How do infant feeding method, sleeping location, and postpartum depression interact with maternal sleep quality?

Impact of sleep on postpartum health outcomes: a systematic review and meta-analysis

OBJECTIVE

To examine the impact of postpartum sleep interventions and postpartum sleep on maternal health outcomes.

DESIGN

Systematic review with random-effects meta-analysis. Online databases were searched on 12 January 2024.

STUDY ELIGIBILITY CRITERIA

Studies of all designs (except case studies and reviews) in all languages were eligible if they contained information on the population (individuals up to 1-year post partum), sleep interventions/exposures including (type, duration, frequency, alone or in combination with other components), comparator (control or different duration, frequency or type of sleep intervention) and outcomes: mental health, cardio-metabolic, postpartum weight retention (PPWR), low back pain and pelvic girdle pain, breastfeeding and urinary incontinence.

RESULTS

60 studies (n=20 684) from 14 countries were included. 'High' certainty of evidence showed that sleep interventions were associated with a greater decrease in depressive symptom severity compared with no intervention (five randomised controlled trials; n=992; standardised mean difference -0.27, 95% CI -0.40 to -0.14; small effect). Sleep interventions had no impact on the odds of developing depression ('moderate' certainty of evidence) or anxiety or anxiety symptom severity ('low' certainty of evidence). Additionally, 'low' certainty of evidence demonstrated no effect on cardiometabolic outcomes (systolic blood pressure, diastolic blood pressure, mean arterial pressure), anthropometric measures (maternal weight, body mass index) or prevalence of exclusive breastfeeding. 'Low' certainty of evidence from observational studies found that high-quality sleep reduces the odds of developing anxiety and reduces the severity of depression and anxiety symptoms. 'Low' and 'very low' certainty of evidence from observational studies found that shorter sleep duration is associated with greater PPWR.

CONCLUSIONS

Postpartum sleep interventions reduced the severity of depression symptoms.

The Effect of Early-Initiated Half-Swaddling and Kangaroo Care Practices on Maternal Sleep Quality and Postpartum Depression in Term Infants: A Randomized Controlled Trial

This study aimed to investigate the effects of half-swaddling and kangaroo care practices early initiated in mothers of term babies on maternal sleep quality and postpartum depression. This study was prospective, four-arm randomized controlled trial. This study was conducted in 136 mothers and term baby hospitalized in Trakya University Hospital between April 2023 and August 2024. Participants were randomly divided into four groups using computer program with 34 mothers in each group: control (A), half-swaddling (B), kangaroo care (C), half-swaddling, and kangaroo care (D). Starting, 1st, 2nd, 3rd, and 6th months, the data of all four groups were collected with the Questionnaire Form, Edinburgh Postpartum Depression Scale (EPDS), and Pittsburgh Sleep Quality Index (PSQI). Bonferroni and multiple linear regression (MLR) were used for advanced statistics. C and D groups had more positive effects on depression, while B and D groups had more positive effects on maternal sleep quality (p < 0.001). The combination of half-swaddling and kangaroo care practices early initiated in term babies has a significant effect on reducing the risk of postpartum depression, and half-swaddling practice has an important effect on improving maternal sleep quality. Trial Registration: ClinicalTrials.gov: NCT06348316.

The effect of Ocimum basilicum on the prevention of postpartum depression symptoms and sleep quality: A triple-blind randomized controlled clinical trial

Background

Postpartum depression is a multifactorial and complex disorder. Various approaches for preventing and treating this condition have been suggested. Nevertheless, there is no definitive proof confirming their efficacy. This study is designed to assess the effectiveness of basil in preventing postpartum depression (primary outcome) and sleep quality (secondary outcome).

Methods

This triple-blind parallel clinical trial (participants, the researcher, and the data analyst were blinded to the assigned interventions) included 78 postpartum women at Taleghani Hospital, Tabriz, Iran, between April 2023 and April 2024. Participants who scored 12 or less on the Edinburgh Postnatal Depression Scale (EPDS) were included in the study. The intervention started within 72 h following birth and continued for eight weeks postpartum. The intervention group received two daily capsules containing dried basil leaf powder, while the control group received 500 mg of starch. The EPDS and postpartum sleep quality scale were completed through structured interviews at eight weeks postpartum. The Mann-Whitney U test was used to compare the mean postpartum depression scores before and after the intervention, and ANCOVA was used to compare the mean postpartum sleep quality scores.

Results

The median (25th, 75th percentile) depression score after intervention in the basil and placebo groups was 1.0 (0.0, 2.0) and 1.0 (0.0, 3.0), respectively, with no statistically significant difference between the groups (p = 0.966). The mean (standard deviation) sleep quality score after the intervention in the basil and placebo groups was 17.63 (3.44) and 16.15 (3.20), respectively. There was no statistically significant difference in sleep quality scores between the basil and placebo groups (p = 0.400).

Conclusion

The results show that basil does not prevent postpartum depression or improve sleep quality. Future studies should investigate the effects of basil at higher doses and in extract form.

Association of maternal postpartum depression, anxiety, and stress symptoms: a network analysis

BACKGROUND

New mothers frequently encounter postpartum depression, anxiety, and stress symptoms, which pose challenges in diagnosis and treatment owing to their intricate interplay. This study employs network analysis to explore the interconnections between these symptoms and identify potential intervention points.

METHODS

The study was carried out from December 2023 to June 2024 at the postpartum clinics of three representative tertiary hospitals in Nantong City. The participants were mothers undergoing their 42-day postpartum check-up. Participants completed the Edinburgh Postnatal Depression Scale (EPDS), the Depression, Anxiety, and Stress Scales (DASS-21), and the Maternal postpartum stress scale (MPSS). The R language was used to construct the network. Network analysis was also carried out to explore the network structure, centrality indices (strength, closeness, betweenness, and expected influence), and the stability of the network.

RESULTS

A total of 625 women were included. The resulting network indicates a close interconnection between communities associated with depression, anxiety, and stress. As assessed on the centrality index, "I have felt sad or miserable" (EPDS-8), "Baby's irregular patterns of daily sleep" (MPSS-9), "lack of time for myself" (MPSS-19), "I have been so unhappy that I have been crying" (EPDS-4), and "Physical appearance after childbirth" (MPSS-20) are the five most important nodes of these three network structures. High network stability (> 0.7).

CONCLUSION

Postpartum-specific stress symptoms play a significant role in the network of postpartum depression, anxiety, and stress, and identifying the central symptoms of depression, anxiety, and stress can provide a scientific basis for the development of precise interventions.

CLINICAL TRIAL NUMBER

Not Applicable.

Comparing the prevalence and influencing factors of postpartum depression in primiparous and multiparous women in China

Background

Few studies have compared the influencing factors of postpartum depression between primiparous and multiparous women. Therefore, this study is aimed to investigate the prevalence and influencing factors of postpartum depression in primiparous and multiparous women, and provide reference suggestions for clinical nursing.

Methods

A total of 429 postpartum women who gave birth at a Maternal and Child Health Hospital in Shandong Province, China, from April to June 2024, were recruited by convenience sampling. A Sociodemographic Questionnaire, Edinburgh Postpartum Depression Scale, Pittsburgh Sleep Quality Index, and Perceived Social Support Scale were used for investigation. SPSS 26.0 was used to analyze the data, and multivariate regression was employed to analyze the influencing factors of postpartum depression between primiparous and multiparous women.

Results

The total prevalence of postpartum depression among 429 postpartum women (191 primiparas and 238 multiparas) was 22.14%. The prevalence of postpartum depression among primiparous and multiparous women were 21.99% and 22.27%, respectively, with no statistically significant difference [OR=1.016, 95% CI (0.642, 1.608)]. Sleep quality is a common protective factor for postpartum depression in both primiparous and multiparous women, while perceived social support is another protective factor for multiparous women. The risk factors are different in both two group, there is no risk factor found in primiparous women, the newborns health and women's expectation on newborns gender are risk factors for postpartum depression in multiparous women.

Conclusions

Both primiparous and multiparous women have a high risk of postpartum depression. In order to promote the mental health of postpartum women, precise nursing measures should be adopted for different parity of postpartum women in clinical practice.

The role of sleep protection in preventing and treating postpartum depression

Postpartum sleep disruption is a risk factor for postpartum depression (PPD) as well as a potential treatment target. In the first 6 months after delivery, when the risk of PPD is greatest, fragmented maternal sleep is most often related to necessary infant night feedings. Clinicians' conversations about planning for and navigating postpartum sleep should include questions about patient expectations, cultural traditions, and available support. For women at high risk of PPD, or with moderate to severe PPD or other symptoms of mental illness, protecting one 4-5 hour period of consolidated nighttime sleep may be necessary and effective. This can be achieved by having another adult step in for 1-2 infant night feedings or by employing other strategies. OBs can encourage high-risk patients to develop a postpartum plan for sleep protection by initiating this conversation during pregnancy.

Evaluating Malnutrition Practices and Mother's Education on Children Failure to Thrive Symptoms Using Entropy-Weight and TOPSIS Method

BACKGROUND/OBJECTIVES

Failure to thrive (FTT) is mostly caused by insufficient consumption of nutrient-rich food, recurrent infections like diarrhea and intestinal worms, substandard caregiving practices, and limited availability of health and other vital services. Furthermore, there was a correlation between the educational level of mothers and the occurrence of FTT in children aged 6-12 months. Thus, the objective of the current research is twofold: (i) to investigate other factors related to FTT and (ii) to evaluate the impact of them on FTT in Sub-Saharan African countries and their urban areas.

METHODS

We used weight entropy and TOPSIS methods to approach the research question. In particular, the entropy-weight method is effective for precisely evaluating the relative significance of the selected criteria for TOPSIS computation. Thus, data were retrieved from the database of UNICEF for the year 2019 for nine Sub-Saharan countries, and based on the methods used, five criteria have been selected for consideration. Those of mothers in higher education were identified as having a higher weight, which means that this can affect positively the ability of mothers to mitigate the situation of FTT and protect their children.

RESULTS

The findings of the study highlight the factors of maternal education at a higher level and unhealthy habits as those with the greatest weight and impact on the FTT. Moreover, the results indicate that the association between maternal education, and especially higher education, and FTT is stronger in Ethiopia. Despite the limited amount of research on the specified relationship in Sub-Saharan countries, this study is among the initial ones to examine it.

CONCLUSIONS

The current study can aid policymakers in devising appropriate policies and implementing effective measures to tackle FTT in Sub-Saharan Africa, like enhancing the number of mothers in these countries to be integrated into the educational system to help both themselves and their children mitigate or avoid the symptoms of FTT.

Digital Training for Nurses and Midwives to Improve Treatment for Women with Postpartum Depression and Protect Neonates: A Dynamic Bibliometric Review Analysis

The high prevalence of postpartum depression makes it necessary for midwives and nurses to implement prenatal interventions for expectant mothers. The current study aims to investigate and highlight the importance of the digital training of nurses in order to help women mitigate the symptoms of postpartum depression and protect infants. To approach this, we conducted a bibliometric analysis to address the study's main objective. Articles were retrieved from the Scopus database for the timeframe 2000-2023. Data analysis was conducted using the statistical programming language R (version R-4.4.) and the bibliometric software VOSviewer (version 1.6.20) and Biblioshiny (version 4.1.4), focused on year, journal, and country. For this investigation, we selected a total of 31 MeSH keywords and sub-headings that exhibited significant frequencies. We consistently used six significant clusters of MeSH keywords. We obtained a total of 585 articles from the Scopus database that were major contributors to the field of PPD, as evidenced by their extensive publication of research articles and their influential role in the domain. The studies included a thorough analysis of depression research, the use of scales for diagnosing and screening PPD, psychological studies related to PPD, and the exploration of causes, mechanisms, outcomes, and genetic factors. Our study's results demonstrate a steady and significant increase in the availability of information on PPD. Importantly, the novelty of the current study lies in highlighting the need for a transition in the ways in which nurses and midwives are trained to mitigate postpartum disease by integrating emerging technologies into their practices. The knowledge provided here has the potential to serve as a foundation for future advancements in obstetric psychology, both presently and in the future.

Prenatal exposure to poly- and perfluoroalkyl substances and postpartum depression in women with twin pregnancies

BACKGROUND

Women with multiple pregnancies are vulnerable to experience postpartum depression (PPD). Emerging evidence indicates an association between poly- and perfluoroalkyl substances (PFAS) exposure and PPD in women delivering singletons. The health risks of PFAS may also be present in women delivering twins.

OBJECTIVE

To estimate the impacts of prenatal PFAS exposure on the risk of PPD in women with twin pregnancies.

METHODS

Our study included 150 mothers who gave birth to twins and were enrolled in the Wuhan Twin Birth Cohort. The concentrations of maternal plasma PFAS were measured in each trimester and averaged. Eight individual PFAS were included in analyses. We used Edinburgh Postnatal Depression Scale to evaluate maternal depression at early pregnancy and 1 and 6 months after childbirth. The outcome was dichotomized using a cutoff value of ≥10 for main analyses. Associations were examined using multiple informant models and modified Poisson regressions. PFAS mixture effects were estimated using quantile g-computation.

RESULTS

Using quantile g-computation models, a quartile increase in the PFAS mixture during the first, second, third, and average pregnancy was significantly associated with a relative risk (RR) of 1.73 (95% CI: 1.42, 2.12), 1.54 (95% CI: 1.27, 1.84), 1.75 (95% CI: 1.49, 2.08), and 1.63 (95% CI: 1.35, 1.97) for PPD at 6 months after childbirth, respectively. The results of the single-PFAS models also indicated significant positive associations between individual PFAS and PPD at both 1 and 6 months.

CONCLUSIONS

The first study of women with twin pregnancies suggests that prenatal exposure to PFAS increases PPD risk up to 6 months postpartum. Twin pregnant women should receive long-term follow-up after delivery and extensive social support.