Sleep duration and quality in healthy nulliparous and multiparous women across pregnancy and post-partum

Sleep-wake timing and chronotype in perinatal periods: longitudinal changes and associations with insomnia symptoms, sleep-related impairment, and mood from pregnancy to 2 years postpartum

Across the perinatal transition, existing research focuses mainly on significant changes in sleep duration and quality, neglecting sleep timing. This study investigated change trajectories of sleep timing and chronotype from late pregnancy to 2 years postpartum and examined longitudinal associations of chronotype with symptoms of insomnia, daytime sleep-related impairment, and mood. Data were from a two-arm randomised controlled trial testing parent-focused wellbeing interventions. Participants were a community sample of nullipara without severe sleep/mental health conditions. Participants self-reported bedtime, rise-time, chronotype, insomnia symptoms, sleep-related impairment, depression, and anxiety at seven time points: gestation Weeks 30 and 35, and postpartum Months 1.5, 3, 6, 12 and 24. Trajectories were estimated using mixed-effects models with continuous time, quadratic splines, and a knot at childbirth, controlling for age and group allocation. A total of 163 participants (mean [SD] age 33.35 [3.42] years) took part. Bedtime and rise-times delayed during late pregnancy (~8 and ~20 min, respectively) but became progressively earlier (~20 and ~60 min, respectively) over the 2 postpartum years. Chronotype became more eveningness in late pregnancy, and more morningness after childbirth, however changes were small. Controlling for sleep duration and efficiency, greater morningness was associated with significantly less symptoms of insomnia and sleep-related impairment over time (all p < 0.001); longitudinal associations between chronotype and symptoms of depression and anxiety were non-significant (all p > 0.65). Sleep-wake timing and chronotype became progressively earlier from pregnancy to 2 years postpartum. Morningness chronotype may be sleep-protective during the transition from pregnancy to parenthood. Mechanisms underlying these associations require further research.

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

INTRODUCTION

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

The Integration of the Maternal Care with Sleep During the Postpartum Period

Our entire life occurs in a constant alternation between wakefulness and sleep. The impossibility of living without sleep implies that any behavior must adapt to the need for sleep, and maternal behavior does not escape from this determination. Additionally, maternal behavior in mammals is a highly motivated behavior, essential for the survival of the offspring. Thus, the mother has to adapt her physiology of sleep to the constant demands of the pups, where each species will have different strategies to merge these two physiological needs. However, all studied female mammals will experience sleep disturbances at some point of the postpartum period.

Changes in parental sleep from pregnancy to postpartum: A meta-analytic review of actigraphy studies

Sleep changes in new parents are widely observed but there is no extant meta-analysis of changes to sleep parameters in this group. We completed a meta-analysis of changes in actigraphy-measured parent sleep between pregnancy and the end of the first year of a child's life. A search of six databases was completed. Following review using predetermined inclusion and exclusion criteria, 16 papers were left for review. Data were extracted, analysed and each paper was reviewed for methodological quality. Where possible, subgroup analysis was completed based on time since birth and location of the study, and meta-regression of parent age. Parents' total sleep time and sleep efficiency were shown to decrease following the birth of a child, with wake after sleep onset increasing. This change was most notably observed in the first four weeks after birth. Up to 16 weeks post-birth, differences were still apparent, but sleep parameters were beginning to return to pre-birth levels. New parents experience a significant change in multiple sleep parameters following the birth of a child. Future data collection, using best practice actigraphy measurement, reporting a broader range of variables and including fathers, as well as mothers, is warranted.

Does breastfeeding influence sleep? A longitudinal study across the first two postpartum years

BACKGROUND

The association between breastfeeding and sleep of the gestational parent is poorly understood. This longitudinal study investigated how breastfeeding is associated with total nighttime sleep duration and sleep efficiency (percentage of total sleep time in bed) in nulliparous participants over the first two postpartum years.

METHODS

Nulliparous participants (N = 155, M_age  = 33.45, SD_age  = 3.50) self-reported patterns of breastfeeding via telephone interviews and sleep via self-report at 1.5, 3, 6, 12 and 24 months postpartum. Data were analyzed using mixed-effects models, with breastfeeding variables as predictors and sleep variables as outcomes, controlling for relevant covariates.

RESULTS

Neither the presence of breastfeeding nor the percentage of human milk in infants' total diets was significantly associated with participants' sleep duration or sleep quality (P-values > 0.08). This finding held after controlling for the number of nighttime feeds (P-values > 0.11). However, greater numbers of nighttime feeds, regardless of feeding content, were strongly associated with shorter sleep duration and poor sleep efficiency (P-values < 0.05). On average, with each additional nighttime feed, nocturnal sleep duration decreased by 6.6-8.4 minutes, and sleep efficiency decreased by 2.88%-3.02%.

CONCLUSIONS

Data from this study showed that breastfeeding per se was not associated with shorter or poor nocturnal sleep, but the number of nighttime feeds was. Sharing nighttime infant care amongst different carers in the household could help reduce postpartum sleep disturbance and ameliorate its negative impact on wellbeing.

Sleep patterns and intraindividual sleep variability in mothers and fathers at 6 months postpartum: a population-based, cross-sectional study

OBJECTIVES

Given that postpartum sleep is an important family process, further investigations including both mothers and fathers are necessary. The present study aimed to describe and compare sleep patterns and intraindividual night-to-night variability in mothers and fathers at 6 months postpartum using subjective and objective sleep measures.

DESIGN

Cross-sectional study.

SETTING

General community-based study in Montreal, QC, Canada.

PARTICIPANTS

Thirty-three couples (mothers and fathers) with no self-reported history of medical and mental health conditions participated in this study.

RESULTS

Parental sleep was measured across 10 consecutive nights using both a daily sleep diary and actigraphy. Results demonstrated that mothers' subjective and objective sleep was more fragmented compared with fathers (shorter longest consecutive sleep duration and more nocturnal awakenings; p<0.001). While mothers and fathers did not differ in their self-reported nocturnal sleep duration (p>0.05), actigraphy indicated that mothers obtained significantly longer nocturnal sleep duration (448.07 min±36.49 min) than fathers (400.96 min±45.42 min; p<0.001). Intraindividual sleep variability was revealed by relatively high coefficients of variation for parents across both subjective and objective indices related to sleep fragmentation (between 0.25 and 1.32). Actigraphy also demonstrated variability by mothers sleeping 6 hours consecutively on less than 3 nights, 27.27% (±22.81), and fathers on less than 6 nights, 57.27% (±24.53), out of 10. Associations were also found between parental sleep and family factors, such as age and infant sleep location (p<0.05).

CONCLUSIONS

These findings advance our knowledge of how sleep unfolds within the family system beyond the early postpartum weeks and/or months. Given the link between disturbed sleep and family functioning, the current research accentuates the importance of examining postpartum sleep patterns and variability in parents.

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

INTRODUCTION

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

METHOD

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

RESULT

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

CONCLUSION

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

Trajectories and Depressive Symptoms During the Perinatal Period: A Longitudinal Population-Based Study in China

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.

Cognitive Behavioural Therapy and Light Dark Therapy for Maternal Postpartum Insomnia Symptoms: Protocol of a Parallel-Group Randomised Controlled Efficacy Trial

Background: Symptoms of insomnia are common in new mothers and have been associated with a range of negative maternal and child outcomes. Despite this, interventions to improve maternal postpartum sleep remain scarce. Cognitive Behavioural Therapy (CBT) and Light Dark Therapy (LDT) represent two promising interventions for insomnia symptoms and associated daytime consequences such as fatigue. This randomised controlled trial examines whether CBT and LDT improve maternal insomnia symptoms as the primary outcome and maternal sleep disturbance, mood, fatigue, and sleepiness as secondary outcomes. This protocol paper outlines the development, design, and implementation of the trial. Methods: Participants are an Australian community-sample of 90 first-time mothers who are 4-12 months postpartum with self-reported symptoms of insomnia (Insomnia Severity Index scores ≥ 8). Exclusion criteria include current severe sleep/psychiatric disorders, unsettled infant sleep behaviour, sleep-affecting medication use, and photosensitivity. Eligible women are randomised into a CBT (strategies targeting sleep, worries, fatigue, and relaxation), LDT, or a treatment-as-usual control condition. Interventions are therapist-assisted and personalised through two telephone calls and include a series of automated intervention emails delivered over 6 weeks. Primary and secondary outcomes are assessed at four time points: baseline, intervention mid-point, post-intervention, and 1-month post-intervention. Discussion: If found effective, these interventions could represent efficacious, safe, and inexpensive treatments for improving postpartum insomnia and mitigate its negative impact on maternal well-being. Interventions tested are highly scalable and can be integrated into postpartum care and made available to the broader community. ANZCTR trial registration: Accessible at: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618000842268.

Quasi-Experimental study of effects of lighting on rest, activity and melatonin in postpartum women

OBJECTIVES

to compare the parameters of the activity/rest cycle of early postpartum breastfeeding women under a controlled and uncontrolled long wavelength ray light regimen.

METHODS

quasi-experimental study with breastfeeding women and their babies during postnatal rooming-in, São Paulo, Brazil. Participants were allocated to either an experimental (intervention) or a comparison group. The intervention involved exposure of the woman in a controlled room with artificial long wavelength ray light at night. Each woman's level of 6-sulfatoxymelatonin at 24 hours and activity/rest times was analyzed.

RESULTS

the mean activity/rest times of women in the experimental and comparison groups were similar. The mean percentages of total load of 6-sulfatoxymelatonin during the day and night were similar (p=0.09). At 24 hours, the experimental group presented a significantly lower mean percentage of total load compared to the comparison group (p=0.04).

CONCLUSIONS

women who stayed in the room with long-wavelength artificial light showed no difference in activity/rest and 6-sulfatoxymelatonin levels in the early postpartum period.

Sleep, biological rhythms and anxiety in the perinatal period: a systematic review protocol

INTRODUCTION

Pregnancy and new parenthood is an exciting time, but also a stressful life event that can predispose to mental health challenges. Perinatal anxiety is one such challenge, and is an important contributor to parental distress and other negative outcomes. Sleep and biological rhythms are often disrupted in the perinatal period. These disruptions have been associated with postpartum depression, and in some cases with perinatal anxiety. However, the literature concerning the association with perinatal anxiety is inconsistent and may be methodologically limited. To our knowledge, there has been no comprehensive review published characterising the relationships between sleep, biological rhythms, and perinatal anxiety and related disorders to date. In this systematic review, we will summarise the current state of the literature concerning these relationships, allowing us to highlight gaps and potentially inform clinical understanding of perinatal anxiety, sleep and biological rhythms.

METHODS AND ANALYSIS

Primary research articles will be eligible for inclusion if they assess perinatal anxiety or related disorders using validated criteria (self-report or diagnostic), assess sleep and biological rhythms in the perinatal period, include >4 participants and meet other inclusion/exclusion criteria. We will conduct comprehensive searches of MEDLINE, PsycINFO, Embase and CINAHL, with coverage spanning from database conception to search date (August 1, 2021). Key search concepts include (1) the perinatal period, (2) sleep/biological rhythms and (3) anxiety. Risk of bias will be evaluated using the Cochrane Risk of Bias Tool. Data will be narratively synthesised, with quantitative synthesis included if possible. When relevant, strength of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation criteria, and potential publication bias will be assessed.

ETHICS AND DISSEMINATION

Research ethics approval is not required. Study results will be reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results will be disseminated to relevant stakeholders as conference presentation(s) and submitted for publication in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

200166.

The Relationship Between a Baby's Age and Sleepiness in a Sample of Mothers

One question of great practical importance for the parents, and especially the mother, after the birth of a baby, refers to how long the time during which they have to go with less and more fragmented sleep actually lasts. Most of the studies only explore this issue up to 6 months of the newborn's life, and less is known about the sleep problems the mothers may have after this initial period. The objective of this study is to examine the relationship between the sleep disruption and daytime sleepiness of mothers with infants until 2 years old compared to a group of women currently not at care of babies. To this end, a sample of 113 women, 67 currently bringing up a baby of under 2 years old, and the remainder without a baby at their care under 6 years old, reported sleep duration, sleep interruptions, sleep quality, and responded to questionnaires of sleep quality and daytime sleepiness. The relationship between the age of the children and the comparison between the groups was used to highlight the sleep problems of the mothers taking care of the infant. The results showed that there was a positive relationship between the age of the infant and the duration of the sleep of the mothers and that the duration of sleep for them was similar to those of the women in the control group about 6 months after the infant was born. However, fragmentation of sleep, daytime sleepiness, and sleep problems were still higher than in the control group for mothers with children between 6 and 12 months old.

Sleep HAPi: A Feasibility and Descriptive Analysis of an Early and Longitudinal Sleep Education Intervention for Pregnant Women

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.

Sleep and physical activity from before conception to the end of pregnancy in healthy women: a longitudinal actigraphy study

BACKGROUND

Sleep and physical activity changes are common in pregnancy, but longitudinal data starting before conception are scarce. Our aim was to determine the changes of the daily total sleep time (TST) and physical activity duration (PAD) from before conception to end of pregnancies in respect of pregestational maternal factors.

METHODS

This longitudinal observational study formed part of the CONIMPREG research project and recruited healthy women planning to become pregnant. Sleep and physical activity were recorded around-the-clock for ≥4 days via actigraphy before conception and during each trimester of pregnancy. Data were adjusted according to pregestational maternal body composition, parity and age.

RESULTS

Among 123 women with eligible data, the unadjusted mean (95% confidence interval) TST increased from 415.3 min (405.5-425.2 min) before conception to 458.0 min (445.4-470.6 min) in the 1st trimester, remaining high through the 2nd and 3rd trimesters. Variation was substantial before conception (±2SD range: 307-523 min). The unadjusted mean PAD before conception was 363.7 min (±2SD range: 120-608 min), decreasing sharply to 262.1 min in the first trimester and more gradually thereafter. Vigorous and moderate activity decreased more than light activity. TST and PAD were significantly associated with age, parity, and pregestational body fat percentage; lean body mass was negatively correlated with TST. Results were generally unaffected by seasonal variations.

CONCLUSION

Marked variations were found in pregestational TST and PAD. Healthy women slept ≥30 min longer during pregnancy, while PAD decreased by ≥ 90 min in early pregnancy and continued to decrease thereafter.

Associations between prenatal sleep and psychological health: a systematic review

STUDY OBJECTIVES

This systematic review aimed to examine the: (1) strength of associations between prenatal sleep (ie, duration, quality, and insomnia) and psychological health (ie, depression, anxiety, and stress); and (2) moderating influence of sociodemographic characteristics (ie, maternal age, gestational age/trimester, parity, marital and socioeconomic status [SES]), body mass index (BMI), and meeting sleep recommendations.

METHODS

A systematic search was conducted using PubMed, PsycINFO, Web of Science, and CINHAL to identify studies with at least one sleep measure and a psychological health outcome. Effect sizes (ES) were calculated by associations between individual components of sleep and psychological health (eg, sleep quality-depression).

RESULTS

Reviewed studies (n = 32) included 14,648 participants and yielded 219 ES. ES for anxiety/stress were combined due to insufficient data to analyze individually. Average strengths of associations for sleep duration-depression (ES = .52) and sleep duration-anxiety/stress (ES = .48), sleep quality-depression (ES = .55) and sleep quality-anxiety/stress (ES = .58), and insomnia-depression (ES = .67) ranged from medium to large. Marital status, parity, BMI, and meeting sleep recommendations moderated sleep duration-depression and sleep duration-anxiety/stress. SES, gestational age/trimester, parity, and BMI moderated sleep quality-depression and sleep quality-anxiety/stress associations.

CONCLUSIONS

Poor sleep quality and depression are prevalent during pregnancy and may negatively impact maternal and fetal outcomes. Moderating effects suggest that pregnant women of different BMI status and gestational age differ in their sleep habits and depression and anxiety/stress levels. Findings highlight the need to better understand the impact of these associations on maternal-fetal outcomes to inform interventions to improve sleep and psychological health.

A mixed methods study of perinatal sleep and breastfeeding outcomes in women at risk for postpartum depression

INTRODUCTION

Pregnant and postpartum women experience significant sleep disruption, but the role of perinatal sleep disturbances in breastfeeding is understudied.

METHODS

In this observational cohort study, we used mixed methods to examine associations between perinatal sleep and breastfeeding. Forty-eight women (mean age 28.2 ± 4.9 years) who were euthymic at enrollment but had a history of major depression (n = 43) or bipolar disorder (n = 5) had sleep recorded with wrist actigraphy. We determined feeding status through daily diaries and used semi-structured interviews to identify themes regarding participants' experiences, breastfeeding decisions, and behaviors. To examine whether sleep disturbance during pregnancy predicted breastfeeding (BF) rates, we defined "lower sleep efficiency" (LSE) and "higher sleep efficiency" (HSE) groups based on the median split of actigraphic SE at 33 weeks' gestation (cutoff SE = 84.9%) and classified mothers as No-BF, Mixed-BF (BF + formula), and Exclusive-BF at 2 weeks postpartum.

RESULTS

Percentages of women who did any breastfeeding were: Week 2 = 72.3%, Week 6 = 62.5%, Week 16 = 50%. LSE mothers were less likely than HSE mothers to initiate breastfeeding (percent No-BF: LSE = 45.8%, HSE = 16.7%, P < .05). Average actigraphic sleep onset, sleep offset, time in bed, sleep duration, and SE did not differ based on breastfeeding status at any time point. Qualitative themes included insufficient preparation for the demands of breastfeeding, interrupted and nonrestorative sleep, and unrelenting daytime tiredness.

CONCLUSIONS

In our sample, preserved actigraphic SE during pregnancy was associated with initiation and continuation of breastfeeding. Future work should examine whether improving sleep in pregnancy improves mothers' feeding experiences.

Determinants of postpartum sleep duration and sleep efficiency in minority women

STUDY OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

How the Sleep of Couples Changes from Pregnancy to Three Months Postpartum

BACKGROUND

Sleep disturbances are frequent during pregnancy and postpartum. However, detailed research of sleep in couples during pregnancy and postpartum is lacking.

OBJECTIVE

Changes of sleep for primi- and multiparous pregnant women and their partners from late pregnancy to three months postpartum. The particular focus of this study is on sex differences in sleep, sleep problems, mutual sleep influence of couples, and the influences of parity and feeding methods on couples' sleep.

MATERIALS AND METHODS

The sample included 69 pregnant couples in the last trimester of pregnancy (t1) and three months after birth (t2). Sleep was measured with sleep diary for both times of measurement. The Pittsburgh Sleep Quality Index (PSQI) assessed sleep disturbances. Other variables as parity and infant feeding type were determined by questionnaire. Besides results for woman and men, also dyadic data are calculated.

RESULTS

Over the time women had a worse sleep quality than men. They had a prolonged sleep onset latency, higher frequency and longer duration of night wakings than men. Sleep efficiency for women was prepartal 83.32% and postpartal 83.6% below the clinically cut-off value of 85%. For 56.52% of women at t1 and for 55.07% at t2 PSQI scores exceeded the clinically cut-off of 5. However, men suffered from a sleep loss after birth of their child, too. In pregnancy and postpartum men reported lower total sleep time at both times of measurement in comparison to women. For 30.43% of men at T1 and for 24.64% at T2 PSQI score exceeded the clinically cut-off of 5. Sleep efficiency for men was prepartal 90.96% and postpartal 90.69%. Results indicate predictive links between prepartal PSQI of couples to postpartal PSQI. Neither parity nor feeding method could explain variance in postpartal PSQI-score.

CONCLUSION

This is one of the very rare studies incorporating dyadic data. Results show the need of diagnosing and treating existing sleep problems in pregnancy to prevent future sleep problems postpartum.

A Review of Sleep Architecture and Sleep Changes During Pregnancy

Importance

Poor sleep is widely recognized as a common complaint in pregnancy, and yet there are incomplete data on the exact nature of these complaints, what their implications for fetal and maternal health are, and how to best recognize and address these significant health issues.

Objectives

The purpose of this article is to review the current literature on the changes in objectively measured sleep parameters that occur during pregnancy, identify any possible trends, and discuss current implications for obstetric outcomes and treatments.

Evidence Acquisition

PubMed NCBI and Google Scholars database were searched for a variety of sleep-related terms, and articles were selected based on relevance to the topic and method of sleep pattern monitoring.

Results

Poor sleep is ubiquitous during pregnancy, and the relatively few studies evaluating the issue using objective polysomnography have small sample sizes. However, data suggests sleep architecture changes begin as early as the first trimester, and there is evidence that primigravid sleep structure never returns to prepregnancy levels after birth. In addition, cesarean delivery frequency, early labor, labor length, depression, gestational hypertension, and gestational diabetes all appear to be influenced by sleep changes. Current treatments are based on nonpregnant populations and may not be appropriate for the gravid patient.

Conclusions and Relevance

Disordered sleep is a more widespread and serious issue than most women are aware, and there are numerous obstetric and general health implications to cause clinician concern. More research is needed on both electroencephalography architecture changes and treatment options.

Mothers' and fathers' sleep: Is there a difference between first-time and experienced parents of 6-month-olds?

Sleep disruption and deprivation are highly prevalent among parents of an infant. However, most postpartum sleep studies focus solely on mothers, and few studies have investigated whether sleep differs between first-time and experienced parents. The present study aimed to determine whether self-reported sleep duration and quality differ between first-time and experienced mothers and fathers during the postpartum period. A total of 111 parents (54 couples and three single mothers) of 6-month-old infants completed a 2-week sleep diary to evaluate measures of sleep duration, sleep continuity, and sleep quality. An analysis of covariance model was used to compare the sleep variables of first-time to experienced parents. Breastfeeding frequency, infant sleep location, depression, education, and work status were used as co-variables. First-time mothers reported a longer consecutive nocturnal sleep duration (mean [SEM] 297.34 [17.15] versus 246.01 [14.79] min, p < .05), fewer nocturnal awakenings (mean [SEM] 1.57 [0.20] versus 2.12 [0.17], p < .05), and rated their sleep quality higher (mean [SEM] score 7.07 [0.36] versus 5.97 [0.30], p < .05) than experienced mothers, while total nocturnal sleep duration did not differ. There were no differences in subjective sleep measures between first-time and experienced fathers. The present study indicates that experienced mothers reported more fragmented sleep and perceived having worse sleep quality than first-time mothers, but that paternal sleep did not differ as a function of parental experience. These findings have clinical implications for healthcare professionals working with families of various configurations and sizes.

Short Nighttime Sleep Duration and High Number of Nighttime Awakenings Explain Increases in Gestational Weight Gain and Decreases in Physical Activity but Not Energy Intake among Pregnant Women with Overweight/Obesity

Pregnant women are at a high risk for experiencing sleep disturbances, excess energy intake, low physical activity, and excessive gestational weight gain (GWG). Scant research has examined how sleep behaviors influence energy intake, physical activity, and GWG over the course of pregnancy. This study conducted secondary analyses from the Healthy Mom Zone Study to examine between- and within-person effects of weekly sleep behaviors on energy intake, physical activity, and GWG in pregnant women with overweight/obesity (PW-OW/OB) participating in an adaptive intervention to manage GWG. The overall sample of N = 24 (M age = 30.6 years, SD = 3.2) had an average nighttime sleep duration of 7.2 h/night. In the total sample, there was a significant between-person effect of nighttime awakenings on physical activity; women with >1 weekly nighttime awakening expended 167.56 less physical activity kcals than women with <1 nighttime awakening. A significant within-person effect was also found for GWG such that for every increase in one weekly nighttime awakening there was a 0.76 pound increase in GWG. There was also a significant within-person effect for study group assignment; study group appeared to moderate the effect of nighttime awakenings on GWG such that for every one increase in weekly nighttime awakening, the control group gained 0.20 pounds more than the intervention group. There were no significant between- or within-person effects of sleep behaviors on energy intake. These findings illustrate an important need to consider the influence of sleep behaviors on prenatal physical activity and GWG in PW-OW/OB. Future studies may consider intervention strategies to reduce prenatal nighttime awakenings.

Perinatal Insomnia and Mental Health: a Review of Recent Literature

PURPOSE OF REVIEW

The perinatal period is a time of high risk for insomnia and mental health conditions. The purpose of this review is to critically examine the most recent literature on perinatal insomnia, focusing on unique features of this period which may confer specific risk, associations with depression and anxiety, and emerging work on perinatal insomnia treatment.

RECENT FINDINGS

A majority of perinatal women experience insomnia, which may persist for years, and is associated with depression and anxiety. Novel risk factors include personality characteristics, nocturnal perinatal-focused rumination, and obesity. Mindfulness and physical activity may be protective. Cognitive-behavioral therapy for insomnia is an effective treatment. Perinatal insomnia is exceedingly common, perhaps due to factors unique to this period. Although closely linked to perinatal mental health, more work is needed to establish causality. Future work is also needed to establish the role of racial disparities, tailor treatments, and determine whether insomnia treatment improves perinatal mental health.

Sleep Disturbance in Early Pregnancy, but Not Inflammatory Cytokines, May Increase Risk for Adverse Pregnancy Outcomes

BACKGROUND

It is unclear whether subjective or objective measures of sleep during pregnancy are more pertinent to pregnancy outcomes. Moreover, it is unclear as to whether subjective indices (i.e., those likely influenced by psychological thoughts and emotions) are more likely than objective measures to modify inflammatory cytokines.

METHOD

Subjective and objective measures of sleep were collected from 166 pregnant women. Sleep data, both aggregate and variability measures, from diary and actigraphy, were ascertained for three 2-week periods during early gestation (10-20 weeks). A fasting morning blood sample was assayed for the cytokines (IL-6, IFN-γ, and TNF-α). Sleep, stress, and depression questionnaires were also collected. Repeated measures ANOVAs, regression models, and independent t tests were used to analyze the data.

RESULTS

Diary-assessed total sleep time (p < .05) and actigraphy-assessed sleep latency (p = .05) were negatively associated with gestational age. Variability in actigraphy-assessed sleep latency (p < .01) was negatively associated with infant weight. None of the cytokines was associated with any of the outcomes. t tests revealed that those with a complication were older (p < .05) and had higher pre-pregnancy BMI (p < .05), higher self-reported stress (p < .05), and lower IFN-γ (p < .05).

CONCLUSION

Findings suggest that longer and more variable sleep latency, as well as shorter sleep duration, is associated with shorter gestational age or a lower birth weight infant. Overall, the findings suggest that among a low-risk, healthy sample of pregnant women, sleep disturbance does not pose a substantial risk for adverse delivery outcomes.

Sleep and sleep disorders in pregnancy

Pregnancy is associated with a number of physiologic changes in the body including hormonal, anatomical, and mechanical. These changes alter many physiologic functions including sleep. The literature suggests that a number of women develop changes in duration, pattern, and quality of sleep during pregnancy. In addition, these changes also pave the way for expression of sleep disorders (e.g., insomnia, obstructive sleep apnea, and restless legs syndrome). Change in sleep and appearance of sleep disorders not only influence pregnant women, but also have negative influences on the fetus and outcomes of pregnancy. However, optimal management of these disorders may reverse adverse consequences. In this chapter, risk factors, clinical presentation, and management of insomnia, obstructive sleep apnea, and restless legs syndrome during pregnancy are discussed in view of the available literature.

Polysomnographic features of pregnancy: A systematic review

Symptoms of sleep disturbances are common among pregnant women and generally worsen across gestation. Pregnancy-related sleep disorders are not only associated with a poor quality of life of the affected mothers, but also with adverse perinatal outcomes, including perinatal depression, gestational diabetes, preeclampsia, and preterm birth. The current knowledge about the impact of sleep disorders during pregnancy largely derives from the results of sleep surveys conducted in various populations. However, the number of studies examining changes in objective sleep variables during pregnancy via polysomnography has progressively increased in recent years. Here we systematically reviewed the polysomnographic studies available in the literature with the aim to describe the sleep pattern and to identify possible markers of sleep disruption in pregnant women. Based on our analysis, subjective worsening of sleep quality across gestation is related to objective changes in sleep macrostructure, which become particularly evident in the third trimester. Pregnancy per se does not represent an independent risk factor for developing major polysomnography-assessed sleep disorders in otherwise healthy women. However, in women presenting predisposing factors, such as obesity or hypertension, physiological changes occurring during pregnancy may contribute to the onset of pathological conditions, especially sleep-disordered breathing, which must be carefully considered.

Effect of maternal sleep in late pregnancy on leptin and lipid levels in umbilical cord blood

OBJECTIVES

To study the impact of maternal sleep in late pregnancy on birth weight (BW) and leptin and lipid levels in umbilical cord blood.

STUDY DESIGN

A total of 277 healthy and singleton pregnancy women were recruited for participation in the Shanghai Sleep Birth Cohort Study (SSBC) during their 36-38 weeks of pregnancy, from May 2012 to July 2013. Maternal night sleep time (NST), sleep efficiency (SE), sleep onset latency (SOL) and the percentage of wake after sleep onset (WASO) in NST and midpoint of sleep (MSF) were measured by actigraphy for seven consecutive days. The leptin and lipid levels were determined in cord blood samples collected from the umbilical vein immediately after delivery. Birth information (birth weight, gender, delivery type, etc.) was extracted from medical records. A multivariable linear regression model was applied to examine the effect of maternal sleep in late pregnancy on newborn leptin and lipid levels in umbilical cord blood.

RESULTS

A total of 177 women and their infants were included in the analysis. Maternal mean NST was 7.03 ± 1.10 h in late pregnancy, and 48% had a shorter sleep time (NST < 7 h). The average maternal SE was 72.54% ± 9.66%. The mean percentage WASO/NST was 21.62% ± 9.98%; the average MSF was about 3:34 (0:53); and the SOL was 46.78 ± 36.00 min. After adjustment for confounders, both maternal NST and SE were found to be significantly associated with triglyceride levels (β = -0.219, p = 0.006; β = -0.224, p = 0.006) in umbilical cord blood; and maternal NST was also observed to have positive association with newborn leptin levels (β = 0.146, p = 0.047). However, we did not find significant association between other maternal sleep parameters in late pregnancy and leptin and lipid levels and birth weight.

CONCLUSIONS

Short sleep duration and poor sleep quality during late pregnancy were associated with newborn leptin and lipid levels, and efforts on improving maternal sleep during late pregnancy should be advocated for children's health.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Perinatal Sleep Problems: Causes, Complications, and Management

Changes in sleep are ubiquitous in the perinatal period and it is important to be able to determine when these changes are significant enough to indicate sleep deficiency associated with increased risk for poor maternal and infant outcomes. Guidelines for identifying sleep deficiency include insomnia symptoms, excessively shortened sleep duration, and perception of insufficient or nonrestful sleep. Causes and complicating factors related to such sleep problems have been well-documented and are used to tailor behavioral and pharmacologic treatments for women who are pregnant or in the early postpartum period.

Relationship Between Sleep Quality, Depression Symptoms, and Blood Glucose in Pregnant Women

Sleep quality during pregnancy affects maternal/child health. We aimed to assess changes in sleep quality during pregnancy and determine its relationship to maternal mood, blood glucose, and work schedule among primiparous women. We conducted a prospective/longitudinal/observational study. Ninety-two pregnant women were recruited from Midwestern hospital. Mood and sleep quality data were collected using Edinburgh Postnatal Depression Scale/Pittsburgh Sleep Quality Index at Gestational Weeks 22 and 32. Forty-three women completed the study. Twenty-six women (63%) were African American and the mean age was 23.64 ( SD = 3.82) years. Rate of poor sleep quality increased during pregnancy with 25% of women had scores indicative of depression symptoms. Poor sleep quality score was related to mood scores ( p < .05) and work schedule. Blood glucose was not significantly related to sleep duration. In conclusion, poor sleep quality during pregnancy was associated with poor mood and work schedule, suggesting that interventions targeting mental health and lifestyles are needed.

Prolonged antepartum hospitalization: no time for rest

OBJECTIVE

To characterize sleep patterns among pregnant women undergoing prolonged antepartum hospitalization.

STUDY DESIGN

We conducted a prospective cohort study of women undergoing prolonged antepartum hospitalization after 20 weeks' gestation. Women were recruited to wear an Actigraph, complete a sleep log for 7 consecutive days, and complete a sleep survey at the end of the study period. Actigraphy was used to determine rest and sleep intervals, sleep onset latency, and wake time after sleep onset.

RESULTS

A total of 40 participants were recruited, and 28 had ≥ 5 nights of data for a total of 177 nights of antepartum sleep data. Mean gestational age was 30 weeks. Median sleep duration was 7.05 h ± 1.71 h. In all, 43.5% of women had an average sleep duration of <7 h per night. In all, 28.2% of the study nights had a bedtime between midnight and 5 am. Going to bed between midnight and 5 am was significantly associated with sleep durations of <7 h (70.7 vs. 32.5%, p < .001). Participants reported an average of 2.4 awakenings per night due to hospital-related events.

CONCLUSIONS

Prolonged antepartum hospitalization has a negative impact on sleep duration and quality.

Sleep in the Postpartum: Characteristics of First-Time, Healthy Mothers

Goals for the present study were to (a) describe the sleep of healthy new mothers over a 6-month postpartum period, (b) examine how sleep quality relates to daytime levels of fatigue and sleepiness, and (c) evaluate the relationship between mothers' and infants' sleep parameters. The sample consisted of 37 healthy, partnered, first-time mothers who had experienced full-term vaginal birth and had a healthy infant. We investigated infants' sleep parameters and mothers' sleep, mood, and daytime functioning 2 and 6 months postpartum. We found that at 2 months postpartum, mothers reported sleeping 6 hours at night and just under one hour during the day. Despite relatively frequent nocturnal awakenings, mothers experienced minimal insomnia, nonrefreshing sleep, anxiety, depression, daytime sleepiness, or fatigue at either 2 or 6 months. The most robust relationship between mothers' and infants' sleep was in the number of nocturnal sleep-wake episodes. Of note is that none of the infant sleep parameters was related to mothers' anxiety, depression, fatigue, sleepiness, or nonrefreshing sleep at either time period. Our results indicate that (1) selected low risk new mothers are resilient in terms of sleep quality, daytime functioning, and mood and (2) these are independent of their infants' sleep parameters.

Sleeping for Two: An Open-Pilot Study of Cognitive Behavioral Therapy for Insomnia in Pregnancy

Insomnia and disturbed sleep are common during pregnancy. This study investigated the effectiveness of group cognitive-behavioral therapy for insomnia (CBT-I) delivered in pregnancy. Thirteen pregnant women with insomnia participated in five weekly CBT-I group sessions. All participants completed the study and provided baseline and follow-up data. Significant reductions in insomnia symptoms and increases in subjective sleep quality were observed over the course of the study. Diary and actigraphy assessments of sleep also changed, such that participants reported less time in bed (TIB), shorter sleep onset latency (SOL), increased sleep efficiency (SE), and increased subjective total sleep time (TST). Additionally, symptoms of depression, pregnancy-specific anxiety, and fatigue all decreased over the course of treatment. Effect sizes ranged from medium to large. CBT-I delivered during pregnancy was associated with significant improvements in sleep and mood. The next step in this area of inquiry is to better establish effectiveness via a randomized controlled trial.

Anticipatory guidance to prevent infant sleep problems within a randomised controlled trial: infant, maternal and partner outcomes at 6 months of age

OBJECTIVE

To evaluate the effectiveness of sleep education delivered antenatally and at 3 weeks postpartum to prevent infant sleep problems at 6 months of age.

DESIGN

Sleep intervention within a randomised controlled trial for the Prevention of Overweight in Infancy (POI) study.

PARTICIPANTS

802 families were randomly allocated to one of four groups: usual care (control), sleep intervention (sleep), food, activity and breastfeeding intervention (FAB), and combined group receiving both interventions (combination).

INTERVENTIONS

All groups received standard Well Child care. The sleep intervention groups (sleep and combination) received an antenatal group education session (all mothers and most partners) emphasising infant self-settling and safe sleeping, and a home visit at 3 weeks reinforcing the antenatal sleep education. FAB and combination groups received four contacts providing education and support on breast feeding, food and activity up to 4 months postpartum.

OUTCOME MEASURES

Here we report secondary sleep outcomes from the POI study: the prevalence of parent-reported infant sleep problems and night waking, and differences in sleep duration. Additional outcomes reported include differences in infant self-settling, safe sleep practices, and maternal and partner reports of their own sleep, fatigue and depression symptoms.

RESULTS

Linear or mixed linear regression models found no significant intervention effects on sleep outcomes, with 19.1% of mothers and 16.6% of partners reporting their infant's sleep a problem at 6 months. Actigraphy estimated the number of night wakings to be significantly reduced (8%) and the duration of daytime sleep increased (6 min) in those groups receiving the sleep intervention compared with those who did not. However, these small differences were not clinically significant and not observed in 24 hours infant sleep diary data. No other differences were observed.

CONCLUSION

A strategy delivering infant sleep education antenatally and at 3 weeks postpartum was not effective in preventing the development of parent-reported infant sleep problems.

Relationship between fatigue and sleepiness with general health of mothers in the postpartum period

Background:

Fatigue and changes in sleep patterns are one of the impressive features in the first year after birth, which have negative effects on work, family life, and social relationships. Therefore, the objective of this research was to investigate the relationship between fatigue and Stanford sleepiness with the general health of mothers in the postpartum period.

Materials and Methods:

The current research is a descriptive correlational study which was performed on 190 mothers between 2 and 24 postpartum weeks, referring to the health centers of Isfahan in 2014. All mothers meeting the inclusion criteria were selected through cluster purposive sampling. Data were collected by use of four questionnaires including profile and fertility, fatigue, Stanford sleepiness, and general health. Data were analyzed by statistical tests at a significance level of ≤0.05.

Results:

The results showed that 5.3%, 59.5%, and 35.3% of subjects had mild, moderate, and severe fatigue, respectively. In addition, 26.3% of women showed a public health disorder, and according to Stanford sleepiness, 20.5% of subjects had sleepiness. The statistical results indicated that there were significant relationships between fatigue (P ≤ 0.001, r = 0.52) and Stanford sleepiness (P = 0.04, r = 0.14), and mothers’ general health.

Conclusions:

According to prevalence of fatigue and sleepiness in the postpartum period and its relationship with maternal health, application of sleep health education and appropriate counseling during pregnancy and after delivery is recommended to prevent mothers’ mental complications in order to achieve a safe pregnancy.

Infant sleep and feeding patterns are associated with maternal sleep, stress, and depressed mood in women with a history of major depressive disorder (MDD)

Our goal was to examine associations of infant sleep and feeding patterns with maternal sleep and mood among women at risk for postpartum depression. Participants were 30 women (age ± SD = 28.3 ± 5.1 years) with a history of MDD (but not in a mood episode at enrollment) who completed daily sleep diaries, wore wrist actigraphs to estimate sleep, and had their mood assessed with the Hamilton Depression Rating Scale (HAM-D-17) during four separate weeks of the perinatal period (33 weeks pregnancy and weeks 2, 6, and 16 postpartum). They logged their infants' sleep and feeding behaviors daily and reported postnatal stress on the Childcare Stress Inventory (CSI) at week 16. Mothers' actigraphically estimated sleep showed associations with infant sleep and feeding patterns only at postpartum week 2. Shorter duration of the longest infant-sleep bout was associated with shorter maternal sleep duration (p = .02) and lower sleep efficiency (p = .04), and maternal sleep efficiency was negatively associated with the number of infant-sleep bouts (p = .008) and duration of infant feeding (p = .008). Neither infant sleep nor feeding was associated with maternal sleep at 6 or 16 weeks, but more disturbed infant sleep and more frequent feeding at 6 weeks were associated with higher HAM-D scores at 6 and 16 weeks and higher CSI scores. Sleep in the mother-infant dyad is most tightly linked in the early postpartum weeks, but mothers continue to experience disturbed sleep and infant sleep and feeding behaviors continue to be associated with mothers' depressive symptoms and stress ratings as long as 16 weeks postpartum. These data imply that interventions designed to improve maternal sleep and postpartum mood should include both mothers and infants because improving infant sleep alone is not likely to improve maternal sleep, and poor infant sleep is linked to postpartum depression and stress.

Sleep Moderates and Mediates the Relationship Between Acculturation and Depressive Symptoms in Pregnant Mexican-American Women

OBJECTIVE

Greater acculturation is associated with adverse perinatal outcomes in Mexican-American women, but the mechanisms by which acculturation influences perinatal outcomes are unclear. Pregnant acculturated Mexican-American women are more likely to engage in unhealthy prenatal behaviors relative to those less acculturated, including poor sleep. As sleep disruptions are associated with acculturation and negative perinatal outcomes, particularly maternal depression, alterations in sleep may adversely affect pregnant Mexican-American women.

METHODS

Sixty pregnant women of Mexican descent completed surveys about sleep, acculturation, depressive symptoms and potential protective factor of social support.

RESULTS

Acculturation, but not social support, significantly predicted increased sleep disruptions as well as overall feeling less refreshed upon waking across pregnancy. Moderation analysis indicated that more acculturated women who took longer to fall asleep reported increased depressive symptoms. Feeling refreshed upon waking also mediated the relationship between increased acculturation and elevated maternal depressive symptoms.

CONCLUSIONS

Acculturation and altered sleep contribute to greater risk in Mexican-American women for maternal depressive symptoms in the perinatal period. These findings have implications for prevention and treatment of maternal mental health disorders, which may adversely affect perinatal outcomes in the vulnerable Mexican-American population.

Sleep Hygiene and Sleep Quality of Third-Trimester Pregnant Women

The purpose of this descriptive study was to examine the associations of sleep hygiene and actigraphy measures of sleep with self-reported sleep quality in 197 pregnant women in northern Taiwan. Third-trimester pregnant women completed the Sleep Hygiene Practice Scale (SHPS) and the Pittsburgh Sleep Quality Index (PSQI) as well as the Center for Epidemiologic Studies-Depression Scale (CES-D), and wore an actigraph for 7 consecutive days. Student's t-test was used to compare the SHPS scores and means as well as variability of actigraphy sleep variables between poor sleepers (i.e., PSQI global score >5) and good sleepers (i.e., PSQI global score ≤5). Compared to good sleepers, poor sleepers reported significantly worse sleep hygiene, with higher SHPS scores and higher sleep schedule, arousal-related behavior, and sleep environment subscale scores. Poor sleepers had significantly greater intra-individual variability of sleep onset latency, total nighttime sleep, and wake after sleep onset than good sleepers. In stepwise linear regression, older maternal age (p = .01), fewer employment hours per week (p = .01), higher CES-D total score (p < .01), and higher SHPS arousal-related behavior subscale scores (p < .01) predicted self-reported global sleep quality. Findings support avoiding physically, physiologically, emotionally, or cognitively arousing activities before bedtime as a target for sleep-hygiene intervention in women during pregnancy.

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

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

Do psychosocial sleep interventions improve infant sleep or maternal mood in the postnatal period? A systematic review and meta-analysis of randomised controlled trials

Sleep complaints are common amongst mothers of infants and insufficient, inefficient or fragmented sleep is associated with postnatal depression. The aim of this review is to determine whether psychosocial sleep-focused interventions offered in the perinatal period improve infant sleep or maternal mood. We searched PubMed, PsycInfo, EMBASE and CINAHL with no date restriction. We reviewed 1097 articles, resulting in nine papers (n = 1,656) that fit the eligibility criteria for inclusion in the analyses. The primary outcome was infant sleep, defined as maternal reports of infant nocturnal total sleep time and number of night-time wakes. The secondary outcome was maternal mood. The meta-analysis indicated improvements in reported infant nocturnal total sleep time (Hedge's g = 0.204, p < 0.01). However, there was no evidence for reducing infant night wakes (Hedge's g = 0.103, p = 0.134). There was evidence of maternal mood improvements (Hedge's g = 0.152, p = 0.014), however, this could have been influenced by publication bias. Psychosocial sleep interventions appear to impact the amount of sleep that a mother reports her baby to have, although the infants continue to wake as frequently. More research is needed to confirm whether sleep-related improvements can translate into improvements in maternal mood.

Trajectories of Sleep Quality and Associations with Mood during the Perinatal Period

OBJECTIVE

The aim of this study was to investigate trajectories of sleep quality and associations with mood in the perinatal period. Although it is commonly accepted that subjective sleep quality declines during pregnancy and the transition to parenthood, some women may follow qualitatively distinct trajectories.

DESIGN, SETTING, AND PARTICIPANTS

Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Data were collected from 293 women at four time points: during early pregnancy, at Time 1 (T1; < 22 w gestational age [GA]; late pregnancy, at Time 2 (T2; 32 w GA); during the postnatal period at Time 3 (T3; 3 mo postpartum); and Time 4 (T4; 6 mo postpartum). A group-based semiparametric mixture model was used to estimate patterns of sleep quality throughout the perinatal period.

RESULTS

Four trajectory groups were identified, including patterns defined by high sleep quality throughout (21.5%), mild decrease in sleep quality (59.5%), significant decrease in sleep quality (12.3%) and a group with poor sleep quality throughout (6.7%). Women who had the worst sleep quality at Time 1 and those who experienced significant increases in sleep problems throughout pregnancy were also the groups who reported the highest levels of anxiety and depressive symptoms in early pregnancy and the lowest levels of social support. After controlling for covariates, the groups with worst subjective sleep quality during pregnancy were also the most likely to experience high symptoms of depression in the postpartum period.

CONCLUSIONS

Most of the women in our sample reported mild sleep disturbances through the perinatal period. A subgroup of women reported a significant decline in sleep quality from early to late pregnancy and another reported poor subjective sleep quality throughout pregnancy; these groups had the greatest risk of experiencing high symptoms of depression in the postpartum period.

Beyond the mean: A systematic review on the correlates of daily intraindividual variability of sleep/wake patterns

Features of an individual's sleep/wake patterns across multiple days are governed by two dimensions, the mean and the intraindividual variability (IIV). The existing literature focuses on the means, while the nature and correlates of sleep/wake IIV are not well understood. A systematic search of records in five major databases from inception to November 2014 identified 53 peer-reviewed empirical publications that examined correlates of sleep/wake IIV in adults. Overall, this literature appeared unsystematic and post hoc, with under-developed theoretical frameworks and inconsistent methodologies. Correlates most consistently associated with greater IIV in one or more aspects of sleep/wake patterns were: younger age, non-White race/ethnicity, living alone, physical health conditions, higher body mass index, weight gain, bipolar and unipolar depression symptomatology, stress, and evening chronotype; symptoms of insomnia and poor sleep were associated with higher sleep/wake IIV, which was reduced following sleep interventions. The effects of experimentally reduced sleep/wake IIV on daytime functioning were inconclusive. In extending current understanding of sleep/wake patterns beyond the mean values, IIV should be incorporated as an additional dimension when sleep is examined across multiple days. Theoretical and methodological shortcomings in the existing literature, and opportunities for future research are discussed.

Lavender Fragrance Essential Oil and the Quality of Sleep in Postpartum Women

Background:

Objectives:

Patients and Methods:

Results:

Conclusions:

Association of late-night carbohydrate intake with glucose tolerance among pregnant African American women

Obesity and late-night food consumption are associated with impaired glucose tolerance. Late-night carbohydrate consumption may be particularly detrimental during late pregnancy because insulin sensitivity declines as pregnancy progresses. Further, women who were obese (Ob) prior to pregnancy have lower insulin sensitivity than do women of normal weight (NW). The aim of this study is to test the hypothesis that night-time carbohydrate consumption is associated with poorer glucose tolerance in late pregnancy and that this association would be exacerbated among Ob women. Forty non-diabetic African American women were recruited based upon early pregnancy body mass index (NW, <25 kg m(-2) ; Ob, ≥30 kg m(-2) ). Third trimester free-living dietary intake was assessed by food diary, and indices of glucose tolerance and insulin action were assessed during a 75-g oral glucose tolerance test. Women in the Ob group reported greater average 24-h energy intake (3055 kcal vs. 2415 kcal, P < 0.05). Across the whole cohort, night-time, but not day-time, carbohydrate intake was positively associated with glucose concentrations after the glucose load and inversely associated with early phase insulin secretion (P < 0.05). Multiple linear regression modelling within each weight group showed that the associations among late-night carbohydrate intake, glucose concentrations and insulin secretion were present only in the Ob group. This is the first study to report an association of night-time carbohydrate intake specifically on glucose tolerance and insulin action during pregnancy. If replicated, these results suggest that late-night carbohydrate intake may be a potential target for intervention to improve metabolic health of Ob women in late pregnancy.