Sleep education during pregnancy for new mothers

Pre-pregnancy sleep duration and postpartum depression: a multicenter study in Japan

Postpartum depression (PPD) is as a major public health issue and clinical priority worldwide. This study aimed to investigate the association between pre-pregnancy sleep duration and PPD. A multicenter retrospective study was conducted using clinical data of women who delivered at term between 2014 and 2018 at 12 maternity care hospitals in Japan. A total of 15,314 women were stratified into five groups according to their pre-pregnancy sleep duration: < 6, 6-7, 7-8, 8-9, and ≥ 9 h. Univariate and multivariate regression analyses were conducted to determine whether pre-pregnancy sleep duration affects the Edinburgh Postnatal Depression Scale (EPDS) scores at 1 month postpartum. We also evaluated whether the risk for PPD differs between primipara and multipara women classified according to pre-pregnancy sleep duration. The adjusted odds ratio for high EPDS scores (≥ 9) among women who slept for < 6 h and 6-7 h was 2.08 (95% confidence interval [CI]: 1.60-2.70) and 1.41 (95% CI: 1.18-1.68), respectively, relative to that in women with 7-8 h of sleep as the reference group. A 1-h increase in sleep duration was associated with an approximately 14% reduction in the risk for high EPDS scores. The association between short sleep duration and high EPDS scores was more remarkable in multipara women than in primipara women. Short pre-pregnancy sleep duration is associated with high EPDS scores, and this association is more significant in multipara women than in primipara women. Our findings emphasize the importance of collecting information on pre-pregnancy sleep duration to identify women at a high risk for PPD.

Factors Related to Maternal Oral Health Status: Focus on Pregnant and Breastfeeding Women

Oral health management is vital for pregnant women and their fetuses. This study analyzed the factors affecting maternal oral health status. It used secondary data obtained from the 2019 Korean Community Health Survey. Data were analyzed using SPSS 21.0 for complex descriptive statistics, independent t-test, Pearson’s correlation coefficients, and multiple regression analysis. Multiple regression analysis revealed that age (β = −0.01, p < 0.001), maternal characteristics (β = −0.10, p < 0.001), education (β = −0.06, p = 014), subjective health status (β = 0.27, p < 0.001, sleep duration (β = 0.07, p = 0.003), breakfast frequency (β = −0.16, p < 0.001), unmet dental care needs (β = 0.35, p < 0.001), and depression (β = −0.02, p < 0.001) are key factors of maternal oral health status. Furthermore, oral health status is associated with mental health factors, such as depression. Therefore, the importance of maternal oral health among pregnant and breastfeeding women must be highlighted to promote the health of mothers and their babies.

Prevalence of and Risk Factors for Poor Sleep During Different Trimesters of Pregnancy Among Women in China: A Cross-Sectional Study

BACKGROUND

The management of poor sleep during pregnancy is important for maternal and foetal health. The aim of the present study was to investigate the prevalence of poor sleep quality and risk factors for poor sleep during different trimesters of pregnancy for better management of sleep during pregnancy.

METHODS

A cross-sectional study was conducted among pregnant women in Foshan Women's and Children's Hospital. In total, 2281 pregnant women were analysed, and the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. Cluster logistic regression was used to analyse the risk factors for poor sleep among all participants, and logistic regression models were built to identify potential risk factors for poor sleep quality in different trimesters of pregnancy.

RESULTS

Over half of the participants reported poor sleep quality (51.8%). The rate of poor sleep was lowest in the second trimester. Women who were unmarried had >12 years of education, exercised <3 days/week, were in the third trimester, had a high level of nausea and vomiting during pregnancy (NVP) and had a history of infertility had a higher risk of poor sleep. Pregnancy-related factors contributed most to poor sleep. In the first trimester, the main risk factors for poor sleep were a history of infertility and a high level of NVP. In the second trimester, only a high level of NVP was a risk factor for poor sleep. In the last trimester, the risk factors for poor sleep were more education years, exercise <3 days/week and high levels of NVP.

CONCLUSION

The prevalence and risk factors for poor sleep were different in different trimesters. Clinicians should screen and address poor sleep prior to the first and, especially, the third trimester of pregnancy. Management of poor sleep should be consistent throughout pregnancy and be adjusted in different trimesters.

Using Levine's conservation model in postpartum care: a randomized controlled trial

This randomized controlled trial was conducted with 117 puerperae who were assigned into 2 groups: the intervention group and the control group. While the participants in the intervention group participated in a full program based on the module trainings, the participants in the control group received routine care. There was a significant difference between the women in the intervention and control groups in terms of the variables such as fatigue, sleep, and quality of life. The women in the intervention group experienced less fatigue, and their quality of sleep and quality of life improved considerably. Levine's conservation model enables the provision of the integrative care to women in their postpartum period.

A brief sleep focused psychoeducation program for sleep-related outcomes in new mothers: a randomized controlled trial

Study Objectives

Poor sleep is commonly problematic during pregnancy and postpartum and is associated with depression. This trial investigated the efficacy of prenatal brief, group sleep psychoeducation in improving postpartum maternal sleep, and depression.

Methods

A total of 215 healthy expectant first-time mothers were cluster randomized (1:1) to receive either a 2 × 1.5 h psychoeducation intervention and a set of booklets, or a set of booklets only. Participants completed questionnaires during pregnancy (pre-intervention), and 6 weeks and 4 months postpartum. A post hoc subset of questionnaires was collected at 10 months postpartum. The primary hypothesis was the intervention group would have improved postpartum sleep quality, and reduced levels of insomnia symptoms, fatigue, and daytime sleepiness compared to the control group. Secondary outcomes included depression, anxiety, and stress.

Results

Linear mixed model analyses failed to confirm a group by time interaction on primary or secondary outcomes across all time points. There was no effect of the intervention on outcomes at 6 weeks, or 10 months postpartum. A significant time by group interaction was found at 4 months, favoring the intervention for sleep quality (p = 0.03) and insomnia symptoms (p = 0.03), but not fatigue or daytime sleepiness.

Conclusions

Prenatal sleep psychoeducation did not produce a sustained effect on maternal sleep throughout the postpartum period. There was little evidence of benefits on depressive symptoms.

Clinical Trial Registration

ACTRN12611000859987

Overall health and drinking behavior among pregnant and breastfeeding women in Korea

OBJECTIVES

The study was to conduct a comparative assessment of drinking behaviors and overall health among pregnant and breastfeeding women.

METHODS

This study used data collected from the Korean Community Health Survey in 2015. Data obtained from 2,156 pregnant or breastfeeding women were analyzed using descriptive statistics, the t-test, the chi-square test, and the Pearson correlation coefficient.

RESULTS

Current drinking and alcohol consumption were higher among pregnant women than among breastfeeding women. Depression was twice as common among breastfeeding women than among pregnant women, and stress was much higher among breastfeeding women as well. Breastfeeding women also had lower subjective dental health and more unmet medical needs than pregnant women.

CONCLUSIONS

Although pregnant women were in better overall health than breastfeeding women, many of them were unable to stop drinking, which is a risky and adverse health behavior that negatively affects maternal and fetal health. In order to reduce drinking among pregnant and breastfeeding women, it is necessary to develop a tailored, standardized educational program and national guidelines.

A randomized controlled trial on the effect of lifestyle education for Iranian women and their husbands on post-partum anxiety and depression

This randomized controlled trial was conducted on 189 pregnant women to determine the effect of lifestyle-based training for women and their husbands on post-partum anxiety (PPA) and depression (PPD). Follow-ups were continued up for 6 weeks after childbirth. Participants were allocated to three groups using block randomization. In the first intervention group, both the women and their husbands, and in the second intervention group only the women received the lifestyle-based education. In the control group, women received only routine care. Participants completed the Edinburgh Postnatal Depression Scale and Spielberger State-Trait Anxiety Inventory pre-intervention and 6 weeks after childbirth. When compared with the control group, significant reductions in PPD (adjusted difference: -5.5), state anxiety (-13.6) and trait anxiety (-12.6) scores were observed in the lifestyle education-dyad group, and also significant reductions in PPD (-3.2), state anxiety (-5.8) and trait anxiety (-4.9) scores were observed in the lifestyle education-women only group. Also, significant reductions were observed in PPD (-2.2), state anxiety (-7.8) and trait anxiety (-7.7) scores in the lifestyle education-dyad group compared with the lifestyle education-women only group. Results showed the positive effect of lifestyle training on PPD and PPA, especially if the training is given to the parental dyad.

Comparing the impact of educational behavioral interventions on maternal sleep between face-to-face and electronic training groups, during the postpartum period

INTRODUCTION

The postpartum period is a transition to a critical stage. Moreover, the rapid changes experienced after delivery, expose the mother to unpleasant experiences such as changes in sleep patterns. Trying to an appropriate training method is necessary. This study aims to conduct a comparative study between the impact of face-to-face training and e-training on maternal sleep during the postpartum period.

MATERIALS AND METHODS

The present study was empirically conducted on 110 postpartum mothers who visited the selected healthcare centers of Isfahan in 2015. Mothers randomly divided into three groups (face to face, electronic and control). Data collection tools included demographic and fertility questionnaire and Pittsburgh Sleep Quality Index. Intervention groups were received training such as mothers with necessary instructions regarding the health approaches, relaxation techniques, sleeping place, and energy-saving techniques. Mothers' quality of sleep was measured and compared before training (until the 10^th day after childbirth) then in the second and third cares (from the 10^th to 30^th day after childbirth) in all three groups. Data were analyzed using descriptive statistics and ANOVA and analyze variance with repeated measures in SPSS (SPSS Inc., Chicago, IL, USA,) version 17.

RESULTS

The results showed there was a significant difference among the sleep quality scores in the three times in the e-training (P < 0.001) and face-to-face groups (P < 0.001) and in the control group (P = 0.01), but the improvement in the sleep quality score has been higher in the two groups; e-training and face-to-face, than in the control group. In addition, the mothers' mean sleep quality score was different between the control group and face-to-face group as well as between the control group and e-training group. While, no statistically significant difference was found between the e-training group and face-to-face group.

CONCLUSION

Training through both methods; face-to-face and electronic, had the same impact on maternal sleep quality during the postpartum period. Therefore, despite the belief that in-person trainings are more effective, the findings of this research showed the effectiveness of electronic methods too, and determined that this method, has the same effectiveness as the face-to-face method has.

An analysis of whether sleep disorder will result in postpartum depression

Postpartum depression has become an important topic of concern in recent years. However, very few studies on the causes of postpartum depression exist, and the effects of prenatal sleep disorders on the development of postpartum depression among pregnant women have not been elucidated. This study aimed to understand the association between prenatal sleep disorders and postpartum depression. The National Health Insurance Research Database of Taiwan (between 2000 and 2010) was used to assess the effects of prenatal sleep disorder on the risk of postpartum depression using Cox regression analyses. Prenatal sleep disorder in pregnant women increased the risk of developing postpartum depression (the risk in the sleep disorder cases was 5.359-fold increased compared with control cases). In addition, regardless of postpartum week (≤ 6 weeks, 6-12 weeks, or > 12weeks), the risk of developing postpartum depression in pregnant women with prenatal sleep disorders were increased, by 5.461-fold (P < 0.001), 3.490-fold (P = 0.010), and 3.416-fold (P = 0.015), respectively, compared with pregnant women without sleep disorders. Pregnant women with prenatal sleep disorders exhibited increased risks of developing postpartum depression. For pregnant women with prenatal sleep disorder, postpartum intervention measures should be provided as early as possible to reduce the risk of developing postpartum depression.

The Effect of Life Style Based Education on the Fathers' Anxiety and Depression During Pregnancy and Postpartum Periods: A Randomized Controlled Trial

Due to the harmful effects of prenatal and postnatal anxiety and depression on fathers, the aim of this study was to determine the impact of lifestyle-based training on paternal depression and anxiety (primary outcomes) during the prenatal and postnatal periods. This single-blind randomized controlled clinical trial was conducted on 126 spouses of pregnant women with gestational ages of 24-28 weeks. They were followed up until 6 weeks after childbirth. Using the block randomization method and stratified based on the number of children, the eligible samples were divided into two groups (one receiving two weekly group lifestyle-based training session (lasting 60-90 min) and a control group). Edinburgh Postnatal Depression Scale and Spielberger's State-Trait Anxiety Inventory were filled out by the participants before the intervention, 8 weeks after it, and 6 weeks after childbirth. The general linear model was used to analyze data. Out of 126 fathers, one individual from the intervention group left the study because he was not willing to cooperate. Compared with the control group, there was a significant decrease in depression (adjusted difference: -1.6; 95% CI -2.8 to -0.5), state anxiety (-5.7; -8.6 to -2.9) and trait anxiety (-5.0; -7.8 to -2.2) scores at 8 weeks after intervention as well as postnatal depression (-3.3; -5.0 to -1.5); postnatal state anxiety (-7.5; -11.6 to -3.4), and postnatal trait anxiety (-8.3; -12.2 to -4.4) in the intervention group. The research results indicated the positive impact of training on prenatal and postnatal depression and anxiety in fathers. Given the easy implementation of training interventions during pregnancy, it is suggested that such interventions be paid more attention.

Sleep disturbances and memory impairment among pregnant women consuming khat: An under-recognized problem

Khat (Catha edulis) is a evergreen flowering shrub that is cultivated at high altitudes, especially in East Africa and the southwest of the Arabian Peninsula. The plant contains alkaloids, of which cathinone and cathine have structural similarity and pharmacological action similar to amphetamines. The leaves are, therefore, consumed in some regions as a psychoactive stimulant due to cultural beliefs and misperceptions on the health benefits of khat consumption. This resulted in a growing prevalence of khat consumption among pregnant women. The myriad of physiological changes associated with pregnancy impairs sleep and memory. Moreover, khat has also been shown to have adverse effects on memory and sleep. Therefore, its use during pregnancy may further aggravate those impairments. The purpose of this mini-review is to summarize the changes in sleep and memory during pregnancy and the evidence supporting a relationship between khat consumption and neurocognitive deficits and sleep dysfunctions. The misperceptions of beneficial effects of khat, the high prevalence of consumption among pregnant women, and the possibility of under-reporting of khat abuse do necessitate the development of alternative methodologies to identify cases of unreported khat abuse in pregnant women. It is proposed that screening for sleep problems and memory deficits may help identify under-reported cases of khat abuse in pregnant women.

The association between physical activity and maternal sleep during the postpartum period

Physical activity is associated with improved sleep quality and duration in the general population, but its effect on sleep in postpartum women is unknown. We examined cross-sectional and longitudinal associations between hours/week of self-reported domain-specific and overall moderate to vigorous physical activity (MVPA) and sleep quality and duration at 3- and 12-months postpartum among a cohort of 530 women in the Pregnancy, Infection, and Nutrition Postpartum Study. MVPA was not associated with sleep quality or duration at 3-months postpartum. At 12-months postpartum, a 1 h/week increase in recreational MVPA was associated with higher odds of good (vs. poor) sleep quality (odds ratio, OR 1.14; 95 % confidence interval, CI, 1.03-1.27) and a 1 h/week increase in child/adult care MVPA was associated with lower odds of good (vs. poor) sleep quality (OR = 0.93; 95 % CI 0.88-0.99). A 1 h/week increase in child/adult care MVPA (OR 1.08, 95 % CI 1.00-1.16) was associated with higher odds of long sleep duration and 1 h/week increases in indoor household (OR 1.09, 95 % CI 1.01-1.18) and overall MVPA (OR 1.04, 95 % CI 1.01-1.07) were associated with higher odds of short (vs. normal) sleep duration. Comparing 3-months postpartum to 12-months postpartum, increased work MVPA was associated with good sleep quality (OR 2.40, 95 % CI 1.12-5.15) and increased indoor household MVPA was associated with short sleep duration (OR 1.85, 95 % CI 1.05-3.27) as measured at 12-months postpartum. Selected domains of MVPA and their longitudinal increases were associated with sleep quality and duration at 12-months postpartum. Additional research is needed to elucidate whether physical activity can improve postpartum sleep.

Sleep Quality, Fatigue, and Postpartum Depression of Mother at Six Months after Delivery

PURPOSE

This study was correlation study to identify the factors influencing sleep quality, fatigue, and postnatal depression in mothers who have given birth during the past 6 months.

METHODS

The study was conducted using a survey with questionnaires to 329 mothers who visited E University Medical Center, or three local clinics located in D city, between August and October 2013. Collected data were analyzed using the SPSS/WIN 20.0 program.

RESULTS

Out of 329 subjects, 18.2% showed that they had mild postnatal depression whereas 24.3% had severe postnatal depression. Accordingly, 42.5% reported having postnatal depression. Postnatal depression had a significant correlation with sleep hours after childbirth (r=-.16, p=.003), spousal support (r=-.28, p<.001), sleep quality (r=-.35, p<.001), physical fatigue (r=.66, p<.001), psychological fatigue (r=.69, p<.001), and neurosensory fatigue (r=.56, p<.001). Factors influencing postnatal depression include psychological fatigue, sleep quality, number of child births, and neurosensory fatigue, and these accounted for 53% of postnatal depression.

CONCLUSION

Results indicate that factors influencing postnatal depression involve psychological fatigue, sleep quality, number of child births, and neurosensory fatigue. Therefore for nursing intervention for postpartum mothers, it is necessary to assess the level of depression, fatigue, and sleep quality, and to provide interventions to relieve depression.

Sleep duration, vital exhaustion, and odds of spontaneous preterm birth: a case-control study

BACKGROUND

Preterm birth is a leading cause of perinatal morbidity and mortality worldwide, resulting in a pressing need to identify risk factors leading to effective interventions. Limited evidence suggests potential relationships between maternal sleep or vital exhaustion and preterm birth, yet the literature is generally inconclusive.

METHODS

We examined the relationship between maternal sleep duration and vital exhaustion in the first six months of pregnancy and spontaneous (non-medically indicated) preterm birth among 479 Peruvian women who delivered a preterm singleton infant (<37 weeks gestation) and 480 term controls who delivered a singleton infant at term (≥37 weeks gestation). Maternal nightly sleep and reports of vital exhaustion were ascertained through in-person interviews. Spontaneous preterm birth cases were further categorized as those following either spontaneous preterm labor or preterm premature rupture of membranes. In addition, cases were categorized as very (<32 weeks), moderate (32-33 weeks), and late (34- <37 weeks) preterm birth for additional analyses. Logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).

RESULTS

After adjusting for confounders, we found that short sleep duration (≤6 hours) was significantly associated with preterm birth (aOR = 1.56; 95% CI 1.11-2.19) compared to 7-8 hours of sleep. Vital exhaustion was also associated with increased odds of preterm birth (aOR = 2.41; 95% CI 1.79-3.23) compared to no exhaustion (Ptrend <0.001). These associations remained significant for spontaneous preterm labor and preterm premature rupture of membranes. We also found evidence of joint effects of sleep duration and vital exhaustion on the odds of spontaneous preterm birth.

CONCLUSIONS

The results of this case-control study suggest maternal sleep duration, particularly short sleep duration, and vital exhaustion may be risk factors for spontaneous preterm birth. These findings call for increased clinical attention to maternal sleep and the study of potential intervention strategies to improve sleep in early pregnancy with the aim of decreasing risk of preterm birth.