate, American Board of Psychiatry and Neurology in General and Child and Adolescent Psychiatry, Professor and Division Director, Department of Child and Adolescent Psychiatry, Professor, Department of Pediatrics, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Subhash K Bhatia
- Subhash K. Bhatia, MD; FACPSYCH, MAMS. Diplomate, American Board Psychiatry and Neurology in General Psychiatry and in the Subspecialties of Addiction, Forensic and Geriatric Psychiatry, Distinguished Professor and Senior Associate Chair for Academic Affairs and Faculty Development, Creighton University Department of Psychiatry Adjunct Professor, University of Nebraska College of Medicine, Omaha, NE 68105, USA
| | - Imran S Khawaja
- Imran S. Khawaja MD, FAASM. Medical Director, Center for Sleep Medicine, VA Medical Center, Dallas, Texas, Associate Professor of Psychiatry and Neurology, UT Southwestern School of Medicine, USA
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Do changes in subjective sleep and biological rhythms predict worsening in postpartum depressive symptoms? A prospective study across the perinatal period. Arch Womens Ment Health 2016; 19:591-8. [PMID: 26920913 DOI: 10.1007/s00737-016-0612-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 02/15/2016] [Indexed: 02/04/2023]
Abstract
Abnormalities of sleep and biological rhythms have been widely implicated in the pathophysiology of major depressive disorder (MDD) and bipolar disorder (BD). However, less is known about the influence of biological rhythm disruptions across the perinatal period on postpartum depression (PPD). The objective of this study was to prospectively evaluate the relationship between subjective changes in both sleep and biological rhythms and worsening of depressive symptoms from pregnancy to the postpartum period in women with and without mood disorders. Eighty-three participants (38 euthymic women with a history of a mood disorder and 45 healthy controls) were studied. Participants completed subjective assessments of sleep (Pittsburgh Sleep Quality Index), biological rhythm disturbances (Biological Rhythms Interview of Assessment in Neuropsychiatry), and depressive symptoms (Edinburgh Postnatal Depression Scale) prospectively at two time points: third trimester of pregnancy and at 6-12 weeks postpartum. Multivariate regression analyses showed that changes in biological rhythms across the perinatal period predicted worsening of depressive symptoms in both groups. Moreover, women with a history of a mood disorder showed higher levels of sleep and biological rhythm disruption during both pregnancy and the postpartum period. These findings suggest that disruptions in biological rhythms during the perinatal period increase the risk for postpartum mood worsening in healthy pregnant as well as in pregnant women with a history of mood disorders.
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Abstract
The perinatal period introduces a myriad of changes. One important but often overlooked change is an increased reporting of sleep disturbance. Although casually regarded as a consequence of pregnancy or postpartum, there is emerging evidence implicating significant sleep disturbance, characterized by insomnia symptoms and/or poor sleep quality, with adverse outcomes, such as an increase in depressive symptomatology or the development postpartum depression (PPD). Significant consequences may arise as a result including issues with maternal-infant bonding, effective care for the infant, and behavioral or emotional difficulties in the infant. This review discusses the relevant literature as to how disturbed sleep during pregnancy as well as in the postpartum may increase the risk for PPD.
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Affiliation(s)
- Michele L Okun
- University of Colorado Colorado Springs, 1420 Austin Bluffs Parkway Osborne Center A-408, Colorado Springs, CO, 80918, USA.
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Dørheim SK, Garthus-Niegel S, Bjorvatn B, Eberhard-Gran M. Personality and Perinatal Maternal Insomnia: A Study Across Childbirth. Behav Sleep Med 2016; 14:34-48. [PMID: 25174718 DOI: 10.1080/15402002.2014.941063] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Personality may influence sleep in perinatal women. A follow-up study was conducted among 3,752 pregnant, then postpartum women at Akershus University Hospital, Norway. The Big Five personality dimensions were measured by the Mini-International Personality Item Pool in week 17 of pregnancy. Insomnia was measured by the Bergen Insomnia Scale in pregnancy week 32 and 8 weeks postpartum, along with self-reported sleep times. The Edinburgh Postnatal Depression Scale measured depression, and the Hopkins Symptom Checklist measured anxiety. Adjusted for current anxiety, depression, and demographic variables, the personality traits Neuroticism and Agreeableness were associated with insomnia in pregnancy. No personality traits were associated with postpartum insomnia. Extraversion was associated with longer postpartum sleep duration and better sleep efficiency, and Agreeableness with shorter sleep duration.
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Affiliation(s)
- Signe K Dørheim
- a MoodNet Research Group Division of Psychiatry , Stavanger University Hospital
| | - Susan Garthus-Niegel
- b Division of Mental Health Norwegian Institute of Public Health ;,c Institute and Outpatient Clinics of Occupational and Social Medicine TU Dresden , Faculty of Medicine
| | - Bjørn Bjorvatn
- d Norwegian Competence Center for Sleep Disorders Haukeland University Hospital.,e Department of Global Public Health and Primary Care University of Bergen
| | - Malin Eberhard-Gran
- b Division of Mental Health Norwegian Institute of Public Health ;,f Health Services Research Center Akershus University Hospital.,g Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo
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Tsai SY, Lin JW, Wu WW, Lee CN, Lee PL. Sleep Disturbances and Symptoms of Depression and Daytime Sleepiness in Pregnant Women. Birth 2016; 43:176-83. [PMID: 26776559 DOI: 10.1111/birt.12215] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Sleep disturbance, depression, and daytime sleepiness are among the most prevalent symptoms reported by women during pregnancy. However, available data on the association between sleep disturbances and symptoms of depression and daytime sleepiness in pregnant women are sparse and methodological limitations have been acknowledged. The purpose of the study was to examine objective and self-reported sleep disturbances and symptoms of depression and daytime sleepiness in a group of healthy pregnant women. METHODS A total of 274 third-trimester pregnant women wore a wrist actigraph continuously for 7 days to assess objective sleep quality and quantity. Self-reported sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI), with self-reported poor sleep quality defined as a PSQI score more than 5. The Center for Epidemiologic Studies-Depression Scale (CES-D) and Epworth Sleepiness Scale were used to evaluate symptoms of depression and daytime sleepiness, respectively. RESULTS Sixty-four (23.4%) women were at risk for clinical depression and 69 (25.2%) had daytime sleepiness. Risk of clinically meaningful depressive symptomatology was significantly increased in women with objective total nighttime sleep less than 6 hours (OR 2.53 [95% CI 1.26-5.08]) and self-reported poor sleep quality (OR 3.31 [95% CI 1.74-6.30]), even after multiple adjustment. Neither objective nor self-reported sleep disturbances increased daytime sleepiness in this group of pregnant women. DISCUSSION Both objective nighttime sleep less than 6 hours and self-reported poor sleep quality in healthy third-trimester pregnant women is associated with significant risks for clinical depression. Improving sleep would likely be associated with a reduction in depression symptom severity and an attenuation of the prevalence of depression in pregnant women.
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Affiliation(s)
- Shao-Yu Tsai
- School of Nursing, National Taiwan University, Taipei, Taiwan
| | - Jou-Wei Lin
- Department of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Wen Wu
- Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chien-Nan Lee
- Department of Obstetrics and Gynecology, National Taiwan University, Taipei, Taiwan
| | - Pei-Lin Lee
- Department of Internal Medicine, National Taiwan University, Taipei, Taiwan.,Center of Sleep Disorder, National Taiwan University Hospital, Taipei, Taiwan.,Division of Pulmonary and Critical Care Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Beevi Z, Low WY, Hassan J. Impact of Hypnosis Intervention in Alleviating Psychological and Physical Symptoms During Pregnancy. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2016; 58:368-82. [PMID: 27003486 DOI: 10.1080/00029157.2015.1063476] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Physical symptoms (e.g., vomiting) and psychological symptoms (stress, anxiety, and depression) during pregnancy are common. Various strategies such as hypnosis are available to reduce these symptoms. The objective of the authors in this study is to investigate the impact of a hypnosis intervention in reducing physical and psychological symptoms during pregnancy. A pre-test/post-test quasi-experimental design was employed in this study. The hypnosis intervention was given to the experimental group participants at weeks 16 (baseline), 20 (time point 1), 28 (time point 2), and 36 (time point 3) of their pregnancy. Participants in the control group received only the traditional antenatal care. Participants from both groups completed the Depression Anxiety Stress Scale-21 (DASS-21) and a Pregnancy Symptoms Checklist at weeks 16, 20, 28 and 36 of pregnancy. Results indicated that stress and anxiety symptoms were significantly reduced for the experimental group, but not for the control group. Although mean differences for the depressive symptoms were not significant, the experimental group had lower symptoms at time point 3. The physical symptoms' results showed significant group differences at time point 3, indicating a reduction in the experience of physical symptoms for the experimental group participants. Our study showed that hypnosis intervention during pregnancy aided in reducing physical and psychological symptoms during pregnancy.
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