Sleep disturbances and depressive and anxiety symptoms during pregnancy: associations with delivery and newborn health

Effect of psychological nursing intervention combined with acupressure on postoperative recovery of women after cesarean section

BACKGROUND

Psychological intervention nursing (PIN) has been considered to have a curative effect on cesarean section (CS) postoperative recovery. However, the therapeutic mechanisms remain obscure.

AIM

To explore the effects of PIN combined with acupressure massage on CS postoperative recovery.

METHODS

A retrospective study was conducted on 150 pregnant women admitted to an obstetrics department between January 2020 and January 2023. The control group (CG) received acupressure therapy (n = 73), and the intervention group (IG) received acupressure therapy and PIN therapy (n = 77). Postoperative recovery time was assessed by anal-exhausting, defecation, bed activity, breastfeeding, and hospital stay times. Adverse effects, including infection, bleeding, limb numbness, intrauterine hematoma, urinary retention, and venous thromboembolism, were recorded. the pain visual analogue scale (VAS) was used to evaluate the degree of pain. Anxiety and depression status were qualitatively assessed using the self-rating anxiety scale (SAS), self-rating depression scale (SDS), and Edinburgh postpartum depression scale (EPDS). The Pittsburgh sleep quality index (PSQI) was used to compare sleep quality between the groups.

RESULTS

The baseline data and SAS, SDS, EPDS, and PSQI scores did not significantly differ before CS (P > 0.05) and neither did complication rates between the two groups after CS (P > 0.05). However, anal-exhausting, defecation, waking up, breastfeeding, and hospitalization times were significantly shorter for participants in the IG than those for participants in the CG (P < 0.05). The VAS, SAS, SDS, EPDS, and PSQI scores of the IG were significantly lower than those of the CG (P < 0.05).

CONCLUSION

PIN, combined with acupressure massage, effectively promotes maternal recovery, reduces post-CS pain, and improves postoperative negative emotions and sleeping quality.

Sleep disturbances in late pregnancy: associations with induction of labor

PURPOSE

Sleep disturbances, which are common during pregnancy, may compromise labor. Nevertheless, little is known about associations between sleep disturbances and the likelihood of ending up induction of labor (IOL). Accordingly, we aimed to evaluate the connections between sleep disturbances during pregnancy and IOL.

METHODS

Altogether 1778 women from the FinnBrain Birth Cohort Study with gestation weeks over 37 + 6 were enrolled in the study. The women were divided into IOL (n = 331) and spontaneous onset of labor (SOL, n = 1447) groups. Sleep disturbances in late pregnancy were evaluated using the Basic Nordic Sleep Questionnaire. Logistic regression analyses were conducted with adjustments for age, body mass index, parity, smoking, and depressive symptoms.

RESULTS

Sleep disturbances were frequent in both IOL and SOL groups. In the IOL group 43.0% and in the SOL group 39.0% had poor general sleep quality (P = 0.186). Nocturnal awakenings occurred most commonly, in 94.0% and 93.9%, respectively (P = 0.653). In the IOL group, more women (22.7%) were habitual snorers than in the SOL group (17.0%, P = 0.017), however, the difference lost the statistical significance in adjusted analysis (P = 0.848). Women in the IOL group were more likely to be short sleepers (< 7 h) compared to those in the SOL group (20.2% and 15.4%, respectively, P = 0.034) with no difference after adjustment (P = 0.133). The two groups showed no differences in sleep loss (P = 0.252).

CONCLUSIONS

Deterioration in sleep quality was noticeable in pregnant women, but it was unconnected with IOL. As the frequency of IOL is increasing, more research for related risk factors is needed.

Pregnancy Concerns as Predictors of Sleep Quality in Primigravid Women: A Cross-Sectional Study

Introduction Poor sleep quality may be a risk factor for adverse pregnancy outcomes. Identifying the predictors of sleep disorders can help design effective interventions. The present study aimed to evaluate the impact of pregnancy concerns on the sleep quality of primigravid women. Methods This cross-sectional study was conducted on 220 primigravid women referred to health centers in Hamadan, Iran. In addition to completing the demographic characteristics questionnaire, the Parkinson's Disease Questionnaire (PDQ) questionnaire was completed to determine the level of pregnancy concerns, and the Pittsburgh Sleep Quality Index (PSQI) questionnaire was completed to determine the quality of sleep by pregnant women. Data were analyzed using descriptive statistics, the Pearson correlation coefficient, independent t-test, and univariate and multivariate logistic regression models with a backward method at a 95% confidence level. Results Pregnant women's total PSQI score was 13.8 ± 3.08, and with a PSQI ≥ 5 as a cut-off point, 76.3% of the study's participants had poor sleep quality. There was a significant direct correlation between the total score of PDQ and its subscales with the total PSQI score (P < 0.05). The adjusted regression logistic model showed a significant relationship between the PDQ scores, women's educational level (adjusted odds ratio (AOR) 1.19; confidence interval (CI) 95%: 0.19-2.18), and their spouse's educational level (AOR 1.03; CI 95%: 0.02-2.03) with sleep quality scores. Conclusion Pregnancy concerns, including concerns about birth and the baby, concerns about physical symptoms and body image, and concerns about emotions and relationships, can reduce the sleep quality of primigravid women. Designing and implementing effective interventions to reduce or modify these common concerns can improve the sleep quality of pregnant women and prevent the adverse effects of poor sleep quality on pregnancy outcomes.

Maternal sleep disordered breathing and offspring growth outcome: A systematic review and meta-analysis

Sleep disordered breathing is extremely common in pregnancy and is a risk factor for maternal complications. Animal models demonstrate that intermittent hypoxia causes abnormal fetal growth. However, there are conflicting data on the association between maternal sleep disordered breathing and offspring growth in humans. We investigated this association by conducting a systematic review and meta-analysis. Sixty-three manuscripts, and total study population of 67, 671, 110 pregnant women were included. Thirty-one studies used subjective methods to define sleep disordered breathing, 24 applied objective methods and eight used international codes. Using a random effects model, habitual snoring, defined by subjective methods, and obstructive sleep apnea, diagnosed by objective methods, were associated with an increased risk for large for gestational age (OR 1.46; 95%CI 1.02-2.09 and OR 2.19; 95%CI 1.63-2.95, respectively), while obstructive sleep apnea, identified by international codes, was associated with an increased risk for small for gestational age newborns (OR 1.28; 95%CI 1.02-1.60). Our results support that maternal sleep disordered breathing is associated with offspring growth, with differences related to the type of disorder and diagnostic methods used. Future studies should investigate underlying mechanisms and whether treatment of sleep disordered breathing ameliorates the neonatal growth.

Postpartum Depression and Maternal Care: Exploring the Complex Effects on Mothers and Infants

Postpartum depression (PPD) is a common and debilitating mental health condition affecting many mothers worldwide. This review article aims to explore the complex effects of PPD on mothers and infants, focusing on maternal care. The transition to motherhood is a critical period characterized by numerous physical, psychological, and social changes, making women vulnerable to the onset of PPD. Consequently, PPD can significantly impact a mother's ability to provide optimal care for her infant, leading to potential adverse consequences for both parties. The article synthesizes existing research literature on the topic, encompassing studies from various disciplines, including psychology, psychiatry, obstetrics, and pediatrics. It begins by providing an overview of the prevalence and risk factors associated with PPD, emphasizing the importance of early detection and intervention. The impact of PPD on maternal caregiving behaviors, such as bonding, sensitivity, and responsiveness, is then examined, highlighting the potential disruptions in the mother-infant relationship. Furthermore, the article delves into the potential consequences of impaired maternal care on infant development, including emotional, cognitive, and social domains. Several factors contributing to the complex interplay between PPD and maternal care are discussed, including hormonal changes, psychosocial stressors, and the influence of social support networks. The review also addresses the bidirectional nature of the mother-infant relationship, whereby infant characteristics and behaviors can exacerbate or mitigate the effects of PPD on maternal care. Moreover, the article explores the role of healthcare providers and the importance of implementing effective screening, assessment, and treatment strategies for PPD to promote optimal maternal-infant outcomes. By consolidating current knowledge on the topic, this review article provides valuable insights into the multifaceted effects of PPD on both mothers and infants. Recognizing the significance of maternal care and understanding the mechanisms through which PPD disrupts it can inform the development of targeted interventions to promote early detection, effective treatment, and supportive interventions for mothers experiencing PPD. Ultimately, improving maternal mental health and enhancing maternal-infant relationships can yield long-term positive effects on mothers' and infants' well-being and development.

Genetic variants in the genes of the sex steroid hormone metabolism and depressive symptoms during and after pregnancy

PURPOSE

The aim of this study was to conduct an association analysis of depressive symptoms and polymorphisms in the ESR1, PGR, CYP19A1, and COMT genes in pregnant and postpartum women.

METHODS

The Franconian Maternal Health Evaluation Study (FRAMES) recruited healthy pregnant women prospectively for assessment of maternal and fetal health. The German version of the 10-item Edinburgh Postnatal Depression Scale (EPDS) was completed at three time points in this prospective cohort study. Visit 1 was at study entry in the third trimester of pregnancy, visit 2 was shortly after birth, and visit 3 was 6-8 months after birth. Germline DNA and depression measurements from 361 pregnant women were available for analysis. Six single nucleotide polymorphisms (SNPs) in the above-mentioned genes were genotyped. After reconstruction of haplotypes for PGR (rs1042838 and rs10895068) and CYP19A1 (rs10046 and rs4646), a multifactorial linear mixed model was applied to the data to describe the association between haplotypes and depression values. The single SNPs for ESR1 (rs488133) and COMT (rs4680) were analyzed separately using linear mixed models analogously.

RESULTS

The mean antepartum EPDS measurement was 5.1, the mean postpartal measurement after 48-72 h was 3.5, and the mean value 6-8 months postpartum was 4.2. The SNPs in PGR were reconstructed into three haplotypes. The most common haplotype was GG, with 63.43% of patients carrying two copies and 33.52% carrying one copy. For haplotype GA, the group of carriers of two copies (0.28%) was combined with the carriers of one copy (9.70%). Haplotype reconstruction using CYP19A1 SNPs resulted in three haplotypes. The most common haplotype was TC, with 25.48% of patients carrying two copies and 51.52% one copy. None of the haplotype blocks and neither of the two single SNPs showed any significant associations with EPDS values.

CONCLUSIONS

The candidate haplotypes analyzed in PGR and CYP19A1 and single SNPs in ESR1 and COMT did not show any association with depression scores as assessed by EPDS in this cohort of healthy unselected pregnant women.