Maternal Sleep in Pregnancy and Postpartum Part I: Mental, Physical, and Interpersonal Consequences

Sleep, circadian activity patterns and postpartum depression: A systematic review and meta-analysis of actigraphy studies

Transition to motherhood is a period full of challenges and demands. In this review, we focused on the associations of sleep and circadian activity patterns during and after pregnancy with postpartum mental health factors. A systematic review and meta-analysis were conducted (PROSPERO reference 316,505). A search for articles was performed using PsycARTICLES, PsycINFO, PubMed, MEDLINE, Scopus, Cochrane, DARE, hand search, and citation tracking. The search was meant to identify peer-reviewed, experimental and observational studies reporting on women over 18 years old that assessed sleep and circadian activity patterns during pregnancy or postpartum using actigraphy, and investigated postpartum mental health factors. Nineteen relevant publications were selected. Postpartum total sleep at night was the indicator that was most closely related to the psychological functioning of women after childbirth. The results of the systematic review indicated that postpartum total sleep at night was related to postpartum fatigue, and the results of the meta-analysis suggested that total sleep at night was most strongly linked with postpartum depression. More studies are needed to estimate the associations of sleep-wake rhythm during pregnancy and in the postpartum period with postpartum mental health factors.

The Role of Psychosocial Stress on Cardiovascular Disease in Women: JACC State-of-the-Art Review

Psychosocial stress can affect cardiovascular health through multiple pathways. Certain stressors, such as socioeconomic disadvantage, childhood adversity, intimate partner violence, and caregiving stress, are especially common among women. The consequences of stress begin at a young age and persist throughout the life course. This is especially true for women, among whom the burden of negative psychosocial experiences tends to be larger in young age and midlife. Menarche, pregnancy, and menopause can further exacerbate stress in vulnerable women. Not only is psychosocial adversity prevalent in women, but it could have more pronounced consequences for cardiovascular risk among women than among men. These differential effects could reside in sex differences in responses to stress, combined with women's propensity toward vasomotor reactivity, microvascular dysfunction, and inflammation. The bulk of evidence suggests that targeting stress could be an important strategy for cardiovascular risk reduction in women.

Parental and Child Sleep: Children with Vision Impairment, Autistic Children, and Children with Comorbid Vision Impairment and Autism

BACKGROUND

Parents report associations between children's sleep disturbances and behaviors. Children with neurodevelopmental conditions (e.g., Williams Syndrome and autism) are consistently reported to experience increased sleeping problems. Sleep in children with vision impairment and children with a dual diagnosis of vision impairment and autism remains understudied.

METHODS

Our exploratory study compared sleep profiles in 52 children (aged 4-12 years) and their parents (n = 37), across four groups: children with vision impairment (VI; n = 9), autism (n = 10), comorbid vision impairment + autism (n = 6), and typically developing children (n = 27). Childhood sleep was measured using the parental report Childhood Sleep Habits Questionnaire and sleep diaries. Children's cognitive functioning was measured using digit span, semantic, and phonemic verbal fluency measures. Parental sleep was measured via the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale.

RESULTS

Clinically disordered sleep was reported in all child groups (p ≤ 0.001), particularly children with VI + autism. Age, not sleep quality/quantity, predicted cognitive task performance in TD and autistic groups, but not in VI and VI + autism groups. The child's diagnosis affected parental sleep, particularly in children with a dual diagnosis of VI + autism.

CONCLUSIONS

All participants experienced problematic sleep to varying degrees. Those most affected were children and parents in the VI + autism group, suggesting that autism may be the main driver of sleep problems in our sample.

Obstructive Sleep Apnea in Pregnancy: A Comprehensive Review of Maternal and Fetal Implications

Obstructive sleep apnea (OSA) is a prevalent yet underdiagnosed condition in pregnancy, associated with various maternal and fetal complications. This review synthesizes the current evidence on the epidemiology, pathophysiology, and neurological consequences of OSA in pregnancy, along with the potential management strategies. Articles were sourced from the PubMed, EMBASE, and Cochrane databases until 2023. Our comprehensive review highlights that the incidence of OSA increases during pregnancy due to physiological changes such as weight gain and hormonal fluctuations. OSA in pregnancy is linked with gestational hypertension, pre-eclampsia, gestational diabetes, and potential adverse fetal outcomes such as intrauterine growth restriction and preterm birth. Continuous positive airway pressure (CPAP) therapy remains the most effective management strategy for pregnant women with OSA. However, adherence to CPAP therapy is often suboptimal. This comprehensive review underscores the importance of the early recognition, timely diagnosis, and effective management of OSA in pregnancy to improve both maternal and fetal outcomes. Future research should focus on enhancing screening strategies and improving adherence to CPAP therapy in this population.

Sleep and depression in couples during the transition to parenthood

OBJECTIVES

The objectives were to: (1) investigate the prevalence, differences and changes in sleep quality over time among Chinese couples during pregnancy and at 6 weeks and 6 months postpartum and (2) examine the association between sleep quality and depressive symptoms.

METHOD

This study was part of an intervention study for postnatal depression. Childbearing couples were recruited from antenatal clinics. Data on sleep and depression during pregnancy and at 6 weeks and 6 months postpartum were collected using the Pittsburgh Sleep Quality Index (PSQI) and Edinburgh Postnatal Depression Scale, respectively.

RESULTS

The prevalence of sleep disturbance (PSQI score > 5) during pregnancy and at 6 weeks and 6 months postpartum was 45.0%, 62.8% and 36.8%, respectively, among women and 26.4%, 36.4% and 27.3%, respectively, among men. Sleep quality declined significantly in both partners from pregnancy to 6 weeks postpartum, followed by a significant improvement by 6 months postpartum. The results revealed significant correlations between partners' scores on sleep quality across the perinatal period, with women experiencing poorer sleep quality than men. Poor sleep was associated with depressive symptoms across the perinatal period for both partners.

CONCLUSIONS

This study highlights the importance of screening couples for sleep disturbances throughout pregnancy and the postnatal period and assisting them to develop strategies to improve sleep quality during the transition to parenthood.

Maternal Sleep Health, Social Support, and Distress: A Mixed-Methods Analysis of Mothers of Infants and Young Children in Rural US

OBJECTIVES

The purpose of this study was to explore sleep health in rural maternal populations through a social-ecological framework and identify risk and protective factors for this population.

METHODS

39 individuals who are mothers of infants or children under the age of 5 years completed an online survey, 35 of which completed a subsequent semi-structured interview. Recruitment was limited to one rural community and was in partnership with community healthcare providers. Results were integrated using a convergent, parallel mixed-methods design.

RESULTS

Poor sleep health and high prevalence of insomnia symptoms in rural mothers were evident and associated with social support and maternal distress. Qualitative content from interviews indicated that well-established precipitating and perpetuating factors for insomnia may contribute to poor maternal sleep health. Results also revealed a gap in knowledge and language surrounding sleep health among rural mothers.

CONCLUSIONS

Sleep health is challenged during the transition to motherhood and rural mothers have less access to specialized perinatal and behavioral health care than their urban counterparts. In this sample, poor sleep was attributable to distress in addition to nocturnal infant and child sleep patterns which has implications for psychoeducation and promotion of sleep health in mothers. Sleep is a modifiable health indicator that is associated with several other maternal health outcomes and should be considered an element of a comprehensive maternal health for prevention and intervention across individual, interpersonal, and societal domains of the social-ecological model of sleep health.

Sleep Quality and Associated Factors among Pregnant Women Attending Antenatal Care Unit at the Referral Hospitals in Oromia National Regional State, Ethiopia, 2021: A Multicenter Cross-Sectional Study

INTRODUCTION

Poor sleep quality during pregnancy leads to adverse neonatal outcomes such as low birth weight, intrauterine growth retardation, preterm birth, and operative birth. Though it has many consequences, a limited study was conducted on the prevalence and associated factors of poor sleep quality among pregnant women in Ethiopia.

OBJECTIVE

This study is aimed to determine poor sleep quality and associated factors among pregnant women attending antenatal care units at the selected referral hospitals.

METHODS

Institution-based cross-sectional study was used from April 20 to June 10, 2021. A The data were collected through systematic random sampling. The Pittsburgh Sleep Quality Index (PSQI) was used to assess the outcome variable based on interview.

RESULTS

Out of 423, almost 414 participated in the study with a response rate of 97.9%. The prevalence of poor sleep quality was 54.6% (95% CI: 49.7%, 59%). Based on the trimester; about 44.8%, 36.8%, and 64.2% were observed poor sleep quality in the first, second, and third trimesters, respectively. Third trimester [AOR (Adjusted Odd Ratio) = 4.33; 95% CI (Confidence Interval) (1.43, 13.7)], primigravida [AOR = 4.03; 95% CI (2.59, 7.97)], para ≥2 [AOR = 1.95: 95% CI (1.09, 3.48)], depression [AOR = 4.59: 95% CI (2.31, 9.15)], and perceived stress [AOR = 1.15: 95% CI (1.1, 1.22)] were factors significantly associated.

CONCLUSION

One in every two pregnant women has poor sleep quality. Depression, perceived stress, gestational age, gravida, and parity were identified as associated factors with poor sleep quality. Therefore, healthcare providers should work on screening and counseling for sleep problems during prenatal checkups.

Night-time sleep duration and postpartum weight retention in primiparous women

Objectives

Approximately 75% of women weigh more at 1-year postpartum than pre-pregnancy. More than 47% retain >10 lbs at 1-year postpartum, which is associated with adverse health outcomes for mother and child. Disturbed sleep may contribute to risk of postpartum weight retention (PWR) as short sleep duration is associated with increased risk of obesity. Thus, we investigated whether night-time sleep duration is associated with risk for excessive PWR. We also explored night-time sleep duration and change in postpartum waist circumference.

Methods

This is an ancillary analysis from a prospective cohort study. Participants were healthy primiparous adults with a singleton birth. Excessive PWR at 1-year postpartum was defined as ≥7% of pre-pregnancy weight. Log-binomial and linear regression assessed associations between night-time sleep duration at 6 months postpartum and PWR at 1-year postpartum. Linear regression assessed the association between night-time sleep duration and change in postpartum waist circumference.

Results

Mean age of participants (N = 467) was 29.51 (SD ± 4.78) years. Night-time sleep duration by actigraphy or self-report was not associated with risk for excessive PWR (risk ratio 0.96, [95%CI 0.87-1.06]; risk ratio 0.95 [95%CI 0.83-1.07], respectively) or change in waist circumference.

Conclusion

Night-time sleep duration at 6 months postpartum was not associated with PWR at 1-year postpartum. Mixed findings among our results and previous research could be due to our focus on night-time sleep, and differences in sleep measurement methods and timeframes across studies. More comprehensively assessing sleep, including multiple sleep dimensions, may help advance our understanding of potential links between sleep and PWR.

Trial Registration

The parent study, Motherhood and Pelvic Health (MAP Study), is registered at https://clinicaltrials.gov/ct2/show/NCT02512016, NCT02512016.

Sleep of mothers, fathers, and infants: a longitudinal study from pregnancy through 12 months

STUDY OBJECTIVES

This study assessed and compared mothers' and fathers' sleep trajectories from pregnancy and throughout the first year of the infant's life. We also examined associations between maternal, paternal, and infant sleep.

METHODS

Two hundred and thirty-two couples were recruited for the study during pregnancy. Data were collected during pregnancy and at 4, 8, and 12 months postpartum. Maternal, paternal, and infant sleep were monitored at home for seven nights, using actigraphy, sleep diaries, and the Insomnia Severity Index (ISI).

RESULTS

Mothers showed more impaired sleep quality than fathers, at all assessments, whereas fathers had shorter sleep duration. Based on the ISI, about 70% of mothers and 50% of fathers showed at least subclinical insomnia at the different assessments. Trajectory analyses (controlling for feeding method and sleeping arrangements) demonstrated a significant deterioration in diary-based and actigraphy sleep quality for both parents, from pregnancy to 4 months. Both parents and infants had an increase in sleep quality from 4 to 12 months, though some parental sleep variables showed a quadratic pattern with a decrease in sleep quality at 8 months. Statistically significant triadic associations at the different assessments were found between mothers', fathers', and infants' sleep. Maternal and infant sleep measures were more strongly correlated than paternal and infant sleep.

CONCLUSIONS

The findings highlight the importance of considering the family context of sleep, by demonstrating similarities and differences in the changes that sleep undergoes in new mothers and fathers and by showing how sleep is interrelated between all family members.

Comprehensive evaluation of machine learning algorithms for predicting sleep-wake conditions and differentiating between the wake conditions before and after sleep during pregnancy based on heart rate variability

Introduction

Perinatal women tend to have difficulties with sleep along with autonomic characteristics. This study aimed to identify a machine learning algorithm capable of achieving high accuracy in predicting sleep-wake conditions and differentiating between the wake conditions before and after sleep during pregnancy based on heart rate variability (HRV).

Methods

Nine HRV indicators (features) and sleep-wake conditions of 154 pregnant women were measured for 1 week, from the 23rd to the 32nd weeks of pregnancy. Ten machine learning and three deep learning methods were applied to predict three types of sleep-wake conditions (wake, shallow sleep, and deep sleep). In addition, the prediction of four conditions, in which the wake conditions before and after sleep were differentiated-shallow sleep, deep sleep, and the two types of wake conditions-was also tested.

Results and Discussion

In the test for predicting three types of sleep-wake conditions, most of the algorithms, except for Naïve Bayes, showed higher areas under the curve (AUCs; 0.82-0.88) and accuracy (0.78-0.81). The test using four types of sleep-wake conditions with differentiation between the wake conditions before and after sleep also resulted in successful prediction by the gated recurrent unit with the highest AUC (0.86) and accuracy (0.79). Among the nine features, seven made major contributions to predicting sleep-wake conditions. Among the seven features, "the number of interval differences of successive RR intervals greater than 50 ms (NN50)" and "the proportion dividing NN50 by the total number of RR intervals (pNN50)" were useful to predict sleep-wake conditions unique to pregnancy. These findings suggest alterations in the vagal tone system specific to pregnancy.

Pregnant in a Pandemic: Mental Wellbeing and Associated Healthy Behaviors Among Pregnant People in California During COVID-19

INTRODUCTION

Pregnancy is a time of increased vulnerability to mental health disorders. Additionally, the COVID-19 pandemic has increased the incidence of depression and anxiety. Thus, we aimed to assess mental health and associated healthy behaviors of pregnant people in California during the pandemic in order to contextualize prenatal well-being during the first pandemic of the twenty-first century.

METHODS

We conducted an online cross-sectional study of 433 pregnant people from June 6 through July 29, 2020. We explored 3 hypotheses: (1) mental health would be worse during the pandemic than in general pregnant samples to date; (2) first-time pregnant people would have worse mental health; and (3) healthy behaviors would be positively related to mental health.

RESULTS

Many of our participants (22%) reported clinically significant depressive symptoms and 31% reported clinically significant anxiety symptoms. Multiparous pregnant people were more likely to express worries about their own health and wellbeing and the process of childbirth than were primiparous pregnant people. Additionally, as pregnancy advanced, sleep and nutrition worsened, while physical activity increased. Lastly, anxious-depressive symptomology was significantly predictive of participant sleep behaviors, nutrition, and physical activity during the past week.

DISCUSSION

Pregnant people had worse mental health during the pandemic, and this was associated with worse health-promoting behaviors. Given that the COVID-19 pandemic and associated risks are likely to persist due to low vaccination rates and the emergence of variants with high infection rates, care that promotes mental and physical well-being for the pregnant population should be a public health priority.

Dietary Inflammatory Index and sleep quality and duration among pregnant women with overweight or obesity

STUDY OBJECTIVES

Sleep disturbances, which can worsen during pregnancy, have been linked to inflammatory processes. This study tested the hypothesis that more pro-inflammatory diets during pregnancy are associated with a decrease in sleep quality and shorter sleep duration.

METHODS

The Health in Pregnancy and Postpartum study promoted a healthy lifestyle in pregnant women with pre-pregnancy overweight or obesity (n = 207). Data from <16 weeks and 32 weeks gestation were used. Sleep was measured using BodyMedia's SenseWear® armband. Diet was assessed using two 24-hr dietary recalls. Energy-density Dietary Inflammatory Index (E-DIITM) scores were calculated from micro and macronutrients. Linear mixed-effects models estimated the impact of the E-DII score on sleep parameters.

RESULTS

Women with more pro-inflammatory diets, compared to those with more anti-inflammatory diets, were more likely to be nulliparous (51% vs. 25%, p = 0.03), frequent consumers of fast food (29% vs. 10% consuming on 4-6 days during the previous week, p = 0.01), ever-smokers (21% vs. 6%, p = 0.02), and younger (mean age 29.2 vs. 31.3 years, p = 0.02). For every one-unit increase (i.e., more pro-inflammatory) in the E-DII score, sleep latency increased by 0.69 min (p < 0.01). Among European Americans only, every one-unit higher E-DII was associated with a 2.92-min longer wake-after-sleep-onset (p = 0.02).

CONCLUSION

An E-DII score that is 5 points lower (i.e., more anti-inflammatory) would equate to about 105 min of additional sleep per week among European American women. Anti-inflammatory diets may help to counteract detriments in sleep during pregnancy, especially among European American women. Additional work is needed among African American women.

CLINICAL TRIALS IDENTIFIER

Name: Promoting Health in Pregnancy and Postpartum (HIPP); URL: https://clinicaltrials.gov/ct2/show/NCT02260518; Registration Identifier: NCT02260518.

Social isolation and insomnia among pregnant women in Japan: The Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study

OBJECTIVES

To estimate the prevalence of insomnia and examine the association between social isolation and insomnia among pregnant women.

METHODS

This cross-sectional study was part of the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study from 2013 to 2017. Pregnant women were recruited at obstetric clinics and hospitals in Miyagi Prefecture, Japan. We analyzed 17,586 women who completed the questionnaires and were allowed to transcribe medical records. Insomnia was defined as the Athens Insomnia Scale score of ≥6. The Lubben Social Network Scale-abbreviated version was used to assess social isolation (defined as scores <12), and its subscales were used to assess marginal family ties and marginal friendship ties. Multiple logistic regression analyses were conducted to examine the association between social isolation and insomnia during pregnancy, adjusting for age, parity, prepregnancy body mass index, feelings toward pregnancy, education, income, work status, morning sickness, and psychological distress. Multiple logistic regression analyses were also conducted for marginal family ties and marginal friendship ties.

RESULTS

The prevalence of insomnia in the second trimester was 37.3%. Women who were socially isolated were more likely to have insomnia than women who were socially integrated: the multivariate-adjusted odds ratio (OR) was 1.26 (95% confidence interval [CI], 1.16-1.36). Marginal family ties and marginal friendship ties were also associated with increased risks of insomnia: the multivariate-adjusted ORs were 1.40 (95% CI, 1.25-1.56) and 1.15 (95% CI, 1.07-1.24), respectively.

CONCLUSIONS

Social isolation from family and friends was associated with increased risks of insomnia among pregnant women.

Prevalence and associated factors of poor sleep quality among postpartum women in North West Ethiopia: a community-based study

INTRODUCTION

Although sleep disturbance is a community problem, there is limited study in Ethiopia. Therefore, this study aimed to identify the prevalence and factors affecting postpartum poor sleep quality in women.

METHOD

A community-based cross-sectional study was conducted from July 1st to August 30th, 2021 in Gondar city. The cluster sampling method was used to address 858 study participants. The Pittsburgh Sleep Quality Index (PSQI) 19-item self-report measure of sleep quality over the past month was used to measure maternal sleep quality during the postpartum period and a global PSQI score of 5 or more was used to indicate poor sleep quality. Binary logistic regression was used to identify variable association and 95% confidence level and adjusted Odds Ratio were used to declare association.

RESULT

Poor sleep quality prevalence during postpartum period was 24.0% (95%CI: 21.3-26.9). factors significantly associated with poor sleep quality were family size [AOR = 1.76; 95% CI: (1.14-2.73)], unplanned pregnancy [AOR = 2.11; 95%CI: (1.17-3.80)], had a family history of mental illness [AOR = 3.70; 95%CI: (2.15-6.37)], had known medical disorders [AOR = 2.59; 95%CI: (1.51-4.43)], having intimate partner violence [AOR = 2.58; 95%CI: (1.78-3.75)], and women who can read and write and who complete secondary school [AOR = 2.60; 95% CI: (1.20-5.66)] and [AOR = 2.02; 95%CI: (1.16-3.53)] respectively. On the other hand, being housewife, merchant, and government-employed [AOR = 0.32; 95%CI: (0.14-0.73)], [AOR = 0.13; 95%CI: (0.05-0.34)], and [AOR = 0.38; 95%CI: (0.14-0.98)] respectively were identified to be factors significantly associated with poor sleep quality.

CONCLUSION

Poor sleep quality prevalence is high in the community of Gondar city. Thus, setting strategies to increase women's educational level, providing health education programs to create awareness on the consequence of intimate partner violence which could reduce the violence; increasing screening for medical disorders before or during maternity period, preventing unplanned pregnancy with effective family planning method, and employing women in a certain organization will have a great role in reducing poor sleep quality.

Sleep During Pregnancy

PURPOSE OF REVIEW

This article will provide a brief review of most recent findings of sleep, insomnia, obstructive sleep apnea, and restless leg syndrome during pregnancy.

RECENT FINDINGS

Recent meta-analyses have found that 38.2% of pregnant women experience insomnia, 15% experience obstructive sleep apnea, and 20% experience restless leg syndrome. Poor sleep during pregnancy is associated with increased odds of preterm birth, cesarean section, hypertension, gestational diabetes, and longer deliveries. OSA is also associated with poor outcomes such as maternal hypertension, gestational diabetes, preterm birth, and low infant Apgar score. Incidence of new-onset RLS increases with parity, gestational age, maternal age, and increased maternal adiposity. Typical treatments have been found to be effective for treating sleep disorders in pregnant women. Obtaining sufficient sleep quality and quantity in addition to assessing and treating sleep disorders should be a priority for pregnant women and their providers.

Cumulative childhood interpersonal trauma and parenting stress: The role of self-capacities disturbances among couples welcoming a newborn

BACKGROUND

The birth of a child is a life-defining event which tends to widen the gap between parents' resources and the demands they face, generating parenting stress. In this regard, individuals who experienced childhood trauma, particularly cumulative childhood interpersonal trauma (CCIT), appear more vulnerable, with higher rates of parenting stress. However, dyadic studies are lacking and the mechanisms explaining the association between CCIT and parenting stress remain unknown, limiting the promotion of resilience in parental couples.

OBJECTIVE

Based on the Self-Trauma Model and the Actor-Partner Interdependence Model, this study examined the role of self-capacities disturbances (i.e., affect dysregulation, identity impairment and interpersonal conflicts) in the association uniting CCIT and parenting stress.

PARTICIPANTS AND SETTINGS

A randomly selected sample of 421 parental couples of an infant.

METHODS

Participants completed self-reported measures online.

RESULTS

Path analyses revealed that CCIT was associated to greater parenting stress through affect dysregulation and identity impairment, in both mothers and fathers (R² = 22.4%; 20.7%). APIM modeling revealed a dyadic association between mothers' proneness to interpersonal conflicts and fathers' parenting stress, in addition to indirect effects involving all three self-capacities in the associations between one parent's CCIT and their partner's parenting stress.

CONCLUSIONS

CCIT-exposed individuals may experience parenting stress through difficulties with self-capacities at the individual and dyadic level, highlighting these capacities as promising intervention targets during the postpartum period, and emphasizing the need to involve both parents since intricate dyadic patterns may be at play.

Perceived social support predicts self-reported and objective health and health behaviors among pregnant women

Perinatal health and health behaviors play a crucial role in maternal and neonatal health. Data examining psychosocial factors which predict self-reported health and health behaviors as well as objective indicators downstream of health behaviors among pregnant women are lacking. In this longitudinal study design with 131 pregnant women, perceived social support was examined as a predictor of self-rated health and average levels of sleep quality, health-promoting and health-impairing behaviors, and red blood cell (RBC) polyunsaturated fatty acids across early, mid, and late pregnancy. Participants provided a blood sample and fatty acid methyl esters were analyzed by gas chromatography. Measures included the Multidimensional Scale of Perceived Social Support, Pittsburgh Sleep Quality Index, and Prenatal Health Behavior Scale. Regression models demonstrated that, after adjustment for income, race/ethnicity, age, relationship status, pre-pregnancy body mass index, greater social support was associated with better self-rated health (p = 0.001), greater sleep quality (p = 0.001), fewer health-impairing behaviors (p = 0.02), and higher RBC omega-3 fatty acids (p = 0.003). Associations among social support with health-promoting behaviors, RBC omega-6 fatty acids, or gestational weight gain were not significant. Findings underscore the benefits of perceived social support in the context of pregnancy. Examination of pathways that link social support with these outcomes will be meaningful in determining the ways in which perinatal psychosocial interventions may promote health.

Postpartum sleep health in a multiethnic cohort of women during the COVID-19 pandemic in New York City

OBJECTIVE/DESIGN

Cross-sectional study to examine the determinants of sleep health among postpartum women during the COVID-19 pandemic in New York City (NYC).

SETTING/PARTICIPANTS

A subset of participants recruited as part of the COVID-19 Mother Baby Outcomes (COMBO) cohort at Columbia University (N = 62 non-Hispanic White, N = 17 African American, N = 107 Hispanic).

MEASUREMENTS

Data on maternal sleep, COVID-19 infection during pregnancy, sociodemographic, behavioral, and psychological factors were collected via questionnaire at 4 months postpartum. Self-reported subjective sleep quality, latency, duration, efficiency, disturbances, and daytime dysfunction were examined as categorical variables (Pittsburgh Sleep Quality Index [PSQI]). Associations between sleep variables and COVID-19 status, time of the pandemic, sociodemographic, behavioral, and psychological factors were estimated via independent multivariable regressions.

RESULTS

Mothers who delivered between May-December 2020, who delivered after the NYC COVID-19 peak, experienced worse sleep latency, disturbances and global sleep health compared to those who delivered March-April 2020, the peak of the pandemic. Maternal depression, stress and COVID-19-related post-traumatic stress were associated with all sleep domains except for sleep efficiency. Maternal perception of infant's sleep as a problem was associated with worse global PSQI score, subjective sleep quality, duration, and efficiency. Compared to non-Hispanic White, Hispanic mothers reported worse global PSQI scores, sleep latency, duration and efficiency, but less daytime dysfunction.

CONCLUSIONS

These findings provide crucial information about sociodemographic, behavioral, and psychological factors contributing to sleep health in the postpartum period.

Sleep Disturbance in Pregnancy

Sleep is vital to life, even when women enter into pregnancy state. Good sleep is important for a healthy pregnancy. Sleep disturbances are common during pregnancy and can be due to the change of pregnancy itself or the results of sleep disorders. There is growing evidence linking sleep disturbances with adverse maternal and fetal outcomes. Differentiation of sleep disorders in order to provide appropriate treatment as well as promoting good sleep for pregnant women is important. A multidisciplinary team to provide sleep care during antenatal period may be needed.

C. A, Bränn E, Fransson E, Sundström Poromaa I, Papadopoulos FC, Skalkidou A. Working Memory During Late Pregnancy: Associations With Antepartum and Postpartum Depression Symptoms

Background

Few studies, with conflicting results, report on the association between memory performance and depressive symptoms during the perinatal period. In this study, we aimed to evaluate whether memory performance during late pregnancy is associated with antepartum (APD) and postpartum depression (PPD) symptoms.

Method

We conducted a prospective follow-up of 283 pregnant women, nested within a large cohort of women enrolled in the BASIC study in Uppsala University hospital between 2009 and 2019. The Wechsler Digit Span Task (forward-DSF, backward-DSB and total score-DST) was performed to evaluate short-term memory/attention (DSF) and working memory (DSB) around the 38th gestational week; the Edinburgh Postnatal Depression Scale (EPDS), evaluating depressive symptoms, was filled out at 17, 32, 38 gestational weeks, as well as at 6 weeks postpartum. Unadjusted and multivariate logistic regression was used to assess the association between performance on the Digit Span Task and outcome, namely depressive symptoms (using a cut-off of 12 points on the EPDS) at 38 gestational weeks, as well as at 6 weeks postpartum.

Results

APD symptoms were not significantly associated with DSF (p = 0.769) or DSB (p = 0.360). APD symptoms were significantly associated with PPD symptoms (p < 0.001). Unadjusted regression modeling showed that DSF in pregnancy was a significant predictor of PPD symptoms (OR 1.15; 95% CI, 1.00, 1.33, p = 0.049), and remained a significant predictor when adjusted for confounders (education and feeling rested at assessment; OR 1.21, 95% CI 1.03, 1.42, p = 0.022). DSF was a predictor of PPD symptoms only for women without a pre-pregnancy history of depression (OR 1.32; 95% CI 1.04, 1.67, p = 0.024) and also those without APD (OR 1.20, 95% CI 1.01, 1.43, p = 0.040).

Conclusion

There was no significant association between working and short-term memory performance and APD symptoms. Among all women, but especially non-depressed earlier in life and/or at antepartum, those scoring high on the forward memory test, i.e., short-term memory, had a higher risk for PPD. Future studies are required to further explore the pathophysiology behind and the predictive value of these associations.

A Technology-Based Pregnancy Health and Wellness Intervention (Two Happy Hearts): Case Study

BACKGROUND

The physical and emotional well-being of women is critical for healthy pregnancy and birth outcomes. The Two Happy Hearts intervention is a personalized mind-body program coached by community health workers that includes monitoring and reflecting on personal health, as well as practicing stress management strategies such as mindful breathing and movement.

OBJECTIVE

The aims of this study are to (1) test the daily use of a wearable device to objectively measure physical and emotional well-being along with subjective assessments during pregnancy, and (2) explore the user's engagement with the Two Happy Hearts intervention prototype, as well as understand their experiences with various intervention components.

METHODS

A case study with a mixed design was used. We recruited a 29-year-old woman at 33 weeks of gestation with a singleton pregnancy. She had no medical complications or physical restrictions, and she was enrolled in the Medi-Cal public health insurance plan. The participant engaged in the Two Happy Hearts intervention prototype from her third trimester until delivery. The Oura smart ring was used to continuously monitor objective physical and emotional states, such as resting heart rate, resting heart rate variability, sleep, and physical activity. In addition, the participant self-reported her physical and emotional health using the Two Happy Hearts mobile app-based 24-hour recall surveys (sleep quality and level of physical activity) and ecological momentary assessment (positive and negative emotions), as well as the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and State-Trait Anxiety Inventory. Engagement with the Two Happy Hearts intervention was recorded via both the smart ring and phone app, and user experiences were collected via Research Electronic Data Capture satisfaction surveys. Objective data from the Oura ring and subjective data on physical and emotional health were described. Regression plots and Pearson correlations between the objective and subjective data were presented, and content analysis was performed for the qualitative data.

RESULTS

Decreased resting heart rate was significantly correlated with increased heart rate variability (r=-0.92, P<.001). We found significant associations between self-reported responses and Oura ring measures: (1) positive emotions and heart rate variability (r=0.54, P<.001), (2) sleep quality and sleep score (r=0.52, P<.001), and (3) physical activity and step count (r=0.77, P<.001). In addition, deep sleep appeared to increase as light and rapid eye movement sleep decreased. The psychological measures of stress, depression, and anxiety appeared to decrease from baseline to post intervention. Furthermore, the participant had a high completion rate of the components of the Two Happy Hearts intervention prototype and shared several positive experiences, such as an increased self-efficacy and a normal delivery.

CONCLUSIONS

The Two Happy Hearts intervention prototype shows promise for potential use by underserved pregnant women.

The river of postnatal psychosis: A qualitative study of women's experiences and meanings

OBJECTIVE

This paper reports findings from a study about women's experience of postpartum psychosis which affects 1-2 women in 1000 in the first four to six weeks following childbirth. Previous research reports many women are relucent to disclose symptoms of mental ill health to healthcare professionals, although they are most likely to discuss symptoms and concerns with a health professional known to them.

DESIGN

A qualitative interpretive study using semi-structured interviews.

PARTICIPANTS

Ten women in Australia who had recovered from postpartum psychosis in the last ten years were interviewed.

DATA ANALYSIS

Data were analysed thematically by three researchers to enhance trustworthiness.

RESULTS

The women described their overall experience as traumatic and described what they saw as contributing factors such as a previous history of mental illness or a significant life event that was present before or during pregnancy; the women described how they made meaning of the symptoms they experienced, such as a lack of sleep or changes in their thoughts or behaviours; and the difficulties they experienced during recovery. The women also identified novel ways to support themselves and each other as they recovered.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

Midwives require further education to recognise the symptoms of postpartum psychosis, to ask further probing questions to identify postpartum psychosis in its early stages and to support women as they recover from this illness.

Relaxation interventions for improving sleep outcomes in perinatal women: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Sleep problem is common amongst perinatal women, and stress may trigger and intensify sleep problems in a vicious cycle. Relaxation interventions are gradually being adopted to improve sleep quality in various populations, but little is known about their effectiveness in perinatal women.

OBJECTIVE

To evaluate the effects of relaxation interventions on sleep outcomes amongst all perinatal women aged 18 and above, and identify the essential type, regime and approach in designing relaxation intervention.

DESIGN

Systematic review and meta-analysis of 11 studies among 1046 perinatal women.

DATA SOURCES

We searched Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica dataBASE, PsycINFO, ProQuest Dissertations and Theses, PubMed and Web of Science from their inception until December 15, 2019.

REVIEW METHODS

Studies were assessed for clinical and statistical heterogeneity and considered for meta-analysis. Comprehensive Meta-analysis and The Cochrane Risk of Bias tool were used for meta-analyses and assessing of risk of bias, respectively.

RESULTS

A total of 6346 records were identified, and 11 randomised control trials were selected. Significantly large effects were found in relaxation interventions in improving sleep quality (Cohen's d = 2.55), disturbance (Cohen's d = 1.52), latency (Cohen's d = 1.82) and duration (Cohen's d = 1.14) when compared with those in the control groups. Subgroup analyses showed that antenatal women who performed progressive muscle relaxation (PMR) by themselves for preventive function and long-term practice showed improved sleep quality compared with their counterparts.

CONCLUSION

PMR is preferable as a supplementary intervention to current existing antenatal care. The grade of the overall evidence of the outcomes ranged from very low to low.

IMPLICATIONS FOR PRACTICE

The meta-analysis addressed the effect of relaxation interventions on sleep outcomes amongst perinatal women. Relaxation interventions may effectively improve sleep quality, disturbance, latency and duration amongst perinatal women early in antenatal period. However, further well-designed trials in large samples are required.

The Impact of a Randomized Controlled Trial of a Lifestyle Intervention on Sleep Among Latina Postpartum Women

BACKGROUND

Poor sleep is associated with adverse outcomes among postpartum women. Exercise may improve sleep, but this has not been well examined in the postpartum period.

PURPOSE

To examine the impact of a culturally modified, individually tailored lifestyle intervention on sleep outcomes among postpartum Latina women.

METHODS

Estudio PARTO was a randomized controlled trial aimed at reducing Type 2 diabetes among Latina women with abnormal glucose tolerance in pregnancy. Participants were randomized to a lifestyle (i.e., diet and exercise; n = 70) or a health and wellness control intervention (n = 78) in late pregnancy (baseline). The Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality (PSQI score), onset latency (minutes per night), duration (hours per night), efficiency (percentage of the time in bed asleep), and daytime dysfunction at baseline, 6 weeks, 6 months, and 12 months postpartum.

RESULTS

Mean PSQI score (6.56 ± 3.87), sleep duration (6.84 ± 1.75 hr/night), and sleep efficiency (79.70% ± 18.10%) did not differ between the arms at baseline. Mixed-effects models indicated a greater decrease of 1.29 in PSQI score (i.e., improved sleep quality) in the lifestyle versus health and wellness arm (95% confidence interval [CI] = -2.50 to -0.08, p = .04) over follow-up. There was the suggestion of a smaller decrease in sleep duration (mean = 0.48 hr/night, 95% CI = -0.10 to 1.06, p = .10) in the lifestyle versus health and wellness arm. There were no statistically significant differences in other sleep outcomes between arms.

CONCLUSIONS

Findings suggest that lifestyle interventions improve sleep quality but not sleep duration, sleep onset latency, sleep efficiency, or daytime dysfunction in postpartum Latina women and, therefore, may hold promise for improving subsequent mental and physical health in this population.

CLINICAL TRIALS REGISTRATION

NCT01679210.

Developmental gains and losses during parenthood

The onset of parenthood irrevocably changes the landscape of adults' functioning, amplifying the potential for parents' experiences of both developmental losses and gains/growth, in context of increased responsibilities and more limited access to environmental resources/supports. In this article, we draw on dual theoretical lenses to integrate the frameworks of Baltes' lifespan development theory of gains and loss and Bronfenbrenner's bioecological model. We summarize empirical evidence in relation to a normative transition, exemplified by the transition to parenthood, and a non-normative event, the Coronavirus (COVID-19) pandemic, and show that parents' experiences of developmental loss and gains/growth are inextricably linked. Our findings illustrate how parents' losses/gains are influenced by a broad range of individual and environmental factors, with implications for parent prevention/intervention programs.

Social-ecological considerations for the sleep health of rural mothers

Using a social-ecological framework, we identify social determinants that interact to influence sleep health, identify gaps in the literature, and make recommendations for targeting sleep health in rural mothers. Rural mothers experience unique challenges and protective factors in maintaining adequate sleep health during the postpartum and early maternal years. Geographic isolation, barriers to comprehensive behavioral medicine services, and intra-rural ethno-racial disparities are discussed at the societal (e.g., public policy), social (e.g., community) and individual levels (e.g., stress) of the social-ecological model. Research on sleep health would benefit from attention to methodological considerations of factors affecting rural mothers such as including parity in population-level analyses or applying community-based participatory research principles. Future sleep health programs would benefit from using existing social support networks to disseminate sleep health information, integrating behavioral health services into clinical care frameworks, and tailoring culturally-appropriate Telehealth/mHealth programs to enhance the sleep health of rural mothers.

High body mass index and sleep problems during pregnancy: A meta-analysis and meta-regression of observational studies

Despite the well-established correlation of weight and sleeping problems, little is known about the nature of the association. The present study examined whether pregnant women with high body mass index have a risk of developing sleep problems, and identified any covariates that affect this relationship. We systematically searched electronic databases, specialized journals, various clinical trial registries, grey literature databases and the reference list of the identified studies. All observational studies were obtained from inception until 9 August 2020. The Newcastle-Ottawa Scale was adopted to assess the quality of studies. Stata software was used to conduct meta-analysis and meta-regression. Forty-six observational studies involving 2,240,804 participants across 16 countries were included. Quality assessment scores ranged from 4 to 10 (median = 6). Meta-analyses revealed that the risk of sleep apnea, habitual snoring, short sleep duration and poor sleep quality is increased in pregnant women with high body mass index, but not for daytime sleepiness, insomnia or restless legs syndrome. Subgroup differences were detected on body mass index between different regions, nature of population, year of publication, age group and study quality. Random-effects meta-regression analyses showed that year and quality of publication were covariates on the relationships between pre-pregnant body mass index and sleep apnea risk. Our review shows that sleep apnea, habitual snoring, short sleep duration and poor sleep quality are important concerns for pregnant women with high body mass index. Developing screening and targeted interventions is recommended to promote efficacious perinatal care.

Maternal Depressive Symptoms, Sleep, and Odds of Spontaneous Early Birth: Implications for Racial Inequities in Birth Outcomes

STUDY OBJECTIVES

Delivery prior to full term affects 37% of US births, including ~400,000 preterm births (<37 weeks) and >1,000,000 early term births (37-38 weeks). Approximately 70% of cases of shortened gestation are spontaneous - without medically-indicated cause. Elucidation of modifiable behavioral factors would have considerable clinical impact.

METHODS

This study examined the role of depressive symptoms and sleep quality in predicting the odds of spontaneous shortened gestation among 317 women (135 Black, 182 White) who completed psychosocial assessment in mid-pregnancy.

RESULTS

Adjusting for key covariates, Black women had 1.89 times higher odds of spontaneous shortened gestation compared to White women (OR (95% CI) = 1.89 (1.01, 3.53), p=0.046). Women who reported only poor subjective sleep quality (PSQI > 6) or only elevated depressive symptoms (CES-D ≥ 16) exhibited no statistically significant differences in odds of spontaneous shortened gestation compared to those with neither risk factor. However, women with comorbid poor sleep and depressive symptoms exhibited markedly higher odds of spontaneous shortened gestation than those with neither risk factor [39.2% versus 15.7%, [OR (95% CI) = 2.69 (1.27, 5.70), p = 0.01]. A higher proportion of Black women met criteria for both risk factors (23% of Black women versus 11% of White women; p=0.004), with a lower proportion experiencing neither risk factor (40.7% of Black versus 64.3% of White women; p < 0.001).

CONCLUSIONS

Additive effects of poor subjective sleep quality and depressive symptoms were observed with markedly higher odds of spontaneous shortened gestation among women with both risk factors. Racial inequities in rates of comorbid exposure corresponded with inequities in shortened gestation. Future empirical studies and intervention efforts should consider the interactive effects of these commonly co-morbid exposures.

Determinants of postpartum sleep duration and sleep efficiency in minority women

STUDY OBJECTIVES

To examine demographic, psychosocial, and behavioral determinants of postpartum sleep duration and sleep efficiency among a cohort of black and Latina women.

METHODS

Data were from 148 women (67% black, 32% Latina) at 5 months postpartum, recruited from an academic medical center in Philadelphia. Relevant demographic, psychosocial and behavioral predictors were assessed via questionnaire. Nocturnal sleep was objectively measured for 1 week using wrist actigraphy. Sleep duration was examined as a continuous variable and in categories (<7 versus ≥7 h per night); sleep efficiency was examined as a continuous variable. Independent multiple linear regression models were built to evaluate significant determinants of sleep.

RESULTS

Adjusted models revealed that breastfeeding, having a bedtime after midnight, and being employed were associated with shorter sleep duration (-25-33 min, all p < 0.05). Multiparity, being unmarried, being employed, breastfeeding, having a bedtime after midnight, bedsharing, and responding to infant awakenings by getting up immediately rather than waiting a few minutes to see if the infant fell back asleep, were all significant determinants of sleeping <7 h per night (OR varying: 2.29-4.59, all p < 0.05). Bedsharing was the only variable identified from the multiple regression model that associated with poorer sleep efficiency (-3.8%, p < 0.05).

CONCLUSIONS

Findings may inform interventions for improving postpartum sleep in socioeconomically disadvantaged, racial/ethnic minority postpartum women.

Effects of sleep deprivation on maternal behaviour in animal models: A systematic review and meta-analysis

Pregnancy is a period of numerous physical and emotional changes in women's lives, including alterations in sleep patterns and worsening of pre-existing sleep disturbances, which possibly lead to impaired postpartum maternal behaviour and mother-infant relationship. The effects of sleep deprivation during pregnancy in maternal behaviour have been evaluated in preclinical studies, but have provided inconsistent results. Thus, in the present study, we aimed to evaluate the effects of sleep deprivation during pregnancy on maternal behaviour of animals through a systematic review and meta-analyses. After a two-step selection process, six articles were included, all of them describing rat studies. The most frequently used method of sleep deprivation was rapid eye movement sleep restriction, using the multiple-platform method. Four meta-analyses were performed, none of them presenting significant impact of sleep deprivation on maternal behaviour, failing to reproduce the results observed in previous clinical studies. In conclusion, our results show a lack of translational applicability of animal models to evaluate the effects of sleep deprivation during pregnancy on maternal behaviour.

Sleep and social relationships in healthy populations: A systematic review

Over the past decade, research linking sleep and social relationships has burgeoned. Researchers across the globe are trying to understand whether the quality and quantity of our social relationships matter for sleep, and vice versa. We conducted a systematic review of the literature, identifying over 200 relevant articles examining sleep and social relationships in healthy populations. Here, we summarize our findings by reviewing 1) links between sleep and broad social ties across the lifespan, and 2) links between sleep and specific social relationships identified in the literature search, including romantic relationships, family relationships, and work relationships. Taken together, the literature provides evidence that the quality and presence of social relationships, especially our closest relationships, play a role in how we sleep. Likewise, sleep appears to influence our social bonds. However, the majority of work is correlational, limiting conclusions about the directionality of these effects. We conclude by synthesizing the findings, considering the limitations of the present literature, and identifying key future directions for this emerging area of research.

Estimating the cumulative risk of postnatal depressive symptoms: the role of insomnia symptoms across pregnancy

PURPOSE

Insomnia symptoms during late pregnancy are a known risk for postnatal depressive symptoms (PDS). However, the cumulative effect of various risk factors throughout pregnancy has not been explored. Our aim was to test how various insomnia symptoms (sleep latency, duration, quality, frequent night awakenings, early morning awakenings) and other risk factors (e.g., history of depression, symptoms of depression and anxiety, as well as sociodemographic factors) in early, mid-, and late pregnancy predict PDS.

METHODS

Using data from the FinnBrain Birth Cohort Study and logistic regression analyses, we investigated the associations of distinct insomnia symptoms at gw 14, 24, and 34 with depressive symptoms (Edinburgh Postnatal Depression Scale score ≥ 11) 3 months postnatally. We also calculated separate and combined predictive models of PDS for each pregnancy time point and reported the odds ratios for each risk group.

RESULTS

Of the 2224 women included in the study, 7.1% scored EPDS ≥ 11 3 months postnatally. Our predictive models indicated that sleep latency of ≥ 20 min, anxiety in early pregnancy, and insufficient sleep during late pregnancy predicted the risk of PDS. Furthermore, we found highly elevated odds ratios in early, mid-, and late pregnancy for women with multiple PDS risk factors.

CONCLUSION

Screening of long sleep latency and anxiety during early pregnancy, in addition to depression screening, could be advisable. Odds ratios of risk factor combinations demonstrate the magnitude of cumulating risk of PDS when multiple risk factors are present.

Pregnancy-Related Weight and Postpartum Depressive Symptoms: Do the Relationships Differ by Race/Ethnicity?

Background: There are significant racial/ethnic disparities in the prevalence of postpartum depression. Prior research in the general population suggests that weight status is related to depression and that this relationship varies by race/ethnicity. However, few studies have investigated whether race/ethnicity moderates the relationship between pregnancy-related weight and postpartum depressive symptoms (PPDS). The objective of this study is to examine the relationship between pregnancy-related weight and maternal PPDS overall and by race/ethnicity. Materials and Methods: This study used data from the Early Childhood Longitudinal Study-Birth Cohort (n ≈ 6950). Ordinary least-squares and logistic regression was used to examine whether pregnancy-related weight, including preconception weight status and gestational weight gain (GWG), was associated with PPDS measured using the Center for Epidemiologic Studies-Depression Scale (CES-D). Stratified analyses were used to assess whether these relationships varied by race/ethnicity. Results: Preconception obesity (body mass index [BMI] ≥30 kg/m²) was associated with higher levels of PPDS (β = 0.601, 95% confidence interval [CI], 0.149-1.053). GWG adequacy was not associated with PPDS. Among non-Hispanic (NH) whites, preconception obesity was positively associated with PPDS (β = 1.016, 95% CI, 0.448-1.584). In contrast, among Hispanics, preconception overweight (25 kg/m² ≤ BMI <30 kg/m²) was associated with lower levels of PPDS (β = -0.887, 95% CI, -1.580 to -0.195). There were no statistically significant relationships between pregnancy-related weight and PPDS among NH black or Asian women, but both groups were significantly more likely than NH whites to report PPDS. Conclusion: Whether and how pregnancy-related weight is associated with PPDS varies by race/ethnicity. Addressing preconception weight could help reduce overall levels of PPDS among NH whites but would likely fail to mitigate racial/ethnic disparities in postpartum mental health.

Pregnant women do not display impaired memory formation across one night of sleep

Forgetfulness is a common complaint of pregnant women, who also often report impaired nocturnal sleep. Considering sleep's well-known beneficial role in consolidating newly encoded memory content, we hypothesized that pregnant women would display detrimental changes in objective sleep measures and associated memory deficits. We compared the consolidation of declarative as well as procedural memory across sleep in 21 healthy, third-trimester pregnant women versus 20 matched non-pregnant controls. Subjects encoded and were tested on visuospatial and procedural memory tasks before and after, respectively, a night of sleep spent at home. The emergence of gist-based memories was tested with the Deese-Roediger-McDermott (DRM) paradigm. Sleep was polysomnographically recorded and subjective sleep quality was assessed with questionnaires. Although pregnant in comparison to non-pregnant women reported markedly impaired subjective sleep quality and efficiency, quantitative changes were limited to increases in wakefulness after sleep onset and reductions in rapid eye movement (REM) sleep. Retention of newly learned memory contents, which is believed to reflect sleep-associated memory consolidation, was comparable between groups, as was the formation of gist-based memories. The findings indicate that subjective deteriorations in sleep quality experienced by pregnant women are not necessarily linked to objective impairments. They raise the possibility that sufficient slow wave sleep towards the end of pregnancy allows for normal sleep-related memory consolidation. Although these results were obtained in a small number of pregnant women in very good health and should be corroborated in larger samples, they challenge the assumption of poor sleep and impaired memory as hallmarks of the "pregnancy brain".

Sleep disturbances and inflammatory gene expression among pregnant women: Differential responses by race

Excessive inflammation in pregnancy predicts adverse birth outcomes, including shortened gestational length and lower birthweight, with African American women at greater risk. As substantial racial disparities in sleep quality, and evidence that African Americans have increased vulnerability for sleep-induced inflammatory dysregulation, sleep may be a critical, modifiable health behavior that contributes to racial disparities in birth outcomes. The present study examined sleep disturbance as a predictor of genome-wide transcriptome profiles of peripheral blood samples from 103 pregnant women (33 African American, 70 white) assessed at 18.7 ± 7.2 weeks gestation. We hypothesized that pregnant women with significant sleep disturbances would have gene expression profiles indicating over-expression of inflammatory pathways, with greater effects among African American compared to white women. Promoter-based bioinformatics analyses of differentially expressed genes indicated greater activation of NF-кB, AP1, and CREB transcription factors among African American women with sleep disturbances (all p < 0.05), and enhanced activation of AP1, but not NF-кB and reduced CREB activity among white women with sleep disturbances (p < 0.05). Differences in glucocorticoid receptor (GR) activity were also observed, in which African American women with sleep disturbances had reduced GR activity (p < 0.05), but white women with sleep disturbances showed a trend for enhanced GR activity (p = 0.11). Similarly, Interferon Response Factor (IRF) activity was reduced in African American women while increased in white women with sleep disturbances (p < 0.05). The current study provides novel evidence for gene expression related to inflammation, glucocorticoids, and anti-viral immunity among pregnant women with sleep disturbances, with differential effects by race. African Americans showed greater breadth and magnitude in these proinflammatory and anti-viral pathways than whites, with divergence in anti-inflammatory glucocorticoid, proinflammatory adrenergic-mediated cAMP, and anti-viral interferon responses. These data elucidate the role of sleep disturbances in intracellular inflammatory and anti-viral immunity in pregnancy and provide a potential target for intervention.

Helping Mom Help Baby: Nutrition-Based Support for the Mother-Infant Dyad During Lactation

Lactation and breastfeeding support the short- and long-term health of both mother and infant, yet the success of these processes depend upon individual and combined factors of the pair. Complications during pregnancy and delivery greatly affect the likelihood that a mother will be capable of breastfeeding for at least the recommended 6 months. Guidelines for women regarding postpartum diet and lifestyle management also fail to reflect the diversity of mother-infant pairs and their circumstances. In our analysis of the literature, we have identified a categorical deficit in modern scientific discourse regarding human lactation; namely, that postpartum involves full-body contribution of resources and thus requires the application of nutrition from a systemic perspective.