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Kautz A, Meng Y, Yeh KL, Peck R, Brunner J, Best M, Fernandez ID, Miller RK, Barrett ES, Groth SW, O'Connor TG. Dietary Intake of Nutrients Involved in Serotonin and Melatonin Synthesis and Prenatal Maternal Sleep Quality and Affective Symptoms. J Nutr Metab 2024; 2024:6611169. [PMID: 39015539 PMCID: PMC11250910 DOI: 10.1155/2024/6611169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 03/15/2024] [Accepted: 06/11/2024] [Indexed: 07/18/2024] Open
Abstract
Poor sleep quality and psychological distress in pregnancy are important health concerns. Serotonin and melatonin levels may underlie variation in these adverse outcomes. In this study, we examined dietary nutrients involved in serotonin and melatonin synthesis in relation to maternal sleep quality and affective symptoms during pregnancy. Pregnant women at no greater than normal medical risk at enrollment completed 24-hour dietary recalls in mid-late pregnancy. Usual intakes of vitamin B6, vitamin D, eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA), and tryptophan were estimated from dietary intake of foods and supplements using the National Cancer Institute (NCI) method. Sleep quality, depression, and anxiety were measured using validated questionnaires. Associations between nutrient intakes, sleep quality, and affective symptoms were estimated using generalized estimating equation models adjusting for potential confounding factors. In minimally adjusted models, EPA + DHA and tryptophan intakes were associated with a lower score indicating better sleep quality (b: -1.07, 95% CI: -2.09, -0.05) and (b: -12.40, 95% CI: -24.60, -0.21), respectively. EPA + DHA and tryptophan intakes were also associated with a lower odds of shorter sleep duration and sleep disturbances. In addition, tryptophan was associated with a lower odds of higher sleep latency. However, associations were attenuated and nonsignificant after adjustment for demographic and lifestyle factors. In conclusion, intakes of EPA + DHA and tryptophan were associated with improved sleep quality, but these associations were confounded by maternal demographic and lifestyle characteristics. This study highlights the need to consider dietary intake and pregnancy health in the context of demographic characteristics and lifestyle behaviors.
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Affiliation(s)
- Amber Kautz
- Public Health SciencesUniversity of Rochester Medical Center, Rochester, NY, USA
| | - Ying Meng
- School of NursingUniversity of Rochester Medical Center, Rochester, NY, USA
| | - Kuan-Lin Yeh
- School of NursingUniversity of Rochester Medical Center, Rochester, NY, USA
| | - Robin Peck
- Clinical Research CenterUniversity of Rochester Medical Center, Rochester, NY, USA
| | - Jessica Brunner
- School of NursingUniversity of Rochester Medical Center, Rochester, NY, USA
- Obstetrics and GynecologyUniversity of Rochester Medical Center, Rochester, NY, USA
- PsychiatryUniversity of Rochester Medical Center, Rochester, NY, USA
| | - Meghan Best
- Obstetrics and GynecologyUniversity of Rochester Medical Center, Rochester, NY, USA
| | - I. Diana Fernandez
- Public Health SciencesUniversity of Rochester Medical Center, Rochester, NY, USA
| | - Richard K. Miller
- Obstetrics and GynecologyUniversity of Rochester Medical Center, Rochester, NY, USA
- PediatricsUniversity of Rochester Medical Center, Rochester, NY, USA
- Pathology and Clinical Laboratory MedicineUniversity of Rochester Medical Center, Rochester, NY, USA
- Environmental MedicineUniversity of Rochester Medical Center, Rochester, NY, USA
| | - Emily S. Barrett
- Public Health SciencesUniversity of Rochester Medical Center, Rochester, NY, USA
- Obstetrics and GynecologyUniversity of Rochester Medical Center, Rochester, NY, USA
- Biostatistics and EpidemiologyRutgers School of Public Health, Piscataway, NJ, USA
- Environmental and Occupational Health Sciences InstituteRutgers University, Piscataway, NJ, USA
| | - Susan W. Groth
- School of NursingUniversity of Rochester Medical Center, Rochester, NY, USA
| | - Thomas G. O'Connor
- Obstetrics and GynecologyUniversity of Rochester Medical Center, Rochester, NY, USA
- PsychiatryUniversity of Rochester Medical Center, Rochester, NY, USA
- NeuroscienceUniversity of Rochester Medical Center, Rochester, NY, USA
- PsychologyUniversity of Rochester, Rochester, NY, USA
- Wynne Center for Family ResearchUniversity of Rochester Medical Center, Rochester, NY, USA
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Felder JN, Mirchandaney R, Manber R, Cuneo J, Krystal A, Solomon N, Janette S, Zhang L, Moran P, Mashash M, Epel E, Hecht FM. Feasibility and Acceptability of Mindfulness-based Stress Reduction and Prenatal Sleep Classes for Poor Prenatal Sleep Quality: Pilot Randomized Controlled Trial. Behav Sleep Med 2024:1-15. [PMID: 38850019 DOI: 10.1080/15402002.2024.2359415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
OBJECTIVES The main objectives of the current paper were to examine the feasibility, acceptability, and adherence of a remotely delivered intervention consisting of mindfulness-based stress reduction plus prenatal sleep classes (MBSR+PS) compared with treatment as usual (TAU). METHOD In this pilot randomized controlled trial, 52 pregnant women with poor sleep quality were randomized to MBSR+PS or TAU. MBSR was delivered through eight weekly 2.5-hour sessions, and PS was delivered through eight weekly 30-minute sessions. PS content drew material from cognitive behavioral therapy for insomnia tailored for the perinatal period and from a mindfulness- and acceptance-based lens. Participants completed endpoint measures 10-12 weeks after randomization. RESULTS We surpassed all acceptability targets, including the percentage of eligible participants willing to be randomized (96%), percentage of participants who initiated treatment (88%), and satisfaction scores (Client Satisfaction Questionnaire-8 score M = 28.04, SD = 3.6). We surpassed all feasibility targets, including our enrollment target, retention rate (92%), and measure completion (96%). Finally, we surpassed adherence targets, including MBSR and PS session attendance (≥80%). Though sleep outcomes were exploratory, increases in sleep efficiency were greater in the MBSR+PS group relative to TAU (SMD=.68). CONCLUSIONS Patient-reported poor sleep quality during pregnancy has high public health significance because it is common, consequential, and under-treated. The current feasibility and acceptability data for using remotely delivered MBSR and PS to improve prenatal sleep quality are encouraging and warranting future research that is sufficiently powered and designed to provide efficacy data. In addition, exploratory sleep outcomes offer preliminary evidence that this sleep program may improve sleep efficiency during pregnancy.
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Affiliation(s)
- J N Felder
- Department of Psychiatry and Behavioral Sciences, UCSF, San Francisco, California, USA
- Osher Center for Integrative Health, University of California UCSF, San Francisco, California, USA
| | - R Mirchandaney
- Department of Psychiatry and Behavioral Sciences, UCSF, San Francisco, California, USA
- Osher Center for Integrative Health, University of California UCSF, San Francisco, California, USA
| | - R Manber
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California, USA
| | - J Cuneo
- Osher Center for Integrative Health, University of California UCSF, San Francisco, California, USA
- Department of Obstetrics, Gynecology, & Reproductive Sciences, UCSF, San Francisco, California, USA
| | - A Krystal
- Department of Psychiatry and Behavioral Sciences, UCSF, San Francisco, California, USA
| | - N Solomon
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California, USA
| | - S Janette
- Center for Health and Community, UCSF, San Francisco, California, USA
| | - L Zhang
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, California, USA
| | - P Moran
- Osher Center for Integrative Health, University of California UCSF, San Francisco, California, USA
| | - M Mashash
- Osher Center for Integrative Health, University of California UCSF, San Francisco, California, USA
| | - E Epel
- Department of Psychiatry and Behavioral Sciences, UCSF, San Francisco, California, USA
- Center for Health and Community, UCSF, San Francisco, California, USA
| | - F M Hecht
- Osher Center for Integrative Health, University of California UCSF, San Francisco, California, USA
- Division of General Internal Medicine, Department of Medicine, UCSF, San Francisco, California, USA
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Fischer AR, Doudell KR, Cundiff JM, Green SRM, Lavender CA, Gunn HE. Maternal Sleep Health, Social Support, and Distress: A Mixed-Methods Analysis of Mothers of Infants and Young Children in Rural US. Behav Sleep Med 2024:1-24. [PMID: 38600856 DOI: 10.1080/15402002.2024.2339818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
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.
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Affiliation(s)
| | - Kelly R Doudell
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Jenny M Cundiff
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | | | - Catherine A Lavender
- College of Community Health Sciences, University of Alabama, Tuscaloosa, AL, USA
| | - Heather E Gunn
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
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Bahani M, Zhang Y, Guo Y, Haretebieke S, Wu D, Zhang L. Influencing factors of sleep quality in pregnant: a structural equation model approach. BMC Psychol 2024; 12:171. [PMID: 38528622 DOI: 10.1186/s40359-024-01657-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/11/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND To describe the changes in the level of sleep quality during pregnancy among pregnant women in Urumqi; also to construct a structural equation model of the factors influencing the sleep quality of pregnant women, to analyze the path relationship between the influencing factors, and to take reasonable interventions to prevent and reduce the occurrence of sleep disorders among pregnant women. METHODS 986 pregnant women who gave birth in Urumqi Maternal and Child Health Hospital and Urumqi Youai Hospital between August 2021 and May 2023 were selected. The Pittsburgh Sleep Quality Index (PSQI), Self-Rating Anxiety Scale (SAS), and Edinburgh Postpartum Depression Scale (EPDS) were used to assess the sleep, anxiety, and depression of pregnant women, Building a structural equation model based on AMOS 23.0 Tools. RESULTS The results of structural equation modeling showed that: basic characteristics, obstetrical characteristics, tocolysis, lifestyle, psychological had a direct effect on the PSQI, with path coefficients of 0.243, 0.106, 0.140, 0.174, 0.658, the corresponding T-values for each path are 4.585, 2.677, 2.578, 2.297, and 9.036. The indirect effect of basic characteristics, obstetric characteristics and lifestyle on PSQI was 0.123, 0.020, 0.027. CONCLUSIONS The high incidence of sleep disorders in pregnant women and their close association with psychological symptoms in pregnant women should focus on screening and counseling regarding psychological disorders in pregnant women, thus improving the quality of sleep in pregnant women.
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Affiliation(s)
- Mailiman Bahani
- College of Public Health, Xinjiang Medical University, Urumqi, China
| | - Yuxia Zhang
- Department of Clinical Nutrition, Urumqi Maternal and Child Health Institute, Urumqi, China
| | - Yufeng Guo
- College of Public Health, Xinjiang Medical University, Urumqi, China
| | | | - Di Wu
- College of Public Health, Xinjiang Medical University, Urumqi, China
| | - Liping Zhang
- College of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, China.
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Witkowska-Zimny M, Zhyvotovska A, Isakov R, Boiko DI, Nieradko-Iwanicka B. Maternal Sleeping Problems Before and After Childbirth - A Systematic Review. Int J Womens Health 2024; 16:345-371. [PMID: 38455339 PMCID: PMC10918694 DOI: 10.2147/ijwh.s446490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/22/2024] [Indexed: 03/09/2024] Open
Abstract
The perinatal and postpartum period is of great significance for women due to physiological changes, shifts in circadian rhythms, social setting, and psychological well-being, all of which affect the quality and quantity of their sleep. A mixed-studies systematic review was undertaken to enhance our understanding of sleep disturbances and mood disorders in women in late pregnancy and the postpartum period, their connection with breastfeeding, and the assessment of interventions for sleep disturbance. Three electronic databases (PUBMED, EMBASE and Google Scholar) were searched for qualitative, observational, and mixed-method studies from the year 2016 to June 2023. Twenty-nine articles were included in the analysis. The results were synthesized into four overarching themes: (і) the sleep quality of women in the perinatal period; (ii) the relationship between sleep and breastfeeding; (iii) the relationship between sleep quality and emotional disturbance in the perinatal period; (iv) sleep interventions in the researched group. The subjective nature of the perception of sleep disturbances, along with the absence of an objective measurement tool is clearly an inconvenience. It is advisable to include the assessment of maternal sleep hygiene and family sleep patterns during postpartum healthcare provider appointments to develop strategies not only for women's sleep quality but also for their mental well-being.
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Affiliation(s)
| | - Anastasiia Zhyvotovska
- Department of Psychiatry, Narcology and Medical Psychology, Poltava State Medical University, Poltava, Ukraine
| | - Rustam Isakov
- Department of Psychiatry, Narcology and Medical Psychology, Poltava State Medical University, Poltava, Ukraine
| | - Dmytro I Boiko
- Department of Psychiatry, Narcology and Medical Psychology, Poltava State Medical University, Poltava, Ukraine
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Zhu J, Zheng T, Jin H, Wei M, Yu J, Ni J, Sun K, Zhang J. Sleep Disturbances in Early Gestation and the Risks of Hypertensive Disorders of Pregnancy: A Prospective Cohort Study. Am J Epidemiol 2024; 193:479-488. [PMID: 37968336 DOI: 10.1093/aje/kwad223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/31/2023] [Accepted: 11/14/2023] [Indexed: 11/17/2023] Open
Abstract
Maternal poor sleep quality may increase blood pressure during pregnancy, but sound evidence is still limited and inconsistent. To evaluate whether sleep disturbances in early gestation are risk factors for the development of hypertensive disorders of pregnancy, we conducted the Early Life Plan Project from June 2016 to December 2019. Maternal sleep patterns were assessed at 12-16 weeks of gestation by using the Pittsburgh Sleep Quality Index questionnaire. For gestational hypertension and preeclampsia, we estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) using multinomial logistic regression models adjusting for potential confounders. Among 5,532 eligible women, we observed that maternal blood pressure in early gestation was significantly higher in women with low sleep efficiency (≤85%), long sleep duration (≥9 hours/night), and snoring. Compared with nonsnorers, snoring in early gestation was independently associated with preeclampsia (OR = 1.72 (95% CI: 1.09, 2.73) for snoring once or twice per week; OR = 2.06 (95% CI: 1.01, 4.31) for snoring 3 or more times per week), particularly for term preeclampsia (OR = 1.79 (95% CI: 1.08, 2.95) and 2.26 (95% CI: 1.03, 4.95), respectively). Results suggest that snoring in early gestation may be a significant risk factor for preeclampsia, with a dose-response pattern.
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Manconi M, van der Gaag LC, Mangili F, Garbazza C, Riccardi S, Cajochen C, Mondini S, Furia F, Zambrelli E, Baiardi S, Giordano A, Rizzo N, Fonti C, Viora E, D'Agostino A, Cicolin A, Cirignotta F, Aquilino D, Barassi A, Del Giudice R, Fior G, Gambini O, Giordano B, Martini A, Serrati C, Stefanelli R, Scarone S, Canevini M, Fanti V, Stein HC, Marconi AM, Raimondo E, Viglietta E, Santoro R, Simonazzi G, Bianconcini A, Meani F, Piazza N, Filippakos F, Gyr T. Sleep and sleep disorders during pregnancy and postpartum: The Life-ON study. Sleep Med 2024; 113:41-48. [PMID: 37984016 DOI: 10.1016/j.sleep.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE to prospectively assess sleep and sleep disorders during pregnancy and postpartum in a large cohort of women. METHODS multicenter prospective Life-ON study, recruiting consecutive pregnant women at a gestational age between 10 and 15 weeks, from the local gynecological departments. The study included home polysomnography performed between the 23rd and 25th week of pregnancy and sleep-related questionnaires at 9 points in time during pregnancy and 6 months postpartum. RESULTS 439 pregnant women (mean age 33.7 ± 4.2 yrs) were enrolled. Poor quality of sleep was reported by 34% of women in the first trimester of pregnancy, by 46% of women in the third trimester, and by as many as 71% of women in the first month after delivery. A similar trend was seen for insomnia. Excessive daytime sleepiness peaked in the first trimester (30% of women), and decreased in the third trimester, to 22% of women. Prevalence of restless legs syndrome was 25%, with a peak in the third trimester of pregnancy. Polysomnographic data, available for 353 women, revealed that 24% of women slept less than 6 h, and 30.6% of women had a sleep efficiency below 80%. Sleep-disordered breathing (RDI≥5) had a prevalence of 4.2% and correlated positively with BMI. CONCLUSIONS The Life-ON study provides the largest polysomnographic dataset coupled with longitudinal subjective assessments of sleep quality in pregnant women to date. Sleep disorders are highly frequent and distributed differently during pregnancy and postpartum. Routine assessment of sleep disturbances in the perinatal period is necessary to improve early detection and clinical management.
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Affiliation(s)
- Mauro Manconi
- Sleep Medicine Unit, Neurocenter of the Southern Switzerland, EOC, Regional Hospital of Lugano, Switzerland; Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland; Department of Neurology, University of Bern, Bern, Switzerland.
| | - Linda C van der Gaag
- Istituto Dalle Molle di Studi Sull'Intelligenza Artificiale (IDSIA), USI-SUPSI, Lugano, Switzerland
| | - Francesca Mangili
- Istituto Dalle Molle di Studi Sull'Intelligenza Artificiale (IDSIA), USI-SUPSI, Lugano, Switzerland
| | - Corrado Garbazza
- Sleep Medicine Unit, Neurocenter of the Southern Switzerland, EOC, Regional Hospital of Lugano, Switzerland; Centre for Chronobiology, Psychiatric Hospital of the University of Basel, 4002, Basel, Switzerland
| | - Silvia Riccardi
- Sleep Medicine Unit, Neurocenter of the Southern Switzerland, EOC, Regional Hospital of Lugano, Switzerland
| | - Christian Cajochen
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, 4002, Basel, Switzerland
| | - Susanna Mondini
- UOC NEUROMET IRCCS Institute of Neurological Sciences Bologna, Italy
| | - Francesca Furia
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Elena Zambrelli
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Simone Baiardi
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy; IRCCS - Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Alessandra Giordano
- Sleep Medicine Center, AOU Città Della Salute e Della Scienza, Dipartimento di Neuroscienze "Rita Levi Montalcini", Torino, Italy
| | - Nicola Rizzo
- Division of Obstetrics and Prenatal Medicine, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Cristina Fonti
- IRCCS - Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Elsa Viora
- Prenatal Ecography Unit, AOU Città Della Salute e Della Scienza, Dipartimento di Ostetricia e Ginecologia, Torino, Italy
| | - Armando D'Agostino
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy; Department of Health Sciences, Università Degli Studi di Milano, Italy
| | - Alessandro Cicolin
- Sleep Medicine Center, AOU Città Della Salute e Della Scienza, Dipartimento di Neuroscienze "Rita Levi Montalcini", Torino, Italy
| | | | - Daniele Aquilino
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Alessandra Barassi
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Renata Del Giudice
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Giulia Fior
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Orsola Gambini
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Barbara Giordano
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Alma Martini
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Chiara Serrati
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Rossana Stefanelli
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Silvio Scarone
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Mariapaola Canevini
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy; Department of Health Sciences, Università Degli Studi di Milano, Italy
| | - Valentina Fanti
- Department of Health Sciences, Università Degli Studi di Milano, Italy
| | | | - Anna Maria Marconi
- Department of Health Sciences, Università Degli Studi di Milano, Italy; Department of Obstetrics and Gynecology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Erica Raimondo
- Sleep Medicine Center, AOU Città Della Salute e Della Scienza, Dipartimento di Neuroscienze "Rita Levi Montalcini", Torino, Italy
| | - Emanuela Viglietta
- Sleep Medicine Center, AOU Città Della Salute e Della Scienza, Dipartimento di Neuroscienze "Rita Levi Montalcini", Torino, Italy
| | - Rossella Santoro
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC Clinical Neurologica NeuroMet, Ospedale S. Orsola-Malpighi, Via Albertoni 15, 40138, Bologna, Italy
| | - Giuliana Simonazzi
- Ostetricia e Medicina Dell'Età Prenatale, Ospedale S. Orsola-Malpighi, Via Massarenti 13, 40138, Bologna, Italy
| | - Alessandra Bianconcini
- Ostetricia e Medicina Dell'Età Prenatale, Ospedale S. Orsola-Malpighi, Via Massarenti 13, 40138, Bologna, Italy
| | - Francesco Meani
- Centro di Senologia Della Svizzera Italiana, Ente Ospedaliero Cantonale, EOC, CH, Switzerland
| | - Nicoletta Piazza
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliero Cantonale, EOC, CH, Switzerland
| | - Filippos Filippakos
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliero Cantonale, EOC, CH, Switzerland
| | - Thomas Gyr
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliero Cantonale, EOC, CH, Switzerland
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Koutra K, Margetaki K, Kampouri M, Kyriklaki A, Roumeliotaki T, Vafeiadi M, Bitsios P, Kogevinas M, Chatzi L. Maternal sleep disturbances during late pregnancy and child neuropsychological and behavioral development in early childhood. Eur Child Adolesc Psychiatry 2023; 32:2139-2150. [PMID: 35927528 DOI: 10.1007/s00787-022-02053-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 07/16/2022] [Indexed: 11/25/2022]
Abstract
The present study aims to explore the association of maternal sleep disturbances during late pregnancy on child neuropsychological and behavioral development in preschool years. The study included 638 mother-child pairs from the prospective Rhea mother-child cohort in Crete, Greece. Information on antenatal sleep disturbances was collected through a computer-assisted interview. Children's neuropsychological and behavioral development was assessed using the McCarthy Scales of Children's Abilities (MSCA), the Attention-Deficit Hyperactivity Disorder Test (ADHDT), and the Strengths and Difficulties Questionnaire (SDQ). Multivariate analysis showed that maternal sleep duration less than 8 h was associated with reduced scores in the general cognitive scale (β = -2.28, 95% CI -4.54, -0.02, R2 = 0.417) and memory span (β = -3.24, 95% CI -5.72, -0.77, R2 = 0.304), while mild-severe daytime sleepiness was associated with reduced scores in the memory scale (β = -5.42, 95% CI -10.47, -0.37, R2 = 0.304), memory span (β = -5.44, 95% CI -10.68, -0.21, R2 = 0.304), nd functions of posterior cortex (β = -5.55, 95% CI -10.40, -0.70, R2 = 0.393) of MSCA. Snoring in late pregnancy was related to higher child hyperactivity scores in SDQ (β = 1.05, 95% CI 0.16, 1.95, R2 = 0.160). An interaction between child sex and maternal sleep duration in response to ADHD symptoms was also found (p for interaction < 0.05). Stratified analysis revealed increased hyperactivity, inattention, and ADHD total scores for girls of mothers with sleep duration less than 8 h. Maternal sleep disturbances during pregnancy may be associated with impaired child neuropsychological and behavioral development during the preschool years. Early detection and intervention is necessary to reduce sleep disturbances habits in pregnancy and improve child neurodevelopment.
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Affiliation(s)
- Katerina Koutra
- Department of Psychology, School of Social Sciences, University of Crete, Gallos Campus Crete, 74100, Rethymno, Greece.
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
| | - Katerina Margetaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
- Department of Preventive Medicine, Division of Environmental Health, University of Southern California, Los Angeles, CA, USA
| | - Mariza Kampouri
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Andriani Kyriklaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Theano Roumeliotaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Marina Vafeiadi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Panos Bitsios
- Department of Psychiatry and Behavioral Sciences, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Manolis Kogevinas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- ISGlobal, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Leda Chatzi
- Department of Preventive Medicine, Division of Environmental Health, University of Southern California, Los Angeles, CA, USA
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Lin-Lewry M, Tzeng YL, Li CC, Lee GT, Lee PH, Chen SR, Kuo SY. Trajectories of sleep quality and depressive symptoms in women from pregnancy to 3 months postpartum: a prospective cohort study. J Sleep Res 2023; 32:e13918. [PMID: 37128654 DOI: 10.1111/jsr.13918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 03/16/2023] [Accepted: 04/14/2023] [Indexed: 05/03/2023]
Abstract
Sleep quality and depression during pregnancy often affect women's adaptation to motherhood and are linked with adverse maternal and neonatal outcomes. Using a prospective cohort study comprising 190 pregnant women in central Taiwan, we investigated the trajectories of sleep quality and depressive symptoms and their associated predictors in perinatal women from pregnancy to postpartum. Sleep and depressive symptoms were assessed using the Pittsburgh Sleep Quality Index and the Edinburgh Postnatal Depression Scale, respectively, from mid-pregnancy to 3 months postpartum. We used group-based trajectory modelling and logistic regression modelling to analyse the data collected from the structured questionnaires. Pregnant women (50.5% primipara) with a mean (standard deviation) age of 32.3 (4.1) years were included. We identified three distinctive classes of sleep quality trajectories during the perinatal period: 'stable good' (18.4%), 'increasing poor' (48.9%), and 'stable poor' (32.6%). We further detected three stable trajectories of depressive symptoms: 'stable low' (36.3%), 'stable mild' (42.1%), and 'stable high' (21.6%). A significant association between sleep quality and depression trajectories was evident (p < 0.001). High fatigue symptoms and low social support predicted the high trajectories of poor sleep and depressive symptoms. Distinctive dynamic sleep quality and stable depression trajectories were characterised. Our findings revealed that both the sleep and depression trajectories were closely associated with one another, with common predictors of fatigue symptoms and social support. The early assessment of maternal sleep and depression status is important for identifying at-risk women and initiating interventions tailored to perinatal women to improve their sleep and mental health.
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Affiliation(s)
- Marianne Lin-Lewry
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Ya-Ling Tzeng
- School of Nursing, College of Health Care, China Medical University, Taichung, Taiwan
| | - Chieh-Chen Li
- School of Nursing, College of Health Care, China Medical University, Taichung, Taiwan
| | - Gabrielle T Lee
- Applied Psychology, Faculty of Education, Western University, London, Ontario, Canada
| | - Pi-Hsia Lee
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Su-Ru Chen
- School of Nursing, School of Post-Baccalaureate Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Shu-Yu Kuo
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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10
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Okun ML, Lac A. Postpartum Insomnia and Poor Sleep Quality Are Longitudinally Predictive of Postpartum Mood Symptoms. Psychosom Med 2023; 85:736-743. [PMID: 37506301 DOI: 10.1097/psy.0000000000001234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
OBJECTIVE Insomnia and poor sleep quality are frequently reported by perinatal women. Both are noted to increase the risk of postpartum depression, with less known about their association with postpartum anxiety. This study sought to assess whether perinatal sleep disturbances predicted depression and anxiety symptoms across each month of the first 6 months postpartum in women with a history of depression. METHODS Pregnant women without active depression at enrollment ( N = 159), 18 to 45 years of age, were recruited. In late pregnancy and for up to 6 months postpartum, women completed monthly online questionnaires including the Insomnia Symptom Questionnaire, Pittsburgh Sleep Quality Index, Edinburgh Postnatal Depression Scale, and Generalized Anxiety Disorder-7. Repeated-measures multilevel models were used to predict depression and anxiety across the postpartum. RESULTS The prevalence of insomnia was 20.4%, and the prevalence of poor sleep quality was 67.8% across the first 6 months postpartum. Postpartum insomnia and poor sleep quality at the between-subject and within-subject levels tended to uniquely predict greater depressive and anxiety symptoms, even after controlling for demographic characteristics, prenatal insomnia, and prenatal poor sleep quality. CONCLUSIONS Most of the women in our sample had sleep disturbances across the perinatal period. Consistent with the extant literature, postpartum insomnia and poor sleep quality, but not prenatal measures of sleep, longitudinally predicted greater postpartum depression and anxiety symptoms. The chronic sleep deprivation of insomnia and the subjective experience of poor sleep quality are uniquely relevant risks of postpartum mood disorders. Evaluation and mitigation of perinatal sleep disturbance are ideal opportunities to reduce postpartum mood disorders and subsequent health outcomes.
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Affiliation(s)
- Michele L Okun
- From the Biofrontiers Center (Okun) and Department of Psychology (Lac), University of Colorado Colorado Springs, Colorado Springs, Colorado
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11
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Li N, Wang H, Song Q, Su W, Guo X, Liang Q, Ding X, Liu H, Liang M, Zhang J, Sun L, Qin Q, Chen M, Qu G, Sun Y. Association between sleep change patterns and mental health among preschoolers: The mediating role of resilience. J Psychiatr Res 2023; 165:336-343. [PMID: 37579680 DOI: 10.1016/j.jpsychires.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 05/25/2023] [Accepted: 08/08/2023] [Indexed: 08/16/2023]
Abstract
Sleep disturbance has been recognized as an important factor influencing mental health problems in preschool children. However, no longitudinal studies have investigated the association between sleep change patterns and mental health in preschoolers or the mediating role of resilience. Here, data were collected from 1595 preschool children in 26 kindergartens in four counties in Anhui Province, China, who were followed up (T2) 1 year apart based on baseline surveys (T1). The primary caregivers of the children were asked to complete a structured questionnaire through face-to-face interviews or by completing it themselves. Pearson's correlation and linear regression were used to analyze the relationships among sleep patterns, mental health, and resilience in preschoolers. A structural equation model was used for the mediation analysis. Four patterns of sleep change were identified: persistent-low pattern (1.7%), decreasing pattern (9.8%), increasing pattern (7.3%), and persistent-high pattern (81.3%). Compared to the persistent-low pattern, the increasing pattern and persistent-high pattern were associated with emotional behavioral problems (EBPs) and anxiety. Resilience played a fully mediating role in the relationship between increasing pattern, persistent-high pattern, and EBPs. Resilience partially mediated the effects of increasing and persistent-high pattern on anxiety. More attention should be paid to sleep problems in children with increasing and persistent-high sleep patterns. Resilience is important for understanding the mechanism underlying the correlation between sleep patterns, EBPs, and anxiety. Considering the EBPs and anxiety of preschool children, early intervention for resilience should be considered.
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Affiliation(s)
- Ning Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China; Department of Psychiatry, Xijing Hosptial, the fourth military medical university, Xi'an, 710032, China
| | - Hao Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Qiuxia Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Wanying Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Xianwei Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Qiwei Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China; Children's Hospital of Anhui Medical University, No. 39 Wangjiang Road, Hefei, 230051, Anhui, China
| | - Xiuxiu Ding
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China; Center for Scientific Research and Experiment, the Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei, 230601, Anhui, China
| | - Haixia Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Mingming Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Jian Zhang
- Children's Hospital of Anhui Medical University, No. 39 Wangjiang Road, Hefei, 230051, Anhui, China
| | - Liang Sun
- Fuyang Center for Disease Control and Prevention, No.19, Zhongnan Avenue, Fuyang, 236069, Anhui, China
| | - Qirong Qin
- Ma'anshan Center for Disease Control and Prevention, No.849, Jiangdong Avenue, Ma'anshan, 243011, Anhui, China
| | - Mingchun Chen
- Changfeng County Center for Disease Control and Prevention, Hefei, 231199, Anhui, China
| | - Guangbo Qu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China; Center for Evidence-Based Practice, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
| | - Yehuan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China; Center for Evidence-Based Practice, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China; Chaohu Hospital, Anhui Medical University, No. 64 Chaohubei Road, Hefei, 238000, Anhui, China.
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12
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Zhou X, Hong X, Huang K, Ding X, Yu H, Zhao J, Xuan Y, Yan T, Wang B. Poor sleep quality in early pregnancy increases the risk of developing gestational diabetes mellitus: a propensity score matching analysis. Sleep Breath 2023; 27:1557-1565. [PMID: 36414784 PMCID: PMC9684785 DOI: 10.1007/s11325-022-02748-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/14/2022] [Accepted: 11/14/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to demonstrate the relationship between poor sleep quality in early pregnancy and the risk of developing gestational diabetes mellitus (GDM). METHODS We conducted a nested case-control study and performed a 1:3 propensity score (PS) matching to match pregnant women with GDM to women without GDM. After PS matching, logistic regressions were carried out to describe the association between sleep quality (assessed by Pittsburgh Sleep Quality Index [PSQI]) and the risk of GDM. We also performed a second analysis to explore the association in groups divided according to maternal age. RESULTS A total of 535 women were enrolled in this study. Of 456 women with complete data, the incidence of GDM was 12.1% (55/456). After PS matching, we found poor sleep quality (PSQI > 5) in early pregnancy was a statistically significant risk factor for GDM (OR 2.03; 95% CI 1.02-4.01; p-value = 0.043). The association of poor sleep quality (PSQI > 5) with GDM was significant among women less than 35 years old (OR 2.72; 95% CI 1.22-6.43; p-value = 0.018) but not among women more than or equal to 35 years old after adjusting for all covariates. CONCLUSION Poor sleep quality in early pregnancy is associated with higher risk of developing GDM, especially for women under 35 years old. Screening expectant mothers with sleep problems in the first trimester is suggested.
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Affiliation(s)
- Xu Zhou
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Xiang Hong
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Kaiping Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Xiaoling Ding
- Maternal and Child Health Center of Gulou District, Nanjing, China
| | - Hong Yu
- Department of Obstetrics and Gynecology, Medical School, Southeast University, Nanjing, China
- Department of Obstetrics and Gynecology, Zhong Da Hospital, Southeast University, Nanjing, China
| | - Jun Zhao
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Yan Xuan
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Tao Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Bei Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China.
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HAWKINS M, FEGHALI M, ABEBE KZ, SCIFRES CM, LALAMA CM, COSTACOU T, CATALANO P, SIMHAN H, ORRIS S, MENDEZ D, BUYSSE DJ, DAVIS EM. Mid-pregnancy sleep disturbances are not associated with mid-pregnancy maternal glycemia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.21.23288767. [PMID: 37163085 PMCID: PMC10168493 DOI: 10.1101/2023.04.21.23288767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background In pregnancy, epidemiological data have consistently shown strong associations between sleep quality and duration and maternal glycemia. However, other sleep disturbances such as difficulty falling asleep and staying asleep are common in pregnancy. They may contribute to impaired maternal glycemia through sympathetic nervous system activity, systemic inflammation, and hormonal pathways. However, there is little research examining associations between these specific sleep disturbances and maternal glycemia. Objective This study aimed to investigate the associations of sleep disturbances during mid-pregnancy and mid-pregnancy maternal glycemia and gestational diabetes subtypes. Study Design This is a secondary data analysis of the Comparison of Two Screening Strategies for Gestational Diabetes trial. Participants (n = 828) self-reported the frequency of sleep disturbances (i.e., trouble falling asleep, trouble staying asleep, waking several times per night, and waking feeling tired or worn out) in mid-pregnancy. Gestational diabetes was diagnosed using either the International Associations of Diabetes and Pregnancy Study Groups or Carpenter-Coustan approach. We defined gestational diabetes subtypes based on the degree of insulin resistance and beta-cell dysfunction. We used multinomial logistic regression to examine associations of sleep disturbances with gestational diabetes status (i.e., normal, mild glycemic dysfunction, and gestational diabetes) and gestational diabetes subtypes (i.e., neither insulin resistance or beta-cell dysfunction, insulin resistance only, beta-cell dysfunction only, and insulin resistance and beta-cell dysfunction). Results A total of 665 participants (80%) had normal glycemia, 81 (10%) mild hyperglycemia, and 80 (10%) had gestational diabetes. Among participants with gestational diabetes, 62 (78%) had both insulin resistance and beta-cell dysfunction, 15 (19 %) had insulin resistance only, and 3 had beta-cell dysfunction only or neither insulin resistance nor beta-cell dysfunction. Sleep disturbance frequency was not associated with maternal glycemia or gestational diabetes subtypes. Conclusions Sleep disturbances in mid-pregnancy were not associated with maternal glycemia during mid-pregnancy. Future research should collect data on sleep disturbances at multiple time points in pregnancy and in combination with other sleep disturbances to determine whether sleep plays any role in maternal glycemic control.
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Affiliation(s)
- Marquis HAWKINS
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, PA
| | - Maisa FEGHALI
- University of Pittsburgh, Department of Obstetrics, Gynecology & Reproductive Sciences, Pittsburgh, PA
| | - Kaleab Z ABEBE
- University of Pittsburgh, Department of Medicine, Pittsburgh, PA
| | - Christina M. SCIFRES
- Indiana University School of Medicine, Department of Obstetrics and Gynecology, Indianapolis, IN
| | | | - Tina COSTACOU
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, PA
| | - Patrick CATALANO
- Tufts University School of Medicine, Department of Obstetrics and Gynecology, Boston, MA
| | - Hyagriv SIMHAN
- University of Pittsburgh, Department of Obstetrics, Gynecology & Reproductive Sciences, Pittsburgh, PA
| | - Steve ORRIS
- University of Pittsburgh, Department of Medicine, Pittsburgh, PA
| | - Dara MENDEZ
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, PA
| | - Daniel J. BUYSSE
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA
| | - Esa M DAVIS
- University of Pittsburgh, Department of Medicine, Pittsburgh, PA
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14
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Fu T, Wang C, Yan J, Zeng Q, Ma C. Relationship between antenatal sleep quality and depression in perinatal women: A comprehensive meta-analysis of observational studies. J Affect Disord 2023; 327:38-45. [PMID: 36739002 DOI: 10.1016/j.jad.2023.01.125] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Perinatal depression is a global mental health problem. Studies have suggested that perinatal depression is related to poor sleep quality during pregnancy. However, evidence on the influence and mechanism of sleep quality on the risk of developing perinatal depression remains limited and inconclusive. METHODS A systematic review was conducted in PubMed, Web of Science, Embase, CINAHI and Cochrane Library for relevant original quantitative studies published in English. A hand search of the reference list of relevant studies was also performed. Meta-analysis was performed using RevMan software and a random-effects model. Potential heterogeneity source was explored by subgroup and sensitivity analyses, and potential publication bias was tested using funnel plots and Begg's test. RESULTS A total of ten studies involving 39,574 participants were included in our meta-analysis. Overall, women who experienced poor sleep quality during pregnancy were at a significantly higher risk of developing depression, with antenatal depression 3.72 times higher, postpartum depression 2.71 times higher, and perinatal depression 3.46 times higher, compared to those did not experience poor sleep quality. LIMITATIONS Different measuring tools and unobserved confounding factors may make some bias in our result. What's more, not all included studies were initially designed to assess the association between antenatal sleep quality and the risk of developing perinatal depression. CONCLUSION Our meta-analysis found that antenatal sleep quality was negatively associated with the risk for perinatal depression. Our findings highlight the importance of improving sleep quality during pregnancy for mental health among perinatal women.
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Affiliation(s)
- Tingting Fu
- The Third Xiangya Hospital of Central South University, Department of Nursing, Changsha, Hunan, China
| | - Chunyu Wang
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Jin Yan
- Xiangya Nursing School, Central South University, Changsha, Hunan, China; The Third Xiangya Hospital of Central South University, Department of Nursing, Changsha, Hunan, China.
| | - Qiya Zeng
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Chenjuan Ma
- Rory Meyers College of Nursing, New York University, New York, USA
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15
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Peltonen H, Paavonen EJ, Saarenpää-Heikkilä O, Vahlberg T, Paunio T, Polo-Kantola P. Sleep disturbances and depressive and anxiety symptoms during pregnancy: associations with delivery and newborn health. Arch Gynecol Obstet 2023; 307:715-728. [PMID: 35461389 PMCID: PMC9984335 DOI: 10.1007/s00404-022-06560-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 04/01/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Sleep disturbances and mood symptoms are common in late pregnancy; according to the literature, they can affect delivery and newborn outcomes. This study evaluated the effect of sleep and mood symptoms on delivery and newborn health, because there are insufficient and partly contradictory studies on the topic. METHODS A cohort of 1414 mothers in their third trimester was enrolled in this prospective cross-sectional questionnaire study. Validated questionnaires were assessed for the measurement of sleep disturbances and depressive and anxiety symptoms. The data on delivery and newborn outcomes were obtained from hospital medical records. RESULTS Sleep disturbances were very common. A higher insomnia score (β = - 0.06, p = 0.047) and longer sleep need (β = 0.07, p = 0.047) were related to delivery at a lower gestational age. In addition, a higher insomnia score (β = - 28.30, p = 0.010) and lower general sleep quality (β = - 62.15, p = 0.025) were associated with lower birth weight, but longer sleep duration and longer sleep need with a higher birth weight (β = 28.06, p = 0.019; β = 27.61, p = 0.028, respectively). However, the findings regarding birth weight lost their significance when the birth weight was standardized by gestational weeks. Concerning Apgar scores and umbilical artery pH, no associations were found. Snoring was associated with a shorter duration of the first phase of delivery (β = - 78.71, p = 0.015) and total duration of delivery (β = - 79.85, p = 0.016). Mothers with higher insomnia, depressive, or anxiety symptoms were more often treated with oxytocin (OR 1.54 95% CI 1.00-2.38, p = 0.049, OR 1.76, 95% CI 1.02-3.04, p = 0.049 and OR 1.91, CI 95% 1.28-2.84, p < 0.001, respectively) and those with higher depressive and anxiety symptoms were delivered more often with elective cesarean section (OR 4.67, 95% CI 2.04-12.68, p < 0.001 and OR 2.22, 95% CI 1.03-4.79, p = 0.042). CONCLUSIONS Maternal sleep disturbances and mood symptoms during pregnancy are associated with delivery and newborn health. However, nearly, all the outcomes fell within a normal range, implying that the actual risks are low.
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Affiliation(s)
- Hilla Peltonen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland.
| | - E Juulia Paavonen
- Pediatric Research Center, Child Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Outi Saarenpää-Heikkilä
- Centre for Child Health Research, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Tero Vahlberg
- Department of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland
| | - Tiina Paunio
- Department of Psychiatry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland.,Sleep Research Unit, University of Turku, Turku, Finland
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16
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Association between sleep disorders during pregnancy and risk of postpartum depression: a systematic review and meta-analysis. Arch Womens Ment Health 2023; 26:259-267. [PMID: 36738337 DOI: 10.1007/s00737-023-01295-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
Sleep disorders are common among pregnant females. However, its association with postpartum depression (PPD) is unknown. We aimed to assess if sleep disorders during pregnancy increase the risk of PPD by a systematic review. The databases of PubMed, CENTRAL, ScienceDirect, Embase, and Google Scholar were searched for studies reporting the association between any type of sleep disorder during pregnancy and the risk of PPD. Effect sizes were pooled in a random-effects model. Sixteen studies with data of 12,614 women were included. Meta-analysis indicated that sleep disorders during pregnancy resulted in a statistically significant increased risk of PPD (OR: 2.36 95% CI: 1.72, 2.32). The overall result had high heterogeneity (I2 = 84%). Sub-group analysis based on study location (Asian vs Western), sample size (> 500 vs < 500), depression scale, and PPD assessment time did not change the results. However, we found that only poor sleep quality but not insomnia was associated with PPD. The risk was also increased only with sleep disorders measured in the 3rd trimester but not for the 1st and 2nd trimesters. Evidence suggests that sleep disorders during pregnancy may increase risk of PPD. The risk is high for sleep disorders occurring in the 3rd trimester. Based on these findings, there is a need for thorough screening and subsequent corrective measures to ensure adequate and quality sleep among pregnant females.
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Felder JN, Baer RJ, Rand L, Ryckman KK, Jelliffe-Pawlowski L, Prather AA. Adverse infant outcomes among women with sleep apnea or insomnia during pregnancy: A retrospective cohort study. Sleep Health 2023; 9:26-32. [PMID: 36371381 PMCID: PMC10881279 DOI: 10.1016/j.sleh.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 08/01/2022] [Accepted: 09/26/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate whether sleep apnea or insomnia among pregnant people is associated with increased risk for adverse infant outcomes. DESIGN Retrospective cohort study SETTING: California PARTICIPANTS: The sample included singleton live births. Sleep apnea and insomnia were defined based on ICD-9 and -10 codes. A referent group was selected using exact propensity score matching on maternal characteristics, obstetric factors, and infant factors among individuals without a sleep disorder. MEASUREMENTS Adverse infant outcomes were obtained from birth certificate, hospital discharge, and death records (eg, Apgar scores, neonatal intensive care unit (NICU) stay, infant death, long birth stay, etc.). Logistic regression was used to calculate odds of an adverse infant outcome by sleep disorder type. RESULTS Propensity-score matched controls were identified for 69.9% of the 3371 sleep apnea cases and 68.8% of the 3213 insomnia cases. Compared to the propensity-matched referent group, individuals with a diagnosis of sleep apnea (n = 2357) had infants who were more likely to have any adverse outcome, low 1-min Apgar scores, NICU stay, and an emergency room visit in the first year of life. Infants born to mothers with a diagnosis of insomnia (n = 2212) were at increased risk of few negative outcomes relative to the propensity matched referent group, with the exception of an emergency room visit. CONCLUSIONS In unadjusted analyses, infants born to individuals with a diagnosis of sleep apnea or insomnia were at increased risk of several adverse outcomes. These were attenuated when using propensity score matching, suggesting these associations were driven by other comorbidities.
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Affiliation(s)
- Jennifer N Felder
- Osher Center for Integrative Health, University of California, San Francisco, San Francisco, California, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Rebecca J Baer
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA; UCSF California Preterm Birth Initiative, University of California, San Francisco, San Francisco, California, USA; Department of Pediatrics, University of California, San Diego, San Diego, California, USA
| | - Larry Rand
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA; UCSF California Preterm Birth Initiative, University of California, San Francisco, San Francisco, California, USA
| | - Kelli K Ryckman
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Laura Jelliffe-Pawlowski
- UCSF California Preterm Birth Initiative, University of California, San Francisco, San Francisco, California, USA; Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Aric A Prather
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA; Center for Health and Community, University of California, San Francisco, San Francisco, California, USA
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18
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Song Z, Zhou Y, Zheng Y, Huang W, Meng Z, Li H, Jiang R, Teng Y, Tao M. Factors influencing functional near-infrared spectroscopy in postpartum depression: A cross-sectional study. Int J Gynaecol Obstet 2023; 161:1046-1052. [PMID: 36609765 DOI: 10.1002/ijgo.14663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/09/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To explore whether functional near-infrared spectroscopy (fNIRS) can aid in the early detection and diagnosis of postpartum depression. METHODS The study was a cross-sectional survey that invited all women who sought postpartum health examination 42 days after childbirth between August 2020 and January 2021. Personal information, Edinburgh Postnatal Depression Scale (EPDS), and well as fNIRS results were collected. RESULTS In all, 109 individuals agreed to participate and completed the examination in its entirety. The variance in integral and centroid values was not statistically significant across different subgroups of depression (P > 0.05). The difference in diagnosis of postpartum major depression between EPDS and fNIRS was statistically significant (P < 0.001). fNIRS results in postpartum depression diagnosis were substantially associated with gestational diabetes mellitus (P = 0.027), the number of pregnancies (P = 0.001), and postpartum body mass index (P = 0.035). CONCLUSION fNIRS can provide an objective method for early detection and diagnosis of postpartum depression. Certain clinical conditions can have an effect on brain activity, which may result in postpartum depression. Additional high-quality study is required to establish strong evidence on the subject.
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Affiliation(s)
- Zicheng Song
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yang Zhou
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yuanyi Zheng
- Department of Ultrasound, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wenjun Huang
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zheying Meng
- Department of Ultrasound, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Huiying Li
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Rongzhen Jiang
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yincheng Teng
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Minfang Tao
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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19
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Felder JN, Roubinov D, Zhang L, Gray M, Beck A. Endorsement of a single-item measure of sleep disturbance during pregnancy and risk for postpartum depression: a retrospective cohort study. Arch Womens Ment Health 2023; 26:67-74. [PMID: 36633715 PMCID: PMC9908713 DOI: 10.1007/s00737-022-01287-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/26/2022] [Indexed: 01/13/2023]
Abstract
Poor prenatal sleep quality is associated with increased risk for depressive symptoms but may go undetected in brief, busy prenatal care visits. Among non-depressed pregnant participants, we evaluated whether 1) the endorsement of sleep disturbance on a depression questionnaire predicted postpartum depressive symptoms, 2) the strength of these associations was higher than other somatic symptoms of pregnancy and depression (i.e., fatigue, appetite disturbance), and 3) the endorsement of prenatal sleep disturbance varied by participant characteristics. In this retrospective cohort study, participants had a live birth and completed Patient Health Questionnaire (PHQ-9) during pregnancy and within 8 weeks postpartum between 2012 and 2017. Participants who were non-depressed during pregnancy (PHQ-9 < 10) were included (n = 3619). We operationalized sleep disturbance, fatigue, and appetite disturbance as endorsement of item 3, 4, and 5 on the PHQ-9, respectively, and postpartum depressive symptoms as PHQ-9 total score ≥ 10. Participant characteristic variables included age, race, ethnicity, parity, gestational age at delivery, and preterm birth. Prenatal sleep disturbance was associated with higher odds of postpartum depressive symptoms (aORs 1.9, 95% CI 1.2-3.1 for first trimester; 3.7, 95% CI 1.5-11.5 for second trimester; 3.4, 95% CI 1.9-6.8 for third trimester). Fatigue and appetite disturbance in the first and third trimesters were associated with higher odds of postpartum depressive symptoms. Sleep disturbance varied by race during the first and second trimesters (p < 0.05) and was highest among Black or African American participants (61.8-65.1%). A routinely administered single-item measure of sleep disturbance could identify otherwise lower-risk pregnant individuals who may benefit from depression prevention efforts.
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Affiliation(s)
- Jennifer N. Felder
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA USA ,Osher Center for Integrative Health, University of California, San Francisco, CA USA
| | - Danielle Roubinov
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA USA
| | - Li Zhang
- Department of Medicine, University of California, San Francisco, CA USA ,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA USA
| | - Mark Gray
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO USA
| | - Arne Beck
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO USA
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20
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Wang C, Hou J, Li A, Kong W. Trajectory of Perinatal Depressive Symptoms from the Second Trimester to Three Months Postpartum and Its Association with Sleep Quality. Int J Womens Health 2023; 15:711-723. [PMID: 37193223 PMCID: PMC10182768 DOI: 10.2147/ijwh.s408347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023] Open
Abstract
Purpose Few studies have explored the association between sleep quality and depressive symptoms in perinatal women from the second trimester to the postpartum period. This study aims to explore this relationship using a longitudinal design. Patients and Methods Participants were enrolled at 15 gestational weeks. Demographic information was collected. Perinatal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS). Sleep quality was measured employing the Pittsburgh Sleep Quality Index (PSQI) at five timepoints from enrollment to three months postpartum. Overall, 1416 women completed the questionnaires at least thrice. A Latent Growth Curve (LGC) model was performed to identify the relationship between the trajectories of perinatal depressive symptoms and sleep quality. Results Of the participants, 23.7% screened positive at least once on the EPDS. The perinatal depressive symptoms trajectory, fitted by the LGC model, decreased at early pregnancy and increased from 15 gestational weeks to three months postpartum. The intercept of sleep trajectory positively affected the intercept of perinatal depressive symptoms' trajectory; the slope of sleep trajectory positively affected both the slope and the quadratic coefficient of perinatal depressive symptoms' trajectory. Conclusion The trajectory of perinatal depressive symptoms increased from 15 gestational weeks to three months postpartum following a quadratic trend. Poor sleep quality was associated with depression symptoms beginning at the onset of pregnancy. Moreover, rapidly declining sleep quality could be a significant risk factor for perinatal depression (PND). These findings call for greater attention to perinatal women who report poor and persistently deteriorating sleep quality. Additional sleep-quality evaluations, depression assessments, and referrals to mental health care providers may benefit these women and support PND prevention, screening, and early diagnosis.
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Affiliation(s)
- Chen Wang
- Department of Perinatal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, People’s Republic of China
| | - Jinqin Hou
- Department of Special Education and Psychology, China National Academy of Educational Sciences, Beijing, People’s Republic of China
| | - Anning Li
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Weimin Kong
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, People’s Republic of China
- Correspondence: Weimin Kong, Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No. 251, Yaojiayuan Road, Chaoyang District, Beijing, People’s Republic of China, Tel +8618611942798, Email
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21
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Cohen MF, Corwin EJ, Johnson DA, Amore AD, Brown AL, Barbee NR, Brennan PA, Dunlop AL. Discrimination is associated with poor sleep quality in pregnant Black American women. Sleep Med 2022; 100:39-48. [PMID: 36007430 PMCID: PMC9709719 DOI: 10.1016/j.sleep.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Heightened exposure to racial/ethnic discrimination is associated with poorer sleep health among non-pregnant adults. This relationship has received limited research attention among pregnant women, despite the importance of prenatal sleep quality for optimal maternal and child health outcomes. METHODS We utilized perinatal data from a sample of Black American women (n = 600) participating in a cohort study who reported their lifetime experiences of racial/ethnic discrimination and gendered racial stress during early pregnancy and reported on their sleep quality and depressive symptoms during early and mid-pregnancy. Hierarchical multiple linear regression models were fit to examine associations between lifetime experiences of racial/ethnic discrimination or gendered racial stress and sleep quality during early and mid-pregnancy. We also adjusted for women's concurrent depressive symptoms and tested whether the discrimination/sleep quality association varied by socioeconomic status. RESULTS Greater exposure to racial/ethnic discrimination was associated with poorer sleep quality during early (ΔR2 = 0.04, ΔF = 26.08, p < 0.001) and mid-pregnancy (ΔR2 = 0.02, ΔF = 9.88, p = 0.002). Similarly, greater gendered racial stress was associated with poorer sleep quality during early (ΔR2 = 0.10, ΔF = 65.72, p < 0.001) and mid-pregnancy (ΔR2 = 0.06, ΔF = 40.43, p < 0.001. These findings largely held after adjustment for concurrent prenatal depressive symptoms. Socioeconomic status did not modify the observed relationships. CONCLUSIONS Efforts to decrease institutional and interpersonal experiences of racial/ethnic discrimination and gendered racism would benefit the sleep quality of pregnant Black American women, particularly during early pregnancy.
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Affiliation(s)
| | | | - Dayna A Johnson
- Emory University Department of Epidemiology, Rollins School of Public Health, United States
| | - Alexis Dunn Amore
- Emory University Nell Hodgson Woodruff School of Nursing, United States
| | - April L Brown
- Emory University Department of Psychology, United States
| | - Nia R Barbee
- Emory University Department of Psychology, United States
| | | | - Anne L Dunlop
- Emory University School of Medicine Department of Gynecology and Obstetrics, United States
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22
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Nevarez-Brewster M, Aran Ö, Narayan AJ, Harrall KK, Brown SM, Hankin BL, Davis EP. Adverse and Benevolent Childhood Experiences Predict Prenatal Sleep Quality. ADVERSITY AND RESILIENCE SCIENCE 2022; 3:391-402. [PMID: 36968335 PMCID: PMC10035559 DOI: 10.1007/s42844-022-00070-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 11/28/2022]
Abstract
The objective of the study was to investigate whether adverse and benevolent childhood experiences were associated with trajectories of sleep quality throughout pregnancy. The study was conducted at obstetrics and gynecology clinics in the Rocky Mountain region of the USA. The participants of the study were pregnant individuals (N = 164). Sleep quality was measured with the Pittsburgh Sleep Quality Index at three gestational time points, and adverse childhood experiences (ACEs) and benevolent childhood experiences (BCEs) were assessed once. Multilevel models were conducted to examine the trajectory of sleep quality across gestation in relation to ACEs and BCEs. Sleep quality was similar in early to mid-pregnancy, with a worsening of sleep quality late in pregnancy, following a quadratic trajectory. Higher levels of ACEs predicted poorer prenatal sleep quality (b = 0.36, SE = 0.13, p = .004) throughout pregnancy, while higher levels of BCEs predicted better sleep quality (b = -0.60, SE = 0.17, p < .001) throughout pregnancy. Examination of ACEs subtypes revealed that childhood maltreatment predicted poor sleep quality (b = 0.66, SE = 0.18, p < .001), while childhood household dysfunction was not significantly associated (b = 0.33, SE = 0.21, p = .11). Associations remained after covarying for socioeconomic status and current stressful life events. Both adverse and benevolent childhood experiences predict sleep health during pregnancy. Prevention and intervention strategies targeting resilience and sleep quality during pregnancy should be implemented to promote prenatal health and well-being.
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Affiliation(s)
| | - Özlü Aran
- Department of Psychology, University of Denver, 2155 S Race St, Denver, CO 80208, USA
| | - Angela J. Narayan
- Department of Psychology, University of Denver, 2155 S Race St, Denver, CO 80208, USA
| | - Kylie K. Harrall
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, Aurora, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, USA
| | | | - Benjamin L. Hankin
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, USA
| | - Elysia Poggi Davis
- Department of Psychology, University of Denver, 2155 S Race St, Denver, CO 80208, USA
- Department of Pediatrics, University of California, Irvine, Irvine, USA
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23
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Tracy EL, Berg CA, Butner JE, de Grey RGK, Allen NA, Porter ME, Helgeson VS. Relationship satisfaction moderates links between poor sleep quality and psychological distress among couples coping with type 1 diabetes. Sleep Health 2022; 8:705-713. [PMID: 36307319 DOI: 10.1016/j.sleh.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/04/2022] [Accepted: 09/07/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES We examined links between sleep quality and psychological distress among couples dealing with type 1 diabetes (T1D) across cross-sectional and daily diary methods and investigated whether relationship satisfaction moderated these associations. METHODS 199 persons with T1D and their spouses completed survey questionnaires reporting their own sleep quality, depressive symptoms, and relationship satisfaction. They also completed 14-day diaries reporting their own sleep quality and negative affect. Multi-level actor-partner interdependence models examined associations between sleep quality and psychological distress. RESULTS Cross-sectional and daily diary data revealed an association between poorer sleep quality and higher psychological distress for both persons with T1D and their spouses (ie, actor effects). Some partner effects were found. For example, poorer sleep quality of persons with T1D was associated with greater negative affect for spouses (within persons). Relationship satisfaction moderated the effects of sleep quality on psychological distress. For example, participants' poorer overall daily sleep quality was associated with greater negative affect for those with lower relationship satisfaction but not for those with higher relationship satisfaction (ie, actor effects). In contrast, partners' poorer overall daily sleep quality was associated with participants' greater negative affect for those with higher relationship satisfaction but not for those with lower relationship satisfaction (ie, partner-effects). CONCLUSION Links between sleep quality and psychological distress occur both within and between persons. Relationship satisfaction moderates the effect of poorer sleep quality on psychological distress in a nuanced way.
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Affiliation(s)
- Eunjin Lee Tracy
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
| | - Cynthia A Berg
- University of Utah, Department of Psychology, Salt Lake City, Utah, USA
| | - Jonathan E Butner
- University of Utah, Department of Psychology, Salt Lake City, Utah, USA
| | | | - Nancy A Allen
- University of Utah, College of Nursing, Salt Lake City, Utah, USA
| | - Margot E Porter
- University of Utah, School of Medicine, Salt Lake City, Utah, USA
| | - Vicki S Helgeson
- Carnegie Mellon University, Department of Psychology, Pittsburgh, Pennsylvania, USA
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24
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Nevarez-Brewster M, Demers CH, Mejia A, Haase MH, Bagonis MM, Kim SH, Gilmore JH, Hoffman MC, Styner MA, Hankin BL, Davis EP. Longitudinal and prospective assessment of prenatal maternal sleep quality and associations with newborn hippocampal and amygdala volume. Dev Cogn Neurosci 2022; 58:101174. [PMID: 36375383 PMCID: PMC9661438 DOI: 10.1016/j.dcn.2022.101174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/12/2022] [Accepted: 11/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rapid maturation of the fetal brain renders the fetus susceptible to prenatal environmental signals. Prenatal maternal sleep quality is known to have important health implications for newborns including risk for preterm birth, however, the effect on the fetal brain is poorly understood. METHOD Participants included 94 pregnant participants and their newborns (53% female). Pregnant participants (Mage = 30; SDage= 5.29) reported on sleep quality three times throughout pregnancy. Newborn hippocampal and amygdala volumes were assessed using structural magnetic resonance imaging. Multilevel modeling was used to test the associations between trajectories of prenatal maternal sleep quality and newborn hippocampal and amygdala volume. RESULTS The overall trajectory of prenatal maternal sleep quality was associated with hippocampal volume (left: b = 0.00003, p = 0.013; right: b = 0.00003, p = .008). Follow up analyses assessing timing of exposure indicate that poor sleep quality early in pregnancy was associated with larger hippocampal volume bilaterally (e.g., late gestation left: b = 0.002, p = 0.24; right: b = 0.004, p = .11). Prenatal sleep quality was not associated with amygdala volume. CONCLUSION These findings highlight the implications of poor prenatal maternal sleep quality and its role in contributing to newborn hippocampal development.
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Affiliation(s)
| | - Catherine H Demers
- University of Denver, Department of Psychology, United States; University of Colorado Anschutz Medical Campus, Department of Psychiatry, United States
| | - Alexandra Mejia
- University of Denver, Department of Psychology, United States
| | | | - Maria M Bagonis
- University of North Carolina - Chapel Hill, Department of Psychiatry, United States
| | - Sun Hyung Kim
- University of North Carolina - Chapel Hill, Department of Psychiatry, United States
| | - John H Gilmore
- University of North Carolina - Chapel Hill, Department of Psychiatry, United States
| | - M Camille Hoffman
- University of Colorado Anschutz Medical Campus, Department of Psychiatry, United States; University of Colorado Denver School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, United States
| | - Martin A Styner
- University of North Carolina - Chapel Hill, Department of Psychiatry, United States; University of North Carolina - Chapel Hill, Department of Computer Science, United States
| | - Benjamin L Hankin
- University of Illinois at Urbana-Champaign, Department of Psychology, United States
| | - Elysia Poggi Davis
- University of Denver, Department of Psychology, United States; University of California, Irvine, Department of Pediatrics, United States
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25
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Lucchini M, O’Brien LM, Kahn LG, Brennan PA, Glazer Baron K, Knapp EA, Lugo-Candelas C, Shuffrey L, Dunietz GL, Zhu Y, Wright RJ, Wright RO, Duarte C, Karagas MR, Ngai P, O’Connor TG, Herbstman JB, Dioni S, Singh AM, Alcantara C, Fifer WP, Elliott AJ. Racial/ethnic disparities in subjective sleep duration, sleep quality, and sleep disturbances during pregnancy: an ECHO study. Sleep 2022; 45:zsac075. [PMID: 35724979 PMCID: PMC9453625 DOI: 10.1093/sleep/zsac075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/23/2022] [Indexed: 01/10/2023] Open
Abstract
In the United States, racial/ethnic minoritized groups experience worse sleep than non-Hispanic Whites (nHW), but less is known about pregnant people. This is a key consideration since poor sleep during pregnancy is common and associated with increased risk of adverse perinatal outcomes. This study reports the prevalence of subjective sleep measures in a multi-racial/ethnic pregnant population from the Environmental influences on Child Health Outcomes (ECHO) program. Participants' self-reported race and ethnicity were grouped into: nHW, non-Hispanic Black/African American (nHB/AA), Hispanic, non-Hispanic Asian (nHA). Analyses examined trimester-specific (first (T1), second (T2), third (T3)) nocturnal sleep duration, quality, and disturbances (Pittsburgh Sleep Quality Index and ECHO maternal sleep health questionnaire). Linear or multinomial regressions estimated the associations between race/ethnicity and each sleep domain by trimester, controlling for body mass index and age, with nHW as reference group. We repeated analyses within maternal education strata. nHB/AA participants reported shorter sleep duration (T2: β = -0.55 [-0.80,-0.31]; T3: β = -0.65 [-0.99,-0.31]) and more sleep disturbances (T2: β = 1.92 [1.09,2.75]; T3: β = 1.41 [0.09,2.74]). Hispanic participants reported longer sleep duration (T1: β = 0.22 [0.00004,0.44]; T2: β = 0.61 [0.47,0.76]; T3: β = 0.46 [0.22,0.70]), better sleep quality (Reference group: Very good. Fairly good T1: OR = 0.48 [0.32,0.73], T2: OR = 0.36 [0.26,0.48], T3: OR = 0.31 [0.18,0.52]. Fairly bad T1: OR = 0.27 [0.16,0.44], T2: OR = 0.46 [0.31, 0.67], T3: OR = 0.31 [0.17,0.55]), and fewer sleep disturbances (T2: β = -0.5 [-1.0,-0.12]; T3: β = -1.21 [-2.07,-0.35]). Differences persisted within the high-SES subsample. Given the stark racial/ethnic disparities in perinatal outcomes and their associations with sleep health, further research is warranted to investigate the determinants of these disparities.
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Affiliation(s)
- Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Louise M O’Brien
- Division of Sleep Medicine, Department of Neurology, and Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Linda G Kahn
- Departments of Pediatrics and Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Kelly Glazer Baron
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Emily A Knapp
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claudia Lugo-Candelas
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Lauren Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Galit Levi Dunietz
- Division of Sleep Medicine, Department of Neurology, and Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Rosalind J Wright
- Department of Environmental Medicine and Public Health and Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert O Wright
- Department of Environmental Medicine and Public Health and Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cristiane Duarte
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Margaret R Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Pakkay Ngai
- Division of Pediatric Pulmonology, Department of Pediatrics, Hackensack Meridian School of Medicine, Hackensack, NJ, USA
| | - Thomas G O’Connor
- Departments of Psychiatry, Psychology, Neuroscience, and Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
| | - Julie B Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, New York NY, USA
| | - Sean Dioni
- Department of Pediatrics, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Anne Marie Singh
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - William P Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
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26
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Trajectories and Correlates of Anger During the Perinatal Period. J Obstet Gynecol Neonatal Nurs 2022; 51:599-611. [PMID: 35987262 DOI: 10.1016/j.jogn.2022.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVES To investigate trajectories of anger during pregnancy and the early postpartum period; to identify baseline psychosocial predictors of anger trajectory group membership; and to examine correlates of anger trajectory group membership, including symptoms of depression, anxiety, insomnia, and social support, in the postpartum period. DESIGN Longitudinal descriptive design. SETTING We recruited participants from a maternity clinic in Calgary, Alberta, Canada. PARTICIPANTS The sample included a convenience sample of 143 pregnant women who had basic fluency in English, were older than 17 years of age, and were less than 19 weeks gestation with a single fetus at the time of recruitment. METHODS Participants completed online questionnaires at four time points: early, mid-, and late pregnancy and 2 months after birth. We used group-based semiparametric mixture modeling to estimate patterns of anger. We used multinomial logistic regression to explore associations between baseline predictors and trajectory membership. RESULTS We identified four distinct trajectories of anger during pregnancy through 2 months after birth: minimal-stable anger (52.4%), mild-stable anger (27.5%), moderate-stable anger (12.7%), and high-decreasing anger (7.4%). Membership in the moderate-stable group was associated with greater baseline symptoms of depression, anxiety, and insomnia severity scores compared to the minimal-stable anger group. Moderate-stable trajectory group membership was also associated with greater symptoms of anxiety, depression, and insomnia at 2 months after birth. CONCLUSION Higher levels of anger were associated with worse mental health in pregnancy and after childbirth in our participants. Women should be made aware of anger as a possible mood disturbance by clinicians, and researchers should investigate the consequences of anger during the perinatal period.
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27
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Wang Y, Liu H, Zhang C, Li C, Xu JJ, Duan CC, Chen L, Liu ZW, Jin L, Lin XH, Zhang CJ, Zhang HQ, Yu JL, Li T, Dennis CL, Li H, Wu YT. Antepartum sleep quality, mental status, and postpartum depressive symptoms: a mediation analysis. BMC Psychiatry 2022; 22:521. [PMID: 35918689 PMCID: PMC9344627 DOI: 10.1186/s12888-022-04164-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 07/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor sleep quality and maternal mood disturbances are common during pregnancy and may play pivotal roles in the development of postpartum depression. We aim to examine the trajectories of sleep quality and mental health in women from early pregnancy to delivery and explore the mediating effects of sleep quality and mental status on the link between antepartum depressive symptoms and postpartum depressive symptoms. METHODS In an ongoing prospective birth cohort, 1301 women completed questionnaires in the first, second and third trimesters and at 6 weeks postpartum. In each trimester, sleep quality was measured utilizing the Pittsburgh Sleep Quality Index (PSQI), and mental health was assessed with the Center for Epidemiologic Studies Depression Scale (CES-D), the Self-Rating Anxiety Scale (SAS) and the Perceived Stress Scale (PSS). Postpartum depressive symptoms were evaluated by the Edinburgh Postnatal Depression Scale (EPDS). The bootstrap method was used to test the mediation effect. RESULTS The PSQI, CES-D, and SAS scores presented U-shaped curves across the antenatal period while the PSS score followed a descending trend. Antenatal sleep quality, depressive symptoms, anxiety symptoms and perceived stress all predicted depressive symptoms at 6 weeks postpartum. The influence of antepartum depressive symptoms on postpartum depressive symptoms was mediated by antepartum sleep quality and anxiety symptoms, which accounted for 32.14%, 39.25% and 31.25% in the first, second and third trimesters (P = 0.002, P = 0.001, P = 0.001, respectively). CONCLUSIONS Poor sleep quality and anxiety symptoms in pregnancy mediated the relationship between antepartum depressive symptoms and postpartum depressive symptoms. Interventions aimed at detecting and managing sleep quality and elevated anxiety among depressed women in pregnancy warrant further investigation as preventative strategies for postpartum depression.
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Affiliation(s)
- Yu Wang
- grid.16821.3c0000 0004 0368 8293School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910, Hengshan Rd., Shanghai, 200030 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030 China
| | - Han Liu
- grid.16821.3c0000 0004 0368 8293School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910, Hengshan Rd., Shanghai, 200030 China
| | - Chen Zhang
- grid.16821.3c0000 0004 0368 8293School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910, Hengshan Rd., Shanghai, 200030 China ,grid.8547.e0000 0001 0125 2443Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, 200011 China
| | - Cheng Li
- grid.8547.e0000 0001 0125 2443Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, 200011 China
| | - Jing-Jing Xu
- grid.16821.3c0000 0004 0368 8293School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910, Hengshan Rd., Shanghai, 200030 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030 China
| | - Chen-Chi Duan
- grid.16821.3c0000 0004 0368 8293School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910, Hengshan Rd., Shanghai, 200030 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030 China
| | - Lei Chen
- grid.16821.3c0000 0004 0368 8293School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910, Hengshan Rd., Shanghai, 200030 China
| | - Zhi-Wei Liu
- grid.16821.3c0000 0004 0368 8293School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910, Hengshan Rd., Shanghai, 200030 China
| | - Li Jin
- grid.8547.e0000 0001 0125 2443Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, 200011 China
| | - Xian-Hua Lin
- grid.8547.e0000 0001 0125 2443Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, 200011 China
| | - Chen-Jie Zhang
- grid.16821.3c0000 0004 0368 8293School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910, Hengshan Rd., Shanghai, 200030 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030 China
| | - Han-Qiu Zhang
- grid.16821.3c0000 0004 0368 8293School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910, Hengshan Rd., Shanghai, 200030 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030 China
| | - Jia-Le Yu
- grid.16821.3c0000 0004 0368 8293School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910, Hengshan Rd., Shanghai, 200030 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030 China
| | - Tao Li
- grid.16821.3c0000 0004 0368 8293School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910, Hengshan Rd., Shanghai, 200030 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030 China
| | - Cindy-Lee Dennis
- grid.17063.330000 0001 2157 2938Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Hong Li
- School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, 910, Hengshan Rd., Shanghai, 200030, China.
| | - Yan-Ting Wu
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, 200011, China. .,Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences (No. 2019RU056), Shanghai, China.
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Cohen MF, Corwin E, Dunlop AL, Brennan PA. Psychological Distress Prospectively Predicts Later Sleep Quality in a Sample of Black American Postpartum Mothers. Behav Sleep Med 2022; 20:442-459. [PMID: 34120540 PMCID: PMC8665932 DOI: 10.1080/15402002.2021.1932499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: Previous longitudinal studies have demonstrated prospective relationships between maternal sleep quality and subsequent psychological distress in the postpartum period. Despite evidence for prospective relationships between mood and subsequent sleep quality in adult populations, this direction has not been examined in postpartum women. We aimed to test prospective relationships between sleep quality and subsequent psychological distress, as well as the plausible reverse possibility, in a sample of Black American postpartum mothers (n = 146).Participants: Mothers were recruited prenatally from two hospitals in a Southeastern city of the United States. Eligible and interested mothers enrolled in a follow-up study on infant development. Data from the current study were obtained during the follow-up study.Method: Mothers reported on their psychological distress (i.e., anxiety, depression, stress) and sleep quality at 3- and 6-months postpartum. We performed hierarchical linear regressions to explore whether 1) maternal sleep quality at 3-months postpartum would predict maternal psychological distress at 6-months postpartum, after adjustment for mothers' earlier psychological distress, and 2) whether psychological distress at 3-months postpartum would predict maternal sleep quality at 6-months postpartum, after adjustment for mothers' earlier sleep quality.Results: Maternal sleep quality at 3-months postpartum was not a significant predictor of psychological distress at 6-months postpartum. However, maternal psychological distress at 3-months postpartum was a significant predictor of sleep quality at 6-months postpartum.Conclusions: Mothers' psychological distress earlier in the postpartum was a significant predictor of their later sleep quality. Replication is needed in large, prospective studies, with results stratified by race/ethnicity.
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Affiliation(s)
- Madeleine F. Cohen
- Emory University Department of Psychology, 36 Eagle Row, Atlanta, GA 30322, United States of America
| | - Elizabeth Corwin
- Emory University Neil Hodgson Woodruff School of Nursing, 1520 Clifton Road, Atlanta, GA 30322, United States of America
| | - Anne L. Dunlop
- Emory University Neil Hodgson Woodruff School of Nursing, 1520 Clifton Road, Atlanta, GA 30322, United States of America
| | - Patricia A. Brennan
- Emory University Department of Psychology, 36 Eagle Row, Atlanta, GA 30322, United States of America
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Paulino DSM, Borrelli CB, Faria-Schützer DB, Brito LGO, Surita FG. Non-pharmacological Interventions for Improving Sleep Quality During Pregnancy: A Systematic Review and Meta-Analysis. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:776-784. [PMID: 35605963 PMCID: PMC9948122 DOI: 10.1055/s-0042-1746200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate the effect of non-pharmacological interventions to improve sleep quality during pregnancy. DATA SOURCES A search was made in the NCBI/PubMed, ClinicalTrials.gov, Embase, BVS, and Web of Science databases. There were no limitations regarding language, sample size, and type of non-pharmacological intervention. We have included prospective clinical trials between July 2014 and July 2019. SELECTION OF STUDIES This study was registered in the Prospective International Registration of Systematic Reviews (PROSPERO) database was performed. Publication bias was also assessed with funnel plots. the primary outcome was the total score in the Pittsburgh Sleep Quality Index (PSQI) before and after intervention. Risk of bias and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria were used for assessing methodological quality. From the 28 retrieved studies, we have selected 8 for qualitative analysis and 6 for meta-analysis. DATA COLLECTION Two independent reviewers performed the study selection. In the case of disagreement, a third senior reviewer was consulted. The study was initially assessed based on the title, followed by abstract. Lastly, the full text was assessed to be included. DATA SYNTHESIS A significant improvement on the sleep quality (PSQI score) was observed when all interventions were grouped (MD = -3.03, 95%CI -4.15 to -1.92, n = 623, i2 = 84%, p < 0.001). Analysis by subgroup (music listening: MD = -1.96, 95% CI -3.27 to -0.65, n = 207, i2 = 67%, p = 0.003 and other interventions: MD = -3.66, 95% CI -4.93 to -2.40, n = 416, i2 = 80%, p < 0.001) showed an improvement, with high heterogeneity. Risk of bias has shown performance and detection bias for almost studies, and GRADE evidence was very low for all analyzed variables. CONCLUSION Non-pharmacological interventions-listening to music, physical exercise, relaxation exercises, lettuce seed, sleep hygiene, and acupressure-are effective for improving sleep quality during pregnancy.
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Affiliation(s)
| | - Carolina Bicudo Borrelli
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Mitchell AM, Kowalsky JM, Christian LM, Belury MA, Cole RM. Perceived social support predicts self-reported and objective health and health behaviors among pregnant women. J Behav Med 2022; 45:589-602. [PMID: 35449357 DOI: 10.1007/s10865-022-00306-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/07/2022] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- Amanda M Mitchell
- Department of Counseling and Human Development, College of Education and Human Development, University of Louisville, Woodford and Harriett Porter Building, 1905 South 1st Street, Louisville, KY, 40292, USA.
| | | | - Lisa M Christian
- Department of Psychiatry &, Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Martha A Belury
- Department of Human Nutrition, The Ohio State University, Columbus, OH, USA
| | - Rachel M Cole
- Department of Human Nutrition, The Ohio State University, Columbus, OH, USA
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Bao C, Jin D, Sun S, Xu L, Wang C, Tang W, Zhang W, Bao Y, Xu D, Zhou S, Yu X, Zhao K. Trajectories and Depressive Symptoms During the Perinatal Period: A Longitudinal Population-Based Study in China. Front Psychiatry 2022; 13:762719. [PMID: 35432035 PMCID: PMC9009256 DOI: 10.3389/fpsyt.2022.762719] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 02/02/2022] [Indexed: 11/27/2022] Open
Abstract
Most women in the perinatal period face sleep issues, which can affect their mental health. Only a few studies have focused on sleep trajectories and depressive symptoms of women during the perinatal period in China. This study aims to explore the development trajectory of sleep quality by classifying pregnant women according to the changes in their sleep quality during pregnancy and postpartum and investigate the correlation between different sleep quality trajectory groups and depressive symptoms. The Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality, and the Edinburgh Postnatal Depression Scale (EPDS) was used to assess the symptoms of depression. Participants (n = 412) completed the assessment of sleep quality, depressive symptoms, and some sociodemographic and obstetric data at 36 weeks of gestation, 1 week after delivery, and 6 weeks after delivery. The group-based trajectory model (GBTM) was used to complete the trajectory classification, and logistic regression was used to analyze the predictive factors of postpartum depressive symptoms. Four different sleep quality trajectories were determined: "stable-good," "worsening," "improving," and "stable-poor" groups. The results demonstrate that poor sleep trajectories, social support and parenting experience during the perinatal period are related to postpartum depression. Screening for prenatal sleep problems is crucial for identifying the onset of perinatal depressive symptoms.
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Affiliation(s)
- Ciqing Bao
- Wenzhou Seventh People's Hospital, Wenzhou, China
| | - Dongzhen Jin
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Shiyu Sun
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Ling Xu
- Wenzhou Seventh People's Hospital, Wenzhou, China
| | - Chaoyue Wang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Weina Tang
- Shaoxing 7th People's Hospital, Shaoxing, China
| | - Wenmiao Zhang
- Department of Obstetrics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yin Bao
- Department of Obstetrics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dongwu Xu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Siyao Zhou
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Xin Yu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Ke Zhao
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
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Cohen MF, Dunlop AL, Johnson DA, Dunn Amore A, Corwin EJ, Brennan PA. Intergenerational Effects of Discrimination on Black American Children's Sleep Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074021. [PMID: 35409703 PMCID: PMC8997890 DOI: 10.3390/ijerph19074021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/25/2022] [Accepted: 03/26/2022] [Indexed: 01/27/2023]
Abstract
Greater exposure to racial/ethnic discrimination among pregnant Black American women is associated with elevated prenatal depressive symptomatology, poorer prenatal sleep quality, and poorer child health outcomes. Given the transdiagnostic importance of early childhood sleep health, we examined associations between pregnant women's lifetime exposure to racial/ethnic discrimination and their two-year-old children's sleep health. We also examined women's gendered racial stress as a predictor variable. In exploratory analyses, we examined prenatal sleep quality and prenatal depressive symptoms as potential mediators of the prior associations. We utilized data from a sample of Black American women and children (n = 205). Women self-reported their lifetime experiences of discrimination during early pregnancy, their sleep quality and depressive symptoms during mid-pregnancy, and their children's sleep health at age two. Hierarchical linear multiple regression models were fit to examine direct associations between women's experiences of discrimination and children's sleep health. We tested our mediation hypotheses using a parallel mediator model. Higher levels of gendered racial stress, but not racial/ethnic discrimination, were directly associated with poorer sleep health in children. Higher levels of racial/ethnic discrimination were indirectly associated with poorer sleep health in children, via women's prenatal depressive symptomatology, but not prenatal sleep quality. Clinical efforts to mitigate the effects of discrimination on Black American women may benefit women's prenatal mental health and their children's sleep health.
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Affiliation(s)
- Madeleine F. Cohen
- Department of Psychology, Emory University, Atlanta, GA 30322, USA;
- Correspondence:
| | - Anne L. Dunlop
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, GA 30322, USA;
| | - Dayna A. Johnson
- Department of Epidemiology, Emory University, Atlanta, GA 30322, USA;
| | - Alexis Dunn Amore
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA;
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Shaun MMA, Nizum MWR, Shuvo MA, Fayeza F, Faruk MO, Alam MF, Ahmed MS, Zaman S, Mali SK, Hawlader MDH. Association between depressive symptoms and poor sleep quality among pregnant women in Northern Rural Bangladesh: a community-based cross-sectional study. BMC Psychiatry 2022; 22:201. [PMID: 35303810 PMCID: PMC8933943 DOI: 10.1186/s12888-022-03839-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/08/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Adequate good quality of sleep is essential for physical fitness during pregnancy as well as being a depressive symptoms-free mind. However, there is little evidence of the relationship between depressive symptoms and poor sleep quality among pregnant women in Bangladesh. This study aimed to find the association between depressive symptoms and poor sleep quality among pregnant women in northern rural Bangladesh. METHODS A community-based cross-sectional study was carried out from May 2021 to June 2021 among 481 pregnant women tested positive in the pregnancy test of Jaldhaka and Dimla Upazila of Nilphamari district, Rangpur Division. Data were collected with a structured questionnaire including socio-demographic conditions, sleep quality, and depressive symptoms, comprising the Pittsburgh Sleep Quality Index (PSQI) and the Patient Health Questionnaire- 9 (PHQ-9). RESULTS 8.94% of the women had depressive symptoms, whereas 38.88% of the participants were bad sleepers. However, women who had depressive symptoms [Adjusted odds ratio (AOR) = 2.55; 95% CI 1.33-4.9] and educational qualifications above 10 years [AOR = 0.60; 95% CI: 0.39-0.92] were associated with poor sleep quality. CONCLUSIONS A higher percentage of pregnant women had poor sleep quality, whereas depressive symptoms and academic background of the participants were significantly associated with poor sleep quality. Ensuring adequate sleep time and better quality could be helpful to prevent depressive symptoms.
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Affiliation(s)
- Md Mahbubul Alam Shaun
- Department of Biochemistry and Food Analysis, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki 8602, Patuakhali, Bangladesh
| | - Md Wahidur Rahman Nizum
- Department of Public Health, School of Health and Life Sciences, North South University, Dhaka, 1229 Bangladesh
| | - Md Asaduzzaman Shuvo
- Department of Public Health, School of Health and Life Sciences, North South University, Dhaka, 1229 Bangladesh
| | - Fahmida Fayeza
- Department of Biochemistry and Food Analysis, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki 8602, Patuakhali, Bangladesh
| | - Md Omar Faruk
- Department of Biochemistry and Food Analysis, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki 8602, Patuakhali, Bangladesh
| | - Md Fakrul Alam
- Department of Biochemistry and Food Analysis, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki 8602, Patuakhali, Bangladesh
| | - Md Sabbir Ahmed
- Department of Community Health and Hygiene, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki 8602, Patuakhali, Bangladesh
| | - Sanjana Zaman
- Department of Public Health, Daffodil International University (DIU), Dhaka, 1207 Bangladesh
| | - Sujan Kanti Mali
- Department of Biochemistry and Food Analysis, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki 8602, Patuakhali, Bangladesh
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Polo-Kantola P. Sleep disturbances in pregnancy: Why and how should we manage them? Acta Obstet Gynecol Scand 2022; 101:270-272. [PMID: 35238029 DOI: 10.1111/aogs.14325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
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Bright KS, Stuart S, Mcneil DA, Murray L, Kingston DE. Feasibility and Acceptability of Internet-based Interpersonal Psychotherapy for Stress, Anxiety, and Depression in Prenatal Women: Thematic Analysis Abstract (Preprint). JMIR Form Res 2022; 6:e23879. [PMID: 35687403 PMCID: PMC9233251 DOI: 10.2196/23879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/30/2022] [Accepted: 05/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background Prenatal mental health is a global health concern. Despite the far-reaching impact of prenatal mental health issues, many women do not receive the psychological care they require. Women in their childbearing years are frequent users of the internet and smartphone apps. Prenatal women are prime candidates for internet-based support for mental health care. Objective This study aimed to examine the feasibility and acceptability of internet-based interpersonal psychotherapy (IPT) for prenatal women. Methods Semistructured interviews were conducted with women who had received internet-based IPT modules with guided support as a component of a randomized controlled trial evaluating the scale-up implementation of a digital mental health platform (The Healthy Outcomes of Pregnancy and Postpartum Experiences digital platform) for pregnant women. Qualitative thematic analysis was used to explore and describe women’s experiences. Data were analyzed for emerging themes, which were identified and coded. Results A total of 15 prenatal women were interviewed to examine their experiences and views on the feasibility and acceptability of internet-based IPT modules. Participants found the content informative and appreciated the ways in which the digital mental health platform made the IPT modules accessible to users. Participants voiced some differing requirements regarding the depth and the way information was presented and accessed on the digital mental health platform. The important areas for improvement that were identified were acknowledging greater depth and clarity of content, the need for sociability and relationships, and refinement of the digital mental health platform to a smartphone app. Conclusions This study provides useful evidence regarding treatment format and content preferences, which may inform future development. It also provides research data on the feasibility and acceptability of web-based applications for prenatal mental health care. Trial Registration ClinicalTrials.gov NCT01901796; https://clinicaltrials.gov/ct2/show/NCT01901796
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Affiliation(s)
- Katherine S Bright
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Women's Mental Health Clinic, Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
| | - Scott Stuart
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Deborah A Mcneil
- Maternal Newborn Child & Youth Strategic Clinical Network, Alberta Health Services, Calgary, AB, Canada
| | - Lindsay Murray
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Dawn E Kingston
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
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Pre-pregnancy sleep duration and postpartum depression: a multicenter study in Japan. Arch Womens Ment Health 2022; 25:181-189. [PMID: 34255202 DOI: 10.1007/s00737-021-01136-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/19/2021] [Indexed: 10/20/2022]
Abstract
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.
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Green J, Larkey L, Leiferman JA, Buman M, Oh C, Huberty J. Prenatal yoga and excessive gestational weight gain: A review of evidence and potential mechanisms. Complement Ther Clin Pract 2022; 46:101551. [DOI: 10.1016/j.ctcp.2022.101551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/21/2022] [Accepted: 02/07/2022] [Indexed: 11/16/2022]
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Pitsillos T, Wikström AK, Skalkidou A, Derntl B, Hallschmid M, Lutz ND, Ngai E, Sundström Poromaa I, Wikman A. Association Between Objectively Assessed Sleep and Depressive Symptoms During Pregnancy and Post-partum. Front Glob Womens Health 2022; 2:807817. [PMID: 35174357 PMCID: PMC8841694 DOI: 10.3389/fgwh.2021.807817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/24/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction Sleep problems are common in pregnancy but many studies have relied only on self-reported sleep measures. We studied the association between objectively measured sleep and peripartum depressive symptoms in pregnant women. Material and Methods Sleep was assessed using Actiwatch accelerometers in a sample of 163 pregnant women in the late first (weeks 11–15) or early second trimester (weeks 16–19). Depressive symptoms were assessed in gestational weeks 17, 32 and at 6 weeks post-partum using the Edinburgh Postnatal Depression Scale (EPDS). Multiple linear regression and logistic regression analyses, adjusting for age, BMI, pre-pregnancy smoking, ongoing mental health problems, trimester and season of sleep assessment were carried out to test the association between sleep and depression. Sleep was measured by total sleep time and sleep efficiency, whereas depression was indicated by depressive symptoms and depression caseness. Results are presented as unstandardized beta (B) coefficients or adjusted odds ratios (AOR) and 95% confidence intervals (CI). Results Total sleep time ranged from 3 to 9 h (mean 7.1, SD 0.9) and average sleep efficiency was 83% (SD 6.0). Women with the shortest total sleep time, i.e., in the lowest quartile (<6.66 h), reported higher depressive symptoms during pregnancy (week 17, B = 2.13, 95% CI 0.30–3.96; week 32, B = 1.70, 95% CI 0.03–3.37) but not post-partum. Their probability to screen positive for depression in gestational week 17 was increased more than 3-fold (AOR = 3.46, 95% CI 1.07–11.51) but unchanged with regards to gestational week 32 or 6 weeks post-partum. Sleep efficiency was not associated with depressive symptoms at any stage of pregnancy or post-partum. Discussion In one of the few studies to use objective sleep measures to date, mental health of pregnant women appeared to be affected by shortened sleep, with total sleep time being negatively associated with depressive symptoms in the early second and third trimester. This finding highlights the relevance of identifying and treating sleep impairments in pregnant women early during antenatal care to reduce the risk of concomitant depression.
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Affiliation(s)
- Tryfonas Pitsillos
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Birgit Derntl
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, Tübingen, Germany
- Lead Graduate School, University of Tübingen, Tübingen, Germany
| | - Manfred Hallschmid
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
| | - Nicolas D. Lutz
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- Institute of Medical Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Edith Ngai
- Department of Information Technology, Uppsala University, Uppsala, Sweden
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | | | - Anna Wikman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- *Correspondence: Anna Wikman
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Quin N, Lee JJ, Pinnington DM, Newman L, Manber R, Bei B. Differentiating perinatal Insomnia Disorder and sleep disruption: a longitudinal study from pregnancy to 2 years postpartum. Sleep 2022; 45:6497951. [PMID: 34989808 PMCID: PMC9013000 DOI: 10.1093/sleep/zsab293] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 12/07/2021] [Indexed: 01/07/2023] Open
Abstract
STUDY OBJECTIVES Insomnia Disorder diagnoses require persistent sleep complaints despite "adequate sleep opportunity." Significant Perinatal Sleep Disruption makes this diagnosis challenging. This longitudinal study distinguished between Insomnia Disorder and Perinatal Sleep Disruption and their sleep and mental health correlates. METHODS One hundred sixty-three nulliparous females (age M ± SD = 33.35 ± 3.42) participating in a randomized controlled trial repeated the Insomnia Disorder module of the Duke Structured Interview for Sleep Disorders and Patient-Reported Outcome Measurement Information System measures for sleep and mental health at 30- and 35-weeks' gestation, and 1.5, 3, 6, 12, and 24 months postpartum (944 interviews, 1009 questionnaires completed). We compared clinical features when Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Insomnia Disorder criteria (without the Duration criterion) were: (1) met (Insomnia Disorder), (2) not met only because of the sleep opportunity criteria (Perinatal Sleep Disruption), and (3) not met due to other criteria (Low Complaint). RESULTS Proportions of Insomnia Disorder were 16.0% and 19.8% during early and late third trimester, and ranged 5.3%-11.7% postpartum. If the sleep opportunity criteria were not considered, rates of Insomnia would be 2-4 times higher (21.4%-40.4%) across time-points. Mixed-effects models adjusting for covariates showed that compared to Low Complaint, both Insomnia Disorder and Perinatal Sleep Disruption scored significantly higher on insomnia and sleep disturbance scales, sleep effort, and sleep-related impairments (p values < .01), but depression and anxiety were comparable (p values > .12). CONCLUSION Assessing sleep complaints without considering sleep opportunities can result in over-diagnosis of Insomnia Disorder in the perinatal periods. Insomnia Disorder and Perinatal Sleep Disruption were both associated with adverse sleep and mood outcomes, and need to be carefully differentiated and appropriately addressed. Clinical Trial Registration: The SEED Project (Sleep, Eat, Emotions, and Development): A randomized controlled pilot study of a perinatal sleep intervention on sleep and wellbeing in mothers and infants. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371634, Australian New Zealand Clinical Trials Registry: ACTRN12616001462471.
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Affiliation(s)
- Nina Quin
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Women’s Mental Health Service, Royal Women’s Hospital, Parkville, VIC, Australia
| | - Jin Joo Lee
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Women’s Mental Health Service, Royal Women’s Hospital, Parkville, VIC, Australia
| | - Donna M Pinnington
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Women’s Mental Health Service, Royal Women’s Hospital, Parkville, VIC, Australia
| | - Louise Newman
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Bei Bei
- Corresponding author. Bei Bei, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, 18 Innovation Walk, Clayton Campus, VIC 3800, Australia.
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Chen H, He Y, Zeng X, Chen Q, Zhou N, Yang H, Zhou W, Zhang L, Yang R, Huang Q, Zhang H. Sleep Quality is an Independent Predictor of Blood Glucose and Gestational Diabetes Mellitus: A Longitudinal Study of 4550 Chinese Women. Nat Sci Sleep 2022; 14:609-620. [PMID: 35431589 PMCID: PMC9012300 DOI: 10.2147/nss.s353742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/24/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To investigate whether pregnant women's subjective sleep quality during the first trimester independently predicted blood glucose and gestational diabetes mellitus (GDM). METHODS A total of 4550 pregnant women in the first trimester were enrolled in Chongqing Health Center for Women and Children, China, from January to October 2020.The Pittsburgh Sleep Quality Index (PSQI) was used to measure subjective sleep quality. Depression symptoms and anxiety were measured with the Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7). Oral glucose tolerance tests (OGTT) and blood glucose area under the curve (AUC) were used for estimation of blood glucose and diagnosis of GDM during the second trimester. Linear, mixed model, and logistic regression were used to analyze the association between PSQI and blood glucose as well as GDM. RESULTS 946/4550 were diagnosed with GDM (20.8%). In the mixed model analysis, the blood glucose level of the highest-scoring group (PSQI score = 18) was 1.94 (95% CI: 0.45~3.43, P = 0.011) mmol/L higher than that of the lowest-scoring group (PSQI score = 0). After adjusting for potential confounders, a one-point PSQI score increase was associated with a 0.014 (95% CI: 0.001~0.027, P = 0.039) mmol/L increase in blood glucose level. Blood glucose AUC was also positively associated with PSQI scores (β = 0.034, 95% CI: 0.003~0.064, P = 0.030). The results for the logistic regression model showed that PSQI was marginal positively correlated with GDM (OR = 1.146, 95% CI: 0.995~1.321, P = 0.059) when age and BMI were not controlled for. When investigating the association between PSQI and the GDM-diagnosed time window, the 1-h diagnosed GDM had a borderline positive correlation with PSQI (OR = 1.182, 95% CI: 0.993~1.405, P = 0.060). CONCLUSION Sleep quality during the first trimester may be a risk factor for elevated blood glucose and GDM later in gestation.
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Affiliation(s)
- Hongyan Chen
- Quality Management Department, Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Yang He
- Operating Room, Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Xiaoling Zeng
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University (Army Medical University), Chongqing, People's Republic of China
| | - Qing Chen
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University (Army Medical University), Chongqing, People's Republic of China
| | - Niya Zhou
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University (Army Medical University), Chongqing, People's Republic of China
| | - Huan Yang
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University (Army Medical University), Chongqing, People's Republic of China
| | - Wenzheng Zhou
- Quality Management Department, Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Liwen Zhang
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University (Army Medical University), Chongqing, People's Republic of China
| | - Rong Yang
- Obstetric Outpatient Department, Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Qiao Huang
- Obstetric Outpatient Department, Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Hua Zhang
- Administration Office, Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
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Insomnia evaluation and treatment during peripartum: a joint position paper from the European Insomnia Network task force "Sleep and Women," the Italian Marcè Society and international experts task force for perinatal mental health. Arch Womens Ment Health 2022; 25:561-575. [PMID: 35419652 PMCID: PMC9072480 DOI: 10.1007/s00737-022-01226-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 03/27/2022] [Indexed: 12/22/2022]
Abstract
Insomnia symptoms are frequent during peripartum and are considered risk factors for peripartum psychopathology. Assessing and treating insomnia and related conditions of sleep loss during peripartum should be a priority in the clinical practice. The aim of this paper was to conduct a systematic review on insomnia evaluation and treatment during peripartum which may be useful for clinicians. The literature review was carried out between January 2000 and May 2021 on the evaluation and treatment of insomnia during the peripartum period. The PubMed, PsycINFO, and Embase electronic databases were searched for literature published according to the PRISMA guidance with several combinations of search terms "insomnia" and "perinatal period" or "pregnancy" or "post partum" or "lactation" or "breastfeeding" and "evaluation" and "treatment." Based on this search, 136 articles about insomnia evaluation and 335 articles on insomnia treatment were found and we conducted at the end a narrative review. According to the inclusion/exclusion criteria, 41 articles were selected for the evaluation part and 22 on the treatment part, including the most recent meta-analyses and systematic reviews. Evaluation of insomnia during peripartum, as for insomnia patients, may be conducted at least throughout a clinical interview, but specific rating scales are available and may be useful for assessment. Cognitive behavioral therapy for insomnia (CBT-I), as for insomnia patients, should be the preferred treatment choice during peripartum, and it may be useful to also improve mood, anxiety symptoms, and fatigue. Pharmacological treatment may be considered when women who present with severe forms of insomnia symptoms do not respond to nonpharmacologic therapy.
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De Chiara L, Mazza C, Ricci E, Koukopoulos AE, Kotzalidis GD, Bonito M, Callovini T, Roma P, Angeletti G. The Relevance of Insomnia in the Diagnosis of Perinatal Depression: Validation of the Italian Version of the Insomnia Symptom Questionnaire. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12507. [PMID: 34886233 PMCID: PMC8656599 DOI: 10.3390/ijerph182312507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sleep disorders are common in perinatal women and may underlie or trigger anxiety and depression. We aimed to translate and validate and evaluate the psychometric properties of the Italian version of the Insomnia Symptom Questionnaire (ISQ), in a sample of women during late pregnancy and 6-months postpartum according to the DSM-5 criteria. METHODS The ISQ was administered to 292 women prenatally along with other measures of sleep quality, depression, and anxiety, to examine its construct and convergent validity. Women were readministered the ISQ six months postdelivery to assess test-retest reliability. Women were divided into DSM-5 No-Insomnia (N = 253) and Insomnia (N = 39) groups. RESULTS The insomnia group had received more psychopharmacotherapy, had more psychiatric family history, increased rates of medically assisted reproduction, of past perinatal psychiatric disorders, and scored higher on almost all TEMPS-A dimensions, on the EPDS, HCL-32, PSQI, and on ISQ prenatally and postnatally. ISQ scores correlated with all scales, indicating adequate convergent and discriminant validity; furthermore, it showed antenatal-postnatal test-retest reliability, 97.5% diagnostic accuracy, 79.5% sensitivity, 94.9% specificity, 70.5% positive predictive power, and 92.8% negative predictive power. CONCLUSIONS The ISQ is useful, valid, and reliable for assessing perinatal insomnia in Italian women. The Italian version showed equivalent properties to the original version.
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Affiliation(s)
- Lavinia De Chiara
- Department of Neurosciences, Mental Health, Sensory Functions (NESMOS), Sant’Andrea University Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Via Grottarossa 1035-1039, 00189 Rome, Italy; (L.D.C.); (G.D.K.); (G.A.)
| | - Cristina Mazza
- Department of Neuroscience, Imaging and Clinical Sciences, G. d’Annunzio University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (C.M.); (E.R.)
| | - Eleonora Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, G. d’Annunzio University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (C.M.); (E.R.)
| | - Alexia Emilia Koukopoulos
- Department of Neuroscience/Mental Health, UOC Psichiatria, Psicofarmacologia Clinica, Azienda Ospedaliera Universitaria Policlinico Umberto I, Viale Regina Elena, 328, 00161 Rome, Italy;
| | - Georgios D. Kotzalidis
- Department of Neurosciences, Mental Health, Sensory Functions (NESMOS), Sant’Andrea University Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Via Grottarossa 1035-1039, 00189 Rome, Italy; (L.D.C.); (G.D.K.); (G.A.)
| | - Marco Bonito
- Dipartimento Materno Infantile, San Pietro Fatebenefratelli Hospital, Via Cassia, 600, 00189 Rome, Italy;
| | - Tommaso Callovini
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy;
| | - Paolo Roma
- Department of Human Neurosciences, Sapienza University of Rome, Viale Regina Elena 334, 00161 Rome, Italy
| | - Gloria Angeletti
- Department of Neurosciences, Mental Health, Sensory Functions (NESMOS), Sant’Andrea University Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Via Grottarossa 1035-1039, 00189 Rome, Italy; (L.D.C.); (G.D.K.); (G.A.)
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Felder JN, Epel ES, Neuhaus J, Krystal AD, Prather AA. Randomized controlled trial of digital cognitive behavior therapy for prenatal insomnia symptoms: Effects on postpartum insomnia and mental health. Sleep 2021; 45:6444826. [PMID: 34850238 DOI: 10.1093/sleep/zsab280] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/04/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To evaluate the effects of digital cognitive behavior therapy for insomnia (dCBT-I) delivered during pregnancy on subjective sleep outcomes, depressive symptoms, and anxiety symptoms through six months postpartum. METHODS People up to 28 weeks gestation (N=208) with insomnia were randomized to six weekly sessions of dCBT-I or standard care. We report follow-up data at three and six months postpartum. The primary outcome was insomnia symptom severity. Secondary sleep outcomes included global sleep quality and insomnia caseness. Mental health outcomes included depressive and anxiety symptom severity. We evaluated between-condition differences in change from baseline for each postpartum timepoint and categorical outcomes. RESULTS dCBT-I participants did not experience significantly greater improvements in insomnia symptom severity relative to standard care participants, but they did experience higher rates of insomnia remission and lower rates of insomnia caseness at six months postpartum. dCBT-I participants experienced greater improvements in depressive symptom severity from baseline to both postpartum timepoints, and in anxiety symptom severity from baseline to three months postpartum. The proportion of participants with probable major depression at three months postpartum was significantly higher among standard care (18%) than dCBT-I (4%, p=.006) participants; this between-condition difference was pronounced among the subset (n=143) with minimal depressive symptoms at baseline (18% vs 0%). CONCLUSION dCBT-I use during pregnancy leads to enduring benefits for postpartum insomnia remission. Findings provide strong preliminary evidence that dCBT-I use during pregnancy may prevent postpartum depression and anxiety, which is notable when considering the high frequency and importance of these problems.
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Affiliation(s)
- Jennifer N Felder
- Osher Center for Integrative Medicine, University of California, San Francisco, USA.,Department of Psychiatry, University of California, San Francisco, USA
| | - Elissa S Epel
- Department of Psychiatry, University of California, San Francisco, USA.,Center for Health and Community, University of California, San Francisco, USA
| | - John Neuhaus
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Andrew D Krystal
- Department of Psychiatry, University of California, San Francisco, USA
| | - Aric A Prather
- Department of Psychiatry, University of California, San Francisco, USA.,Center for Health and Community, University of California, San Francisco, USA
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Kriengtuntiwong T, Zaw YH, Taneepanichskul N. Brain-Derived Neurotrophic Factor (BDNF) Depression and Subjective Sleep Quality in the First Trimester of Pregnancy Among Migrant Workers in Thailand. J Multidiscip Healthc 2021; 14:2549-2556. [PMID: 34552333 PMCID: PMC8450157 DOI: 10.2147/jmdh.s322355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/03/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction Brain-derived neurotrophic factor (BDNF) influences neurodevelopment during pregnancy. Maternal sleep quality and depression are suggested to influence BDNF levels. The objective of this study was to assess the association between depression, sleep quality, and BDNF levels among Myanmar migrant pregnancies. Methods A cross-sectional study was conducted at Krathum Baen Hospital, Samut Sakhon province, from June to October 2018. A total of 108 first-trimester women were recruited into our study. Maternal blood was collected to analyze BDNF. Depression levels were assessed using the Patient Health Questionnaire (PHQ-9) instrument. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was applied to evaluate subjective sleep quality. Because BDNF was skewed, binary logistic regression was analyzed. Results We found that 28.7% of pregnant women reported poor sleep quality, and 33.4% were classified as having mild to moderate depression. After adjusting for covariate variables, pregnant women with depression had higher BDNF levels than those without depression (OR = 2.972, 95% CI = [1.111, 7.949], p = 0.030). Pregnant women with poor sleep quality had lower BDNF levels than those who had good sleep quality (OR = 0.359, 95% CI = [0.132, 0.972], p = 0.044). Discussion The results suggested that BDNF might be an alternative tool to assess sleep quality in pregnant women.
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Affiliation(s)
- Thuvachit Kriengtuntiwong
- College of Public Health Science, Chulalongkorn University, Bangkok, Thailand.,Department of Mental Health, Srithanya Hospital, Nonthaburi, Thailand
| | - Ye Htet Zaw
- Defense Services Medical Academy, Yangon, Myanmar
| | - Nutta Taneepanichskul
- College of Public Health Science, Chulalongkorn University, Bangkok, Thailand.,HAUS IAQ Research Unit, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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45
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Hawkins M, Marcus B, Pekow P, Rosal MC, Tucker KL, Spencer RMC, Chasan-Taber L. The Impact of a Randomized Controlled Trial of a Lifestyle Intervention on Sleep Among Latina Postpartum Women. Ann Behav Med 2021; 55:892-903. [PMID: 33580651 DOI: 10.1093/abm/kaaa118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Marquis Hawkins
- Department of Epidemiology, University of Pittsburgh, Public Health, Pittsburgh, PA, USA
| | - Bess Marcus
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Penelope Pekow
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA, USA
| | - Milagros C Rosal
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Katherine L Tucker
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Rebecca M C Spencer
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, USA
| | - Lisa Chasan-Taber
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA, USA
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MacKinnon AL, Madsen JW, Dhillon A, Keys E, Giesbrecht GF, Williamson T, Metcalfe A, Campbell T, Mrklas KJ, Tomfohr-Madsen L. Sleeping for two: study protocol for a randomized controlled trial of cognitive behavioral therapy for insomnia in pregnant women. Trials 2021; 22:532. [PMID: 34384459 PMCID: PMC8358257 DOI: 10.1186/s13063-021-05498-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Insomnia and sleep disturbances are common in pregnancy and have potentially significant consequences for both maternal and infant health. There is limited research examining the effectiveness of cognitive behavioral therapy for insomnia (CBT-I) during pregnancy. With increased distress and limited access to services during the COVID-19 pandemic, there is also an unprecedented need for telehealth delivery of treatment programs for pregnant women. The aims of this trial are to evaluate the impact of the Sleeping for Two adaptation of CBT-I in pregnancy (in-person or telehealth) versus treatment as usual (TAU) in reducing symptoms of insomnia (primary outcome), as well as increasing gestational length and reducing symptoms of depression (secondary outcomes). METHODS A two-arm, single-blinded, parallel group randomized controlled trial (RCT) design with repeated measures will be used to evaluate the impact of CBT-I compared to TAU among a sample of 62 pregnant women, enrolled between 12 and 28 weeks of gestation, who self-identify as experiencing insomnia. Five weekly individual sessions of CBT-I will be delivered in person or via telehealth depending on physical distancing guidelines. Assessment of insomnia diagnosis by structured interview, self-reported insomnia symptom severity and sleep problems, and sleep quantity and quality as measured by a daily diary and actigraphy will occur at 12-28 weeks of pregnancy (T1), 1 week post-treatment (T2), and 6 months postpartum (T3). DISCUSSION CBT-I delivered in pregnancy has the potential to reduce symptoms of insomnia and depression and could lead to reduced risk of preterm birth, all of which can minimize risk of negative maternal and child health and developmental consequences in the short (e.g., infant death) and long terms (e.g., developmental delays). This RCT builds on a successful open pilot trial conducted by our team and will provide further evaluation of a novel evidence-based treatment for pregnancy-related insomnia, which can be widely disseminated and used to treat individuals that are most in need of intervention. Findings will enhance understanding of pregnancy-related sleep problems, as well as means by which to improve the health and sleep of mothers and their children. TRIAL REGISTRATION ClinicalTrials.gov NCT03918057. Registered on 17 April 2019.
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Fischer AR, Green SRM, Gunn HE. Social-ecological considerations for the sleep health of rural mothers. J Behav Med 2021; 44:507-518. [PMID: 33083923 PMCID: PMC7574991 DOI: 10.1007/s10865-020-00189-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/30/2020] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Alexandra R Fischer
- Department of Psychology, University of Alabama, Box 87034, Tuscaloosa, AL, 35487, USA
| | | | - Heather E Gunn
- Department of Psychology, University of Alabama, Box 87034, Tuscaloosa, AL, 35487, USA.
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48
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Ladyman C, Gander P, Huthwaite M, Sweeney B, Signal TL. Sleep HAPi: A Feasibility and Descriptive Analysis of an Early and Longitudinal Sleep Education Intervention for Pregnant Women. Behav Sleep Med 2021; 19:427-444. [PMID: 32497446 DOI: 10.1080/15402002.2020.1772265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Poor sleep and prior depression are key predictors of perinatal depression, with research suggesting depressive symptoms may emerge in early pregnancy. Sleep is a potentially modifiable risk factor for depression. This pilot study examined the feasibility and acceptability of a six-month sleep education intervention designed to optimize sleep and minimize depressive symptoms throughout pregnancy. Sleep measures and depressive symptoms are described from 12 weeks gestation to 12 weeks postpartum.Participants: A community sample of nulliparous pregnant women with a history of depression were recruited prior to 14 weeks gestation.Methods: An individualized sleep education program was developed and participants engaged in three trimester specific sleep education sessions. Feasibility and acceptability were determined via recruitment and retention rates and participant feedback. Depressive symptoms and sleep were measured at five time points throughout the study.Results: 22 women enrolled in the study and 15 completed the intervention. Participants reported the intervention as highly acceptable. There was minimal change in all dimensions of sleep across pregnancy, but sleep measures were significantly worse at six weeks postpartum and improved by 12 weeks postpartum. Depressive symptoms were significantly lower at the conclusion of the intervention and 12 weeks postpartum compared to trimester 1.Conclusions: This sleep education program appears feasible, acceptable and may be effective in minimizing depressive symptoms in pregnant women with a history of depression. Trials with larger and more diverse samples are warranted and further studies to ascertain efficacy should be undertaken with a control group.
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Affiliation(s)
- Clare Ladyman
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Philippa Gander
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Mark Huthwaite
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Bronwyn Sweeney
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - T Leigh Signal
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
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49
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Ladyman C, Signal TL, Sweeney B, Jefferies M, Gander P, Paine SJ, Huthwaite M. Multiple dimensions of sleep are consistently associated with chronically elevated depressive symptoms from late pregnancy to 3 years postnatal in Indigenous and non-Indigenous New Zealand women. Aust N Z J Psychiatry 2021; 55:687-698. [PMID: 33176439 DOI: 10.1177/0004867420972762] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Poor sleep and depressive symptoms are common throughout the perinatal period, but little is known about the extended time course of depression and the sleep dimensions associated with these trajectories. OBJECTIVE This study investigated different depression trajectories in New Zealand Māori and non-Māori women from late pregnancy to 3 years postnatal. Relationships between multiple dimensions of sleep and these depression trajectories were also investigated. METHODS Data from 856 women (30.6% Māori and 69.4% non-Māori) from the longitudinal Moe Kura cohort study were used. Depressive symptoms and multiple dimensions of sleep (quality, duration, latency, continuity and daytime sleepiness) were collected at 36 weeks' gestation, 12 weeks postnatal and 3 years postnatal. Trajectory analysis was completed using latent class analysis. RESULTS Latent class analysis revealed two distinct groups of depressive symptom trajectories: 'chronic high' and 'stable mild' for both Māori and non-Māori women. Māori women in both trajectories were more likely than non-Māori women to have clinically significant depressive symptoms at every time point. Poorer sleep quality, latency, continuity and greater daytime sleepiness were consistently associated with the chronic high depressive symptom trajectory at all three time points, after controlling for sociodemographic factors. CONCLUSION A significant proportion of Māori and non-Māori women experience chronically high depressive symptoms during the perinatal period and the following years. Across this extended time frame, Māori women have a higher probability of experiencing clinically significant depressive symptoms compared to non-Māori women. These persistent patterns of depressive symptoms occur concurrently with multiple dimensions of poor sleep. Given the well-described impact of maternal depression on the mother, child, family and community, this highlights the importance of healthcare professionals asking about mothers' sleep quality, continuity, latency and daytime sleepiness as potential indicators of long-term mood outcomes.
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Affiliation(s)
- Clare Ladyman
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - T Leigh Signal
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Bronwyn Sweeney
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Mona Jefferies
- Health Services Research Centre, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Philippa Gander
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Sarah-Jane Paine
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Mark Huthwaite
- Department of Psychological Medicine (Wellington), University of Otago, Wellington, New Zealand
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Hecht CL, Aarshati A, Miceli J, Olejniczac D, Peyser T, Geller DA, Antoni M, Kiefer G, Reyes V, Zandberg D, Johnson J, Nilsen M, Tohme S, Steel JL. Trait mindfulness and the mental and physical health of caregivers for individuals with cancer. Eur J Integr Med 2021; 44:101325. [PMID: 34149965 PMCID: PMC8211096 DOI: 10.1016/j.eujim.2021.101325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mindfulness plays a role in moderating the negative mental and physical health outcomes associated with caregiving. The aims of this study were to examine the relationship between trait mindfulness and the (1) psychological functioning, (2) health behaviors, (3) and physical health of caregivers for individuals diagnosed with cancer. METHODS Caregivers completed a battery of questionnaires and examinations assessing sociodemographic characteristics, trait mindfulness, depression, perceived stress, caregiver stress, sleep, diet, physical activity, tobacco use, alcohol use, blood pressure, and BMI. Demographics and cancer diagnostics were collected for the individuals whom caregivers supported. Linear regression, multivariate analyses, and moderator analyses were performed. RESULTS Of the 78 caregivers, the mean age was 63.9 (S.D.=13.1); 59% identified as female; 97% identified as White. Regression analyses indicated that caregivers who reported higher levels of trait mindfulness reported significantly less perceived stress (b= -4.38, SE= 0.88, p <.001), lower levels of depression (b= -3.74, SE= 1.10, p = .001), greater caregiver quality of life (b= -9.05, SE=2.12, p < .001), better sleep quality (b= -0.98, SE=0.44, p = 0.03), and lower rates of tobacco use (b= -10.12, SE= 3.43, p =.003). Trait mindfulness was not significantly related to diet, alcohol use, blood pressure, or BMI. CONCLUSIONS Higher levels of trait mindfulness are associated with positive mental and physical health measure for caregivers. Future research would benefit from further examining mindfulness-based interventions and their impacts in mitigating the negative toll of caregiving in the context of cancer.
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Affiliation(s)
- C L Hecht
- University of Pittsburgh, School of Medicine Kaufmann Building, Suite 601
| | - A Aarshati
- University of Pittsburgh, School of Medicine Kaufmann Building, Suite 601
| | - J Miceli
- University of Pittsburgh, School of Medicine Kaufmann Building, Suite 601
| | - D Olejniczac
- University of Pittsburgh, School of Medicine Kaufmann Building, Suite 601
| | - T Peyser
- University of Pittsburgh, School of Medicine Kaufmann Building, Suite 601
| | - D A Geller
- University of Pittsburgh, School of Medicine Kaufmann Building, Suite 601
| | - M Antoni
- University of Miami Department of Psychology
| | - G Kiefer
- University of Pittsburgh Medical Center's Hillman Cancer Center
| | - V Reyes
- University of Pittsburgh Medical Center's Hillman Cancer Center
| | - D Zandberg
- University of Pittsburgh Medical Center's Hillman Cancer Center
| | - J Johnson
- University of Pittsburgh Medical Center's Hillman Cancer Center
| | - M Nilsen
- University of Pittsburgh Medical Center's Hillman Cancer Center
| | - S Tohme
- University of Pittsburgh School of Nursing
| | - J L Steel
- University of Pittsburgh, School of Medicine Kaufmann Building, Suite 601
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