The Efficacy of an Intervention for the Management of Postpartum Fatigue

The associations between dairy product intake, fatigue status, and physical activity among postpartum women in Saudi Arabia: a cross-sectional study

BACKGROUND

Fatigue is a major issue that affects women during the postpartum period. A healthy dietary pattern and increased physical activity (PA) are commonly recommended lifestyle modifications to promote health during this time. However, little is known about the interrelationship between dairy product intake, PA level, and postpartum fatigue (PPF) among women. The aim of this study was to evaluate whether PPF is associated with dairy product intake in relation to PA level.

METHODS

A total of 242 women were included in this cross-sectional study. Data related to dairy product intake and PA were collected using a food frequency questionnaire and the International Physical Activity Questionnaire-Short Form, respectively. PPF was assessed using the Fatigue Severity Scale. Logistic regression models were used to examine associations between the intake of dairy products and PPF among women engaged in low, moderate, and high levels of PA while controlling for potential confounders.

RESULTS

Higher consumption rates of yogurt and total dairy predicted lower odds of PPF in women engaged in moderate levels of PA (aOR = 0.24 [95% CI = 0.07, 0.86] and 0.70 [95% CI = 0.53, 0.93], respectively). In women engaged in high levels of PA, lower odds of experiencing PPF were predicted by higher consumption rates of milk (aOR = 0.24 [95% CI = 0.07, 0.89]), yogurt (aOR = 0.21 [95% CI = 0.05, 0.83]), laban (aOR = 0.16 [95% CI = 0.03, 0.86]), and total dairy (aOR = 0.66 [95% CI = 0.47, 0.92]). However, no association was observed between dairy product intake and PPF in women with low levels of PA.

CONCLUSIONS

Higher consumption rates of dairy products were associated with lower odds for experiencing PPF, particularly for women engaged in moderate to high levels of PA. These findings support nutritional and PA promotion programs to moderate issues with PPF. However, the cross-sectional design of this study could limit the ability to infer causality between dairy intake, PA, and PPF. Further longitudinal studies are needed to establish causality and explore the mechanisms underlying these associations.

Factors Associated with Poor Sleep Quality in Postpartum Women: A Crossectional Study

Objective  This study aimed to analyze the factors associated with poor sleep quality in women in the postpartum period who were assisted in a municipality in central Brazil. Material and Methods  This is a cross-sectional study ( n  = 400) conducted virtually from 2020 to 2021. Sociodemographic and clinical characteristics, self-perceived sleep, and the Pittsburgh Sleep Quality Index (PSQI) were assessed. Results  It was identified that 82% of postpartum women were between 18 and 35-years-old and had an average monthly household income of R$2,339.27 ± 1,812.95. It was also found that 33.50% (95% CI: 28.7-38.0) had sleep disorders (PSQI >10); 70.25% (95%CI 65.8-74.8) had poor sleep quality (PSQI >5); 57.4% (95% CI: 52.0-63.1) had inadequate sleep on weekdays/workdays; and 64.1% (95% CI 59.3-69.2) had unsuitable sleep on weekends/days off. It was found that the factors associated with sleep disturbance were: age between <18 years and >35 years ( p  = 0.048); difficulty to think clearly ( p  = 0.043); frequent sadness ( p  = 0.046); poor sleep quality; low income ( p  = 0.030); difficulty to think clearly ( p  = 0.013); and loss of interest in things ( p  = 0.030). As for sleep on weekdays, the associated factors were: marital status without a partner ( p  = 0.008); and being a victim of physical violence ( p  = 0.003). Finally, for sleep on weekends/off: nonwhite skin-color ( p  = 0.039); and having postpartum depression ( p  = 0.029). Conclusion  The findings of the present study call attention to the impacts of changes in women's bodies, behavior, and interpersonal relationships caused by the arrival of a newborn. We also highlight the need for a multidisciplinary and comprehensive medical approach in this period.

Factors associated with postpartum fatigue: an exploration of the moderating role of resilience

Background

Postpartum fatigue (PPF) can impair the physical and mental well-being of women. The aims of this study were to assess the associations between fatigue and maternal health-related variables, specifically, sleep quality, depression symptoms, and resilience, and to explore the moderating role of resilience in the relationships between sleep quality, depression symptoms, and fatigue.

Methods

This cross-sectional study used data collected from mothers during the postpartum period via an online platform. PPF was assessed using the Fatigue Severity Scale, whereas sleep quality and depression symptoms were assessed using the Pittsburgh Sleep Quality Index and Edinburgh Postnatal Depression Scale, respectively. The Brief Resilience Scale was used to assess resilience. Simple and multiple binary logistic regression analyses were performed to examine the association of each independent variable with PPF and to determine the most significant predictors of PFF. The data were analyzed using SPSS, and structural equation modeling was performed using AMOS 23. A moderation analysis was performed to explore the moderating role of resilience using the Hayes PROCESS macro.

Results

A total of 1,443 postpartum mothers were included in the analysis. The simple binary logistic regression analysis showed that having chronic disease (odds: 1.52; p = 0.02), mother's age (odds: 0.97; p = 0.03), mother's body mass index (BMI; odds: 1.03; p = 0.01), depression symptoms (odds: 1.09; p ≤ 0.0001), sleep quality (odds: 1.17; p ≤ 0.0001), and resilience (odds: 0.42; p ≤ 0.0001) all contributed to fatigue during postpartum. Multivariate logistic regression showed that the mother's BMI, sleep quality, depression symptoms, and resilience were significant predictors of PPF. Moderation analyses showed that resilience was not a significant moderator between the main effects of sleep quality and fatigue (interaction effect: β = 0.01, p = 0.31, 95% CI: -0.01 to 0.04) or between the main effects of depression symptoms and fatigue during postpartum (interaction effect: β = 0.01, p = 0.82, 95% CI: -0.01 to 0.02).

Conclusion

Given the deleterious effects of PPF on maternal health outcomes, factors associated with PPF should be assessed regularly. In addition to mothers' BMI, sleep quality, and depression symptoms, resilience could also be a crucial factor in predicting fatigue severity during this critical time for mothers even though it was not a significant moderator among this sample.

Effects of a residential psychoeducational parenting program on maternal anxiety and fatigue symptoms

AIMS

To evaluate the effects of a 5-day residential psychoeducational program on maternal anxiety and fatigue symptoms among women admitted with their unsettled infants and determine the psychological, social and demographic characteristics which are associated with the effect sizes.

METHODS

This is a secondary analysis of routinely collected data from mothers with children aged up to 24 months who were admitted to and completed the residential early parenting psychoeducational program at Masada Private Hospital Early Parenting Centre in Melbourne. Maternal anxiety symptoms were assessed using the Edinburgh Postnatal Depression Scale Three-item Anxiety subscale and maternal fatigue symptoms were the Modified Fatigue Assessment Scale at preadmission, predischarge and follow-up 6-weeks post discharge.

RESULTS

Overall, 1220 admissions were included in analyses. Cohen's d for reductions in the anxiety symptoms during the program was 0.64 (95% CI 0.59 to 0.70) and from pre-discharge to post-discharge was 0.14 (95% CI 0.09 to 01.9), and for fatigue was 1.21 (95% CI 1.11 to 1.32). Higher borderline personality disorder symptoms and experiencing more stressful life events were associated with lower mean reductions in anxiety and fatigue symptoms. Women with a history of mental health problems had lower anxiety symptom reductions. Women who were older or had younger babies had lower fatigue score reductions.

CONCLUSION

This study confirms the effectiveness of a 5-day residential early parenting psychoeducational program provided by a private sector facility in reducing postnatal anxiety and fatigue rapidly, with effects maintained to at least 6-weeks post-discharge.

Can psychological interventions prevent or reduce risk for perinatal anxiety disorders? A systematic review and meta-analysis

OBJECTIVE

Little is known about the extent to which interventions can prevent perinatal anxiety disorders. We conducted a systematic review and meta-analysis to examine whether interventions can decrease the onset and symptoms of perinatal anxiety among individuals without an anxiety disorder diagnosis.

METHOD

We conducted a comprehensive literature search across five databases related to key concepts: (1) anxiety disorders/anxiety symptom severity (2) perinatal (3) interventions (4) prevention. We included studies that examined a perinatal population without an anxiety disorder diagnosis, included a comparator group, and assessed perinatal anxiety. We included interventions focused on perinatal anxiety as well as interventions to prevent perinatal depression or influence related outcomes (e.g., physical activity).

RESULTS

Thirty-six studies were included. No study assessing the incidence of perinatal anxiety disorder (n = 4) found a significant effect of an intervention. Among studies assessing anxiety symptom severity and included in the quantitative analysis (n = 30), a meta-analysis suggested a small standardized mean difference of -0.31 (95% CI [-0.46, -0.16], p < .001) for anxiety at post intervention, favoring the intervention group. Both mindfulness (n = 6), and cognitive behavioral therapy approaches (n = 10) were effective.

CONCLUSIONS

Interventions developed for perinatal anxiety were more effective than interventions to prevent perinatal depression. Psychological interventions show promise for reducing perinatal anxiety symptom severity, though interventions specifically targeting anxiety are needed.

Lifestyle medicine for anxiety symptoms: A meta-analysis of randomized controlled trials

BACKGROUND

Lifestyle medicine (LM) is gaining increasing attention as a treatment option for anxiety, but the current state of evidence has not yet been systematically examined.

METHODS

Six electronic databases were systematically searched from inception to February 2022. Randomized controlled trials (RCTs) comparing the effects of multicomponent LM interventions on anxiety symptoms with either care-as-usual, waitlist, no intervention, or attention control group on anxiety symptoms were identified.

RESULTS

A total of 53 RCTs with 18,894 participants were included for qualitative synthesis, in which 45 RCTs with data available were included for meta-analysis. Multicomponent LM intervention was significantly more effective than the control groups in reducing anxiety symptoms at immediate posttreatment (d = 0.19, p < .001) and at short-term follow-up (d = 0.29, p < .001). However, no significant difference at medium-term was found (p = .14), whereas more studies are needed to study the long-term effects. The subgroup analyses suggested that baseline anxiety symptoms was a significant moderator, suggesting that those with moderate level of baseline anxiety symptoms appeared to have greater improvements (d = 0.66, p < .05).

LIMITATIONS

Minimal anxiety symptoms at baseline contributed to the floor effect and influenced the degree of improvement. The included RCTs had a high risk of bias in general with potential publication bias detected.

CONCLUSION

The findings of this meta-analysis provided support for the positive effects of multicomponent LM interventions for anxiety symptoms. Future research is needed to determine the long-term effects of multicimponent LM and the optimal baseline anxiety severity.

Measurement instruments for parental stress in the postpartum period: A scoping review

BACKGROUND

Parenting stress is a particular type of stress that is conceptualized as a negative psychological response to the numerous obligations associated with raising children. Despite a considerable increase in research on parenting stress, little attention has been given to the ways parenting stress are measured.

OBJECTIVES

This scoping review aimed to provide an overview of available instruments measuring parental stress and to describe their psychometric properties.

METHODS

We conducted a scoping review in accordance with international guidelines for scoping reviews. The main search strategy was searches in seven electronic databases. Pairs of reviewers selected relevant studies based on predetermined inclusion and exclusion criteria. Studies had to report one or more psychometric properties of an instrument measuring stress in parents with children 0-12 months. For each included study, we collected information relevant to the review question, guided by the COnsensus based Standards for the selection of health status Measurement INstruments (COSMIN). Finally, we collated, summarized, and reported the findings descriptively.

RESULTS

From 2164 unique record, 64 studies from 24 countries were included. They described 15 instruments, of which four were generic and eleven parental-specific self-administered instruments. Only two studies examined parental stress among fathers. Eleven of the studies were validation studies, but they only described seven of the 15 instruments. Internal consistency was the only information provided by 73.4% of the included studies. None of the instruments had information on all measurement properties as per the COSMIN criteria, and there was no information about measurement error, responsiveness, or interpretability for any of the 15 instruments.

DISCUSSION

There are presently 15 instruments with some associated psychometric information being used to measure parental stress among parents with young children, but the amount of information on the instruments' psychometric properties is slight. There is a need for further research.

Effectiveness of non-pharmacological interventions for reducing postpartum fatigue: a systematic review protocol

INTRODUCTION

Postpartum fatigue is a common symptom among new mothers after their pregnancy. It has a considerable negative impact on women's functional and mental status as well as the development of babies. Identifying effective interventions to prevent or reduce postpartum fatigue is meaningful to improve the quality of life and avoid adverse outcomes of this vulnerable population. This systematic review aims to synthesise non-pharmacological evidence and evaluate the effectiveness of interventions for reducing postpartum fatigue among puerperas.

METHODS AND ANALYSIS

This review will be conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. We will systematically search the Cochrane Library, PubMed, Embase, Web of Science, PsycINFO, CINAHL and ProQuest databases to identify clinical trials implementing non-pharmacological interventions conducted during 0-78 weeks postpartum for fatigue reduction. An additional search of OpenGrey will be conducted to identify grey literature. The search will be performed on 30 March 2021 without restrictions on time and language. Two independent reviewers will be responsible for study selection, data extraction and study quality assessment. The Cochrane risk-of-bias tool will be adopted to evaluate the risk biases of the included randomised controlled trials, and the Risk of Bias in Non-randomised Studies of Interventions will be applied to evaluate non-randomised controlled trials. Any disagreements will be referred to a third reviewer to reach a consensus. Findings will be qualitatively synthesised, and a meta-analysis will be conducted for the statistical combination if outcome data are sufficient and available.

ETHICS AND DISSEMINATION

This systematic review will not involve the collection of primary data and will be based on published data. Therefore, ethics approval is not required. The final findings will be disseminated through peer-reviewed journals and academic conferences.

PROSPERO REGISTRATION NUMBER

CRD42021234869.

Does a nurse-led postpartum self-care program for first-time mothers in Bangladesh improve postpartum fatigue, depressive mood, and maternal functioning?: a non-synchronized quasi-experimental study

Purpose

This study aimed to test the efficacy of a nurse-led postpartum self-care (NLPPSC) intervention at reducing postpartum fatigue (PPF) and depressive mood and promoting maternal functioning among first-time mothers in Bangladesh.

Methods

A non-synchronized quasi-experimental design was used. First-time mothers were recruited during postpartum and assigned to the experimental or control group (34 each). The experimental group received the NLPPSC in the hospital, a 1-day intervention that focused on increasing self-efficacy. The control group received usual care. Data on PPF, depressive mood, maternal functioning, self-care behaviors, postpartum self-efficacy, and self-care knowledge were collected at postpartum 2 weeks (attrition 23.5%) and 6 weeks (attrition 16.1%). Data were analyzed using descriptive statistics, bivariate statistics, and linear mixed model analysis.

Results

One-third (33.3%) of new mothers experienced depressive mood (Edinburgh Postnatal Depression Scale scores of ≥13 points). The NLPPSC intervention was statistically significant in decreasing PPF (β=-6.17, SE=1.81, t=-3.39, p<.01) and increased maternal functioning at postpartum 6 weeks in the experimental group (β=13.72, t=3.73, p<.01) compared to the control. Knowledge was also statistically significant for increased maternal functioning over time (β=.37, SE=.18, t=2.03, p<.05). However, there were no statistically significant differences in depressive mood over time.

Conclusion

The NLPPSC intervention was feasible and effective in improving fatigue and maternal functioning in Bangladeshi mothers by postpartum 6 weeks. Postpartum care knowledge was effective in improved maternal functioning and thus supports implementing the NLPPSC intervention for new mothers after childbirth.

Effectiveness of nonpharmacological interventions for reducing postpartum fatigue: a meta-analysis

BACKGROUND

Postpartum fatigue is the most common issue among postnatal women and it could not only seriously affect the health of mothers but also bring about adverse impacts on their offspring. This meta-analysis aims to synthesize nonpharmacological evidence and evaluate the effectiveness of interventions for reducing postpartum fatigue among puerperae.

METHODS

The Cochrane Library, PubMed, Embase, Web of Science, PsycINFO, CINAHL and ProQuest databases were searched for papers published from inception until June 2021. Grey literature was searched using OpenGrey. Randomized controlled trials (RCTs) or controlled clinical trials (CCTs) evaluating nonpharmacological interventions conducted during 0 ~ 78 weeks postpartum for fatigue reduction were eligible for inclusion. The methodological quality of the included studies was independently assessed by two reviewers using the Cochrane risk-of-bias tool and the risk of bias in nonrandomized studies of interventions. Cohen's kappa coefficient was used to measure inter-rater agreement. The meta-analysis was conducted using Review Manager 5.3.

RESULTS

Seventeen published clinical trials matched the eligibility criteria and ten studies involving 1194 participants were included in this meta-analysis. The intervention start time varied from immediately postpartum care to 1 year after delivery, and duration ranged from 1 day to 3 months. The results revealed that exercise (SMD = - 1.74, 95% CI = -2.61 to - 0.88) and drinking tea (MD = - 3.12, 95% CI = -5.44 to - 0.80) resulted in significant improvements in women's postpartum fatigue at postintervention. Drinking tea may have beneficial effects on depression (MD = - 2.89, 95% CI = -4.30 to - 1.49). Positive effects of psychoeducational interventions on postpartum fatigue or depression were not observed. Physical therapies including mother-infant skin-to-skin contact, taking warm showers and breathing lavender oil aroma were used for reducing postpartum fatigue. No significant risk of publication bias was found. Small number of included studies and sample sizes, not time-matched conditions of control groups, high heterogeneity and the risk of bias within the included studies were the main limitations of our review.

CONCLUSIONS

This review provides evidence that exercise and drinking tea may be effective nonpharmacological interventions for relieving postpartum fatigue. More effective and targeted exercise programs need to be further studied. Rigorous RCTs of drinking tea are needed. Caution is required when interpreting the findings due to the limitations of our study. Further studies are still needed to validate our findings and increase confidence in the results.

Non-pharmacological interventions to reduce anxiety in pregnancy, labour and postpartum: A systematic review

BACKGROUND

The anxiety mothers experience during pregnancy is well known and may have negative consequences for the emotional, psychological, and social development of newborns. Anxiety must therefore be reduced using different strategies.

OBJECTIVE

To determine published non-pharmacological interventions to reduce anxiety during pregnancy, childbirth and postpartum.

METHODS

A systematic peer-review of experimental and quasi-experimental studies was conducted using the PubMed, Scopus, Web of Science (WOS), and CINAHL databases. The quality of the studies was assessed using the Spanish version of the PEDro scale. Two researchers participated independently in the data selection and extraction process.

FINDINGS

587 articles were identified, of which 21 met the eligibility criteria. In eleven studies the intervention was performed during pregnancy, in three of them during labour, in four of them during the postpartum period, and in three of them during pregnancy and postpartum. During pregnancy, the most effective interventions were behavioural activation, cognitive behavioural therapy, yoga, music therapy, and relaxation; during childbirth: aromatherapy; during pregnancy and postpartum: antenatal training, massage by partners, and self-guided book reading with professional telephone assistance.

CONCLUSION AND IMPLICATIONS

The most effective interventions to reduce anxiety were performed either during pregnancy or during the postpartum period, not during labour. Most of the interventions were performed on the women, with few of them being performed on both partners. Non-pharmacological interventions may be applied by nurses and midwives to reduce anxiety during pregnancy, labour and postpartum.

Implementation and Effectiveness of Nonspecialist-Delivered Interventions for Perinatal Mental Health in High-Income Countries: A Systematic Review and Meta-analysis

IMPORTANCE

Task sharing-or training of nonspecialist providers with no formal training in counseling-is an effective strategy to improve access to evidence-based counseling interventions and has the potential to address the burden of perinatal depression and anxiety.

OBJECTIVES

To identify the relevant implementation processes (who, what, where, and how) and to assess the effectiveness of counseling interventions delivered by nonspecialist providers for perinatal depression and anxiety in high-income countries.

DATA SOURCES

CINAHL, Ovid MEDLINE, Ovid MEDLINE In-Process, PsycINFO, Web of Science, Cochrane Central Register of Controlled Trials, and Embase through December 31, 2019. Relevant systematic reviews were also considered.

STUDY SELECTION

Randomized clinical trials of counseling interventions that assessed depression or anxiety after intervention, delivered by a nonspecialist provider for adults, and that targeted perinatal populations in a high-income country were included. Self-help interventions that did not include a provider component were excluded.

DATA EXTRACTION AND SYNTHESIS

Four researchers independently reviewed abstracts and full-text articles, and 2 independently rated the quality of included studies. Random-effects meta-analysis was used to estimate the benefits of the interventions. The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was followed.

MAIN OUTCOMES AND MEASURES

For implementation processes, the frequencies represented by a total or percentage were estimated, where the denominator is the total number of eligible trials, unless otherwise indicated. For effectiveness, primary and secondary outcome data of depression, anxiety, or both symptoms were used, with separate analyses for prevention and treatment, stratified by depression or anxiety. Subgroup analyses compared outcome types (anxiety vs depression) and study objectives (treatment vs prevention).

RESULTS

In total, 46 trials (18 321 participants) were included in the systematic review; 44 trials (18 101 participants) were included in the meta-analysis. Interventions were implemented across 11 countries, with the majority in Australia, UK, and US. Two-thirds (65%) of counseling interventions were provided by nurses and midwives, lasted a mean of 11.2 weeks (95% CI, 6.4-16.0 weeks), and most were delivered face to face (31 [67.4%]). Only 2 interventions were delivered online. A dearth of information related to important implementation processes, such as supervision, fidelity, and participant sociodemographic characteristics, was observed in many articles. Compared with controls, counseling interventions were associated with lower depressive symptoms (standardized mean difference [SMD], 0.24 [95% CI, 0.14-0.34]; 43 trials; I2 = 81%) and anxiety scores (SMD, 0.30 [95% CI, 0.11-0.50]; 11 trials; I2 = 80%). Treatment interventions were reported to be effective for both depressive symptoms (SMD, 0.38 [95% CI, 0.17-0.59]; 15 trials; I2 = 69%) and anxiety symptoms (SMD, 0.34 [95% CI, 0.09-0.58]; 6 trials; I2 = 71%). However, heterogeneity was high among the trials included in this analysis.

CONCLUSIONS AND RELEVANCE

This study found evidence in high-income countries indicating that nonspecialist providers may be effective in delivering counseling interventions. Additional studies are needed to assess digital interventions and ensure the reporting of implementation processes to inform the optimal delivery and scale-up of these services.

Development and evaluation of 'Sleep, Baby & You'-An approach to supporting parental well-being and responsive infant caregiving

Disrupted parental sleep, presenting as post-partum fatigue and perceived as problematic infant sleep, is related to increased symptoms of depression and anxiety among new mothers and fathers. Previous research indicates that UK parents would value an approach that facilitates meeting their infants’ needs while supporting their own sleep-related well-being throughout their infant’s first year. Six initial stakeholder meetings were held with 15 practitioners and 6 parents with an interest in supporting parent-infant sleep needs, to explore existing service provision and identify gaps. The Possums Sleep Program developed and delivered in Brisbane, Australia in a GP clinic setting, was chosen as an appropriate approach. Working collaboratively with a stakeholder group, we translated the Possums Sleep Program into an intervention that could be universally delivered in the UK via NHS antenatal and postnatal practitioners. Parent and practitioner views of the initial materials were obtained via feedback questionnaires and the tool was revised. The intervention was then field-tested by 164 practitioners who delivered it to at least 535 new parents and babies over 5 UK locations, to capture anonymous parent and practitioner views of the intervention concept, the materials, and their experiences with both. The intervention helps parents recalibrate their expectations of infant sleep development, encourages responsive parenting and experimentation to meet their infant’s needs, offers parents strategies for supporting the development of their babies’ biological sleep regulators and promote their own well-being, and teaches parents to manage negative thinking and anxiety that can impede sleep using the principles of Acceptance and Commitment Therapy. The ‘Sleep, Baby & You’ discussion tool, a 14 page illustrated booklet for parents, was field-tested and evaluated by practitioners and parents who offered enthusiastic feedback. Practitioners reported the ‘Sleep, Baby & You’ materials were easy for them to explain and for parents to understand, and were a good fit with the responsive parenting approaches they employed in other areas of their work. Parents who received the intervention postnatally understood the material and found the suggestions easy to follow. All parents who provided feedback had implemented one or more of the suggested changes, with the majority of changes (70%) being sustained for at least two weeks. Practitioners recommended development of digital and antenatal versions and offered feedback on circumstances that might challenge effective uptake of the intervention. ‘Sleep, Baby & You’ is a promising tool for promoting parental attitude and behaviour-change, that aims to adjust parental expectations and reduce negative thinking around infant sleep, promote responsive infant care in the face of infant-related sleep disruption and fatigue, and support parental well-being during the first year of parenthood. Initial field-testing provided insights useful for further development and subsequent testing via a randomised trial. Support exists for incorporating ‘Sleep, Baby & You’ into an anticipatory, universal intervention to support parents who may experience post-partum fatigue and infant sleep disruption.

Brief evidence-based interventions for universal child health services: a restricted evidence assessment of the literature

Background

Universal child health services (UCHS) provide an important pragmatic platform for the delivery of universal and targeted interventions to support families and optimize child health outcomes. We aimed to identify brief, evidence-based interventions for common health and developmental problems that could be potentially implemented in UCHS.

Methods

A restricted evidence assessment (REA) of electronic databases and grey literature was undertaken covering January 2006 to August 2019. Studies were eligible if (i) outcomes related to one or more of four areas: child social and emotional wellbeing (SEWB), infant sleep, home learning environment or parent mental health, (ii) a comparison group was used, (iii) universal or targeted intervention were delivered in non-tertiary settings, (iv) interventions did not last more than 4 sessions, and (v) children were aged between 2 weeks postpartum and 5 years at baseline.

Results

Seventeen studies met the eligibility criteria. Of these, three interventions could possibly be implemented at scale within UCHS platforms: (1) a universal child behavioural intervention which did not affect its primary outcome of infant sleep but improved parental mental health, (2) a universal screening programme which improved maternal mental health, and (3) a targeted child behavioural intervention which improved parent-reported infant sleep problems and parental mental health. Key lessons learnt include: (1) Interventions should impart the maximal amount of information within an initial session with future sessions reinforcing key messages, (2) Interventions should see the family as a holistic unit by considering the needs of parents with an emphasis on identification, triage and referral, and (3) Brief interventions may be more acceptable for stigmatized topics, but still entail considerable barriers that deter the most vulnerable.

Conclusions

Delivery and evaluation of brief evidence-based interventions from a UCHS could lead to improved maternal and child health outcomes through a more responsive and equitable service. We recommend three interventions that meet our criteria of “best bet” interventions.

Trajectory and Predictors of Fatigue Among Chinese Immigrant and Chinese Canadian-Born Women in the Postpartum Period

OBJECTIVE

To describe the proportion of women with improving or worsening symptoms of fatigue at 1, 3, 6, and 12 months after birth; to model the trajectory of fatigue across the first year after birth and identify baseline predictors (e.g., immigrant status) and time-varying predictors; and to describe the degree to which fatigue interferes with activities of daily living across the first year after birth among a cohort of Chinese immigrant and Chinese Canadian-born women.

DESIGN

Prospective cohort study.

SETTING

Toronto, Ontario, Canada.

PARTICIPANTS

Chinese women who were recent immigrants (n = 244), nonrecent immigrants (n = 247), or Canadian born (n = 100).

METHODS

Women completed surveys at 1, 3, 6, and 12 months after birth. We measured fatigue with the use of the Multidimensional Assessment of Fatigue scale. Fatigue predictor variables were classified as baseline (e.g., immigrant status) or time varying (e.g., depression). We used latent growth curve modeling to examine fatigue trajectories and identify predictors over time.

RESULTS

Fatigue followed a nonlinear pattern: it improved from 1 to 6 months after birth and then worsened from 6 to 12 months after birth. Depression, anxiety, infant sleep characteristics, and breastfeeding problems, but not immigrant status, significantly increased risk for fatigue. Several daily activities were significantly influenced by fatigue, particularly early in the postpartum period as well as later, which showed a U-shaped relationship between fatigue and activities of daily living.

CONCLUSION

Fatigue is common and persistent across the postpartum period. Modifiable risk factors related to mental health, infant sleep, and breastfeeding difficulties suggest that preventive strategies for maternal fatigue warrant further investigation.

The psychometric properties of the Barkin index of maternal functioning (BIMF) for the Iranian population

Background

Mothers’ capability for childcare and compatibility with the maternal role represent important challenges in postpartum care. Given the significance of evaluating maternal functioning, and the lack of adequate standard instruments in Iran for this purpose, the present study was aimed at translating and conducting a psychometric assessment of the Barkin Index of Maternal Functioning (BIMF) for Iranian women.

Methods

The instrument was translated into Persian using the Backward Forward method. The study included 530 women in the postpartum period admitted to healthcare centers in Tabriz, Iran; they were selected through the cluster sampling method. Face, content, and construct (through exploratory and confirmatory analyses) validity were presently examined. Reliability of the questionnaire was determined using the internal consistency and test-retest reliability methods.

Results

Two factors (mom’s needs and competency), emerged based on exploratory factor analysis. The x²/df ratio was less than 5, and the values of the Root Mean Square Error of Approximation (RMSEA) and the Root Mean Square Residual (RMR) were less than 0.08 and 0.1, respectively, verifying the model validity. Cronbach’s alpha coefficient and Intra-class Correlation Coefficient (ICC) were calculated as 0.88 and 0.85, respectively, indicating reliability.

Conclusion

The Persian version of the BIMF is a valid and reliable instrument for measuring the postpartum functioning of Iranian mothers.

Factors associated with maternal postpartum fatigue: an observationalstudy

OBJECTIVES

To assess the prevalence of postpartum fatigue at 10 days, 1 month and 3 months, and to describe the sociodemographic and clinical characteristics of women with fatigue and the associations with infant characteristics, maternal-infant attachment, and partner and midwifery support.

SETTING

Maternity care in England. Secondary analysis of 2014 National Maternity Survey.

PARTICIPANTS

Participants were a random sample of 10 000 women selected by the Office for National Statistics using birth registration records. Women aged less than 16 years or if their baby had died were excluded. Questionnaires were sent to women at 3 months post partum and asked about well-being and care during pregnancy, labour, birth and post partum. Specifically, women were asked whether they experienced fatigue/severe tiredness at 10 days, 1 month or 3 months post partum. Responses were received from 4578 women (47% response rate).

RESULTS

Decreasing but substantial proportions of women, 38.8%, 27.1% and 11.4%, experienced fatigue/severe tiredness at 10 days, 1 month and 3 months, respectively. These figures varied significantly by maternal age, level of deprivation, education and parity. Women reporting depression, anxiety, sleep problems and those breast feeding were at significantly increased risk (eg, OR for depression in women with fatigue at 3 months: 2.99 (95% CI 2.13 to 4.21)). Significantly more negative language was used by these women to describe their babies, and they perceived their baby as more difficult than average (eg, two or more negative adjectives used by women with fatigue at 3 months: OR 1.86 (95% CI 1.36 to 2.54)). Women with postpartum fatigue had greater partner support but were significantly less likely to report seeing the midwife as much as they wanted.

CONCLUSIONS

Postpartum fatigue is not inevitable or universal, although early in the postnatal period it affects a substantial proportion of women. Predictors include age and parity, but practical help and support from partners and midwives may be protective factors.

Postpartum fatigue and depression: A systematic review and meta-analysis

BACKGROUND

New parents are vulnerable to fatigue and depressive symptoms. Many studies have reported significant positive correlations between the two in postpartum parents, but the size of correlations varies considerably between studies. The relationship between postpartum fatigue and depression is yet to be systematically synthesized and meta-analyzed.

METHODS

A PROSPERO registered systematic review and meta-analysis (CRD42017065240) was conducted on the correlation between fatigue and depression within the first two years postpartum in parents. Moderation analysis was used to examine the influence of demographic and measurement factors on the effect sizes.

RESULTS

Thirty-five eligible papers were identified (34 on mothers, 1 on fathers). The meta-analytic summary effect size for simultaneously measured fatigue and depressive symptoms among women in the postpartum period was r = 0.52, 95% CI [0.45, 0.59], p < .001. There was a high degree of heterogeneity in the strength of the correlation between studies. This heterogeneity was not accounted for by demographic (e.g., infant age, maternal age, population type) or methodology (e.g., measurement) related moderators.

LIMITATIONS

Studies not reporting or providing correlation between fatigue and depression were not included. Unable to assess some moderators due to limited sample size.

CONCLUSIONS

There is a strong correlation between fatigue and depressive symptoms among women in the first two years after child-birth, but a high degree of heterogeneity in correlation strength exists between studies. Careful assessment of both fatigue and depression when either symptom is reported could facilitate accurate differential diagnosis and prioritizing treatment in postpartum women. Further implications for assessment, treatment, and future research are discussed.

More than depression: a multi-dimensional assessment of postpartum distress symptoms before and after a residential early parenting program

INTRODUCTION

Parents are vulnerable to psychological distress symptoms in the postpartum period. It is routine to screen for depressive symptoms, but anxiety, stress, fatigue, irritability and insomnia symptoms are less often assessed despite their prevalence. This study aimed to assess multiple dimensions of psychological distress, and their reliable change and clinically significant change among women admitted to a residential program for assistance with unsettled infant behaviors (UIB).

METHOD

Women admitted to a five-night residential early parenting program completed self-report measures: the Depression Anxiety Stress Scale, Irritability Depression Anxiety Scale, Fatigue Severity Scale, and Insomnia Severity Index. A sub-group completed a computerized emotional Go-NoGo (EGNG) task as a measure of emotional impulsivity.

RESULTS

Seventy-eight women were recruited (Mage = 34.46, SDage = 4.16). On admission, 48% of women reported clinically elevated depressive symptoms and 97.5% of women not reporting elevated depressive symptoms reported clinical elevations in at least one other form of distress. Upon discharge, all self-report distress symptoms were significantly reduced (all p-values <.001), but reliable and clinically significant change only occurred in a subgroup of women. There were no significant changes in indicators of impulsivity based on the EGNG.

CONCLUSIONS

In addition to, and often in the absence of, depressive symptoms, women attending an early parenting program experienced a wide range of psychological distress, including fatigue, insomnia, anxiety and stress. Different forms of distress improved in different magnitudes to the treatment provided. These findings highlight the need for a multi-dimensional approach in the assessment and treatment of postpartum distress.

Related but different: distinguishing postpartum depression and fatigue among women seeking help for unsettled infant behaviours

BACKGROUND

A growing body of evidence in relatively healthy populations suggests that postpartum depression and fatigue are likely distinct but related experiences. However, differentiating depression and fatigue in clinical settings remains a challenge. This study aimed to assess if depression and fatigue are distinct constructs in women with relatively high fatigue and psychological distress symptoms attending a residential program that assists with unsettled infant behaviour.

METHODS

167 women (age: M = 34.26, SD = 4.23) attending a private residential early parenting program completed the Depression Anxiety Stress Scale (DASS21-D), Fatigue Severity Scale (FSS) and self-report sleep variables before program commencement. Confirmatory Factor Analysis examined the associations between depression and fatigue latent factors.

RESULTS

A two-factor model of separate but related depression and fatigue constructs provided a significantly better fit to the data than a one-factor model of combined depression and fatigue (p < .001). In the two-factor model, the depression and fatigue latent factors were moderately correlated (.41). Further predictive utility of this two-factor model was demonstrated as both depression and fatigue factors were independently predicted by worse self-reported sleep efficiency.

CONCLUSIONS

This study provides empirical evidence that for women attending a clinical service with relatively high fatigue and psychological distress, postpartum depression and fatigue remain separate but related experiences. These findings suggest that in women seeking clinical support in the postpartum period, both depression and fatigue need to be carefully assessed to ensure accurate diagnoses, and (b) whilst depression intervention may improve fatigue, targeted fatigue intervention may also be warranted.

Energy Drinks: Implications for the Breastfeeding Mother

Breastfeeding women may experience disrupted sleep schedules and be tempted to turn to popular energy drinks to reduce fatigue and enhance alertness, prompting the question: What are the maternal and child health implications for breastfeeding mothers consuming energy drinks? Caffeine and vitamin-rich energy drinks contain a variety of herbal ingredients and vitamins; however, ingredient amounts may not be clearly disclosed on product labels. Interactions between herbal ingredients and caffeine are understudied and not well defined in the literature. Some infants can be sensitive to caffeine and display increased irritability and sleep disturbances when exposed to caffeine from breastmilk. Breastfeeding women who consume energy drinks may be ingesting herbal ingredients that have not undergone scientific evaluation, and if taking prenatal vitamins, may unknowingly exceed the recommended daily intake. Caffeinated products are marketed in newer ways, fueling concerns about health consequences of caffeine exposure. We present implications associated with consumption of caffeine and vitamin-rich energy drinks among breastfeeding women. Product safety, labeling, common ingredients, potential interactions, and clinical implications are discussed. Healthcare providers should encourage breastfeeding women to read product labels for ingredients, carbohydrate content, serving size, and to discourage consumption of energy drinks when breastfeeding and/or taking prenatal vitamins, to avoid potential vitamin toxicity.

The Relationships among Postpartum Fatigue, Depressive Mood, Self-care Agency, and Self-care Action of First-time Mothers in Bangladesh

PURPOSE

Postpartum fatigue can impact maternal well-being and has been associated with levels of perceived self-care. This study aimed to examine the relationship among fatigue, depressive mood, self-care agency, and self-care action among postpartum women in Bangladesh.

METHODS

A descriptive cross sectional survey was done with 124 first-time mothers from two tertiary hospitals in Dhaka, Bangladesh. The Modified Fatigue Symptoms checklist, Denyes' Self Care Instrument, the Edinburgh Postnatal Depression Scale, and items on sociodemographic and delivery-related characteristics, were used in Bengali via translation and back-translation process.

RESULTS

High fatigue levels were found in 18.5%(n=23) and 73.4% had possible depression (n=91). There was a significant negative relationship between fatigue and self-care agency (r=-.31, p < .001), and self-care action (r=-.21, p < .05). Fatigue differed by level of self-care agency (t=4.06, p < .001), self-care action (t=2.36, p=.023), newborn's APGAR score (t=-2.93, p=.004), parental preparation class participation (F=15.53, p < .001), and postpartum depressive mood (t=-4.64, p < .001).

CONCLUSION

Findings suggest that high level of self-care efficacy and behaviors can contribute to fatigue management, and highlight the need for practical interventions to better prepare mothers for postpartum self-care, which may, in turn, alleviate postpartum fatigue.

A Postpartum Sleep and Fatigue Intervention Feasibility Pilot Study

The purpose of this pilot study was to evaluate the feasibility, acceptability, and cost of a self-management intervention for postpartum fatigue and sleep in socioeconomically disadvantaged urban women. Helping U Get Sleep (HUGS) is a theory-guided intervention developed from the Individual and Family Self-Management Theory. Medicaid-enrolled participants in the United States were recruited from an inpatient postpartum unit. Treatment and attention control interventions were delivered (15 HUGS, 12 comparison) at a week 3 postpartum home visit and 4 follow-up phone calls. Over the 9-week protocol, the HUGS group demonstrated significant improvements in subjective fatigue and subjective sleep disturbance relative to the comparison group. The HUGS intervention was feasible and acceptable, delivered on average, in 100 min and costing US$79 per participant.

Study of the Impact of Educational Behavioral Interventions on Fatigue in Mothers in the Postpartum Period in the Groups of Face-to-Face and Electronic Training

BACKGROUND

Maternal fatigue in the postpartum period include factors that affect the quality of life and health of both the mother and newborn. This study aimed to investigate two educational approaches regarding mother's fatigue in the postpartum period.

MATERIALS AND METHODS

This experimental study was performed among 110 pregnant mothers during their postpartum care using random sampling. The participants were divided in three groups, namely, face-to-face, e-learning, and control groups. Interventions included individual meetings between the researcher and mothers in the face-to-face group and giving educational compact disc to the e-learning department to improve maternal fatigue. Personal information and fertility data was obtained (before training); the maternal fatigue questionnaire Fatigue Severity Scale (FSS) was completed before and after any type of (face-to-face, e-learning, and control) education. Obtained data were analyzed using one-way analysis of variance (ANOVA) and repeated-measures ANOVA.

RESULTS

Results showed that both face-to-face and e-learning methods had similar maternal fatigue scores. The average change on the maternal fatigue score in the second treatment was (p = 0.02) and the third treatment was (p < 0.001)among three groups that was indicative of significant statistical differences. Similarly, there was no statistically significant difference in the average maternal fatigue score between the two groups before the intervention and in the second and third groups after the intervention. Therefore, over time, the training was unaffected.

CONCLUSIONS

The findings of this study indicate that both face-to-face and e-learning methods are effective to reduce maternal postpartum fatigue.

The views of first time mothers completing an intervention to reduce postpartum weight retention: A qualitative evaluation of the mums OnLiNE study

BACKGROUND

maternal postpartum weight retention (PPWR) has implications for short and long term weight-related health of both the mother and child. Little is known about how mothers perceive they may be best supported to achieve a healthy postpartum weight and healthy lifestyle behaviours. Evaluating existing postpartum weight focussed intervention strategies is an important step in the planning of future programs aimed at supporting new mothers.

AIM

to describe the perspectives of women who completed the mums OnLiNE pilot intervention, regarding the acceptability and effectiveness of a program which aimed to limit PPWR and promote healthy diet and physical activity behaviours in new mothers.

METHOD

descriptive qualitative research methods utilising semi-structured interview questions to explore new mothers' views regarding their participation in the mums OnLiNE intervention were used. All women who completed the intervention were invited to participate in one-on-one interviews via telephone. Interviews were digitally recorded and transcribed verbatim. Data were analysed utilising thematic analysis for common, emerging themes.

FINDINGS

twelve women participated in the interviews. Six main themes including program usefulness, intervention components, walking, self-monitoring, barriers and challenges and future recommendations described women's views of the mums OnLiNE intervention. Women felt well supported being part of the program and their reported awareness of healthy eating increased. Telephone support was the most valued and helpful component of the intervention and the smartphone application for self-monitoring was used more often than the website. Walking was by far the most preferred activity as it was considered enjoyable and achievable and some reported that their incidental walking increased as a result of being part of the program. Lack of time and motivation were the main barriers to participation in the program. Suggestions for future programs included encouraging group support and mother-baby exercise sessions.

CONCLUSION

women perceived the mums OnLiNE intervention to be useful in promoting a healthy lifestyle and valued the support provided. Whilst barriers to participation in healthy lifestyle programs exist, well planned interventions which consider time constraints of new mothers, utilize one-on-one support and offer social engagement with other new mothers may further support women in their attainment of healthy postpartum weight and lifestyle behaviours.

Sleep Quality and Quantity in Low-Income Postpartum Women

PURPOSE

To describe and explore patterns of postpartum sleep, fatigue, and depressive symptoms in low-income urban women.

STUDY DESIGN AND METHODS

In this descriptive, exploratory, nonexperimental study, participants were recruited from an inpatient postpartum unit. Subjective measures were completed by 132 participants across five time points. Objective sleep/wake patterns were measured by 72-hour wrist actigraphy at 4 and 8 weeks. Mean sample age was 25 years, high school educated with 3.1 children. Over half the sample reported an annual income less than 50% of the federal poverty level.

RESULTS

Objectively, total nighttime sleep was 5.5 hours (week 4) and 5.4 hours (week 8). Subjectively, 85% met criteria for "poor sleep quality" at week 4, and nearly half were persistently and severely fatigued through 8 weeks postpartum.

CLINICAL IMPLICATIONS

The majority (65%) of women in this study met the definition of "short sleep duration," defined as sleeping ≤ 6 hours per night. Adverse effects of this short sleep on physical and mental health as well as safety and functioning, especially within the context of poverty, may be profound. There is an urgent need for further research on sleep in low-income underrepresented women to identify interventions that can improve sleep and fatigue as well as discern the implications of sleep deprivation on the safety and physical and mental health of this population.

Efficacy of a footbath for post-partum fatigue in South Korea: A quasi-experimental study

AIM

The purpose of this study was to identify the effects of a footbath on post-partum fatigue.

METHODS

This study used a quasi-experimental design by using an unequivalent control group, pre-post-test design. The participants were divided into experimental and control groups. Fifty post-partum women who were admitted to an obstetrics and gynecology ward of a general hospital were the experimental group and 50 post-partum women who were admitted to an obstetrics and gynecology ward of a women's hospital were the control group. Two hospitals were providing similar postnatal care to their patients and they were located in the same city. The experimental group received a footbath along with postnatal care at the hospital, while the control group received only postnatal care from the hospital. Each group completed the Fatigue Continuum Form at a specified time.

RESULTS

The general characteristics and pretest dependent variables were homogenous between the two groups. The hypothesis was supported post-test as the Fatigue Continuum Form scores differed significantly between the experimental and the control groups.

CONCLUSION

This study showed that a footbath helps to decrease fatigue among post-partum women. In addition, it is a good preventative strategy for post-partum women who should initiate it in the early post-partum period.

"I didn't know it was possible to feel that tired": exploring the complex bidirectional associations between maternal depressive symptoms and fatigue in a prospective pregnancy cohort study

Depressive and fatigue symptoms are common health concerns for women in the postnatal period. Few studies have sought to investigate the role of fatigue in the development and maintenance of depressive symptoms. The aim of this paper was to examine the relationship between depressive symptoms and fatigue over the course of the first 4 years postpartum, in particular focusing on the extent to which fatigue at earlier time points predicted later depressive symptoms and vice versa. Data from over 1000 women participating in a longitudinal study of Australian women's physical and psychological health and recovery after childbirth were used. An autoregressive cross-lagged panel model was tested to assess the mutual influences of fatigue and depressive symptoms across five time points at 3, 6, 12 and 18 months postpartum, and at 4 years postpartum. A complex bidirectional relationship between fatigue and depressive symptoms from 3 months to 4 years postpartum was observed, where fatigue at earlier time points predicted depressive symptoms at later time points, and vice versa. The findings of this study suggest interventions targeting the prevention and management of fatigue may also confer some benefit in improving or preventing the development of depression symptoms in the early parenting period.

The relationship between parental fatigue, parenting self-efficacy and behaviour: implications for supporting parents in the early parenting period

BACKGROUND

Emerging evidence indicates that parental fatigue is associated with low warmth and increased hostility in parent-child interactions. One possible pathway by which fatigue may impact on parenting behaviour is via parental self-efficacy (PSE), whereby high fatigue may undermine PSE, which is often associated with suboptimal parenting behaviour. The current study sought to explore a model of the relationships between parental fatigue, parenting warmth and hostility, where PSE mediates these relationships and whether the nature of these relationships differ by social or family context.

METHODS

The current sample was drawn from a larger Australian community sample survey on parent well-being and parenting. It consisted of 1143 parents (mothers, n = 1003; fathers, n = 140) of children aged 0-4 years.

RESULTS

Path analysis revealed that the relationship between fatigue and parenting warmth and hostility was fully mediated by PSE.

CONCLUSIONS

These results indicate that fatigue has the potential to negatively influence parenting behaviours that are important for their children's well-being and development, and that fatigue plays a mediating role in this relationship. Implications of the study for psycho-education and interventions targeting the management of parental fatigue are discussed.