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Cited by 145Sleep and related disordersInfant Health and DevelopmentBreastfeeding Practices and Influences

Effect of behavioural-educational intervention on sleep for primiparous women and their infants in early postpartum: multisite randomised controlled trial

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Stremler, R., Hodnett, E., Kenton, L., Lee, K., Weiss, S., Weston, J., Willan, A.·2013·BMJ
DOI 10.1136/bmj.f1164PMC PMC3603553
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Abstract

OBJECTIVE: To evaluate the effectiveness of a behavioural-educational sleep intervention delivered in the early postpartum in improving maternal and infant sleep. DESIGN: Randomised controlled trial. SETTING: Postpartum units of two university affiliated hospitals. PARTICIPANTS: 246 primiparous women and their infants randomised while in hospital with an internet based randomisation service to intervention (n=123) or usual care (n=123) groups. INTERVENTIONS: The behavioural-educational sleep intervention included a 45-60 minute meeting with a nurse to discuss sleep information and strategies to promote maternal and infant sleep, a 20 page booklet with the content discussed, and phone contacts at one, two, and four weeks postpartum to reinforce information, provide support, and problem solve. The usual care group received calls at weeks one, two, and four to maintain contact without provision of advice. MAIN OUTCOME MEASURES: Primary outcome was maternal nocturnal (9 pm to 9 am) sleep (minutes) and secondary outcome was longest stretch of infant nocturnal sleep (minutes) measured at six and 12 weeks postpartum by actigraphy. Other outcomes measured at six and 12 weeks were number of maternal and infant night time awakenings by actigraphy, fatigue visual analogue scale, general sleep disturbance scale, and Edinburgh postnatal depression scale. Rates of exclusive breast feeding were measured at 12 weeks postpartum only. RESULTS: All women who completed any outcome measures at six or 12 weeks were included in analysis. Sleep outcomes were completed at one or both of six and 12 weeks postpartum for 215 of 246 (87%) women (110/123 intervention and 105/123 usual care). Longitudinal mixed effects model analyses indicated no significant differences between the groups on any of the outcomes. The estimated mean difference in maternal nocturnal sleep between the intervention and usual care groups was 5.97 minutes (95% confidence interval -7.55 to 19.5 minutes, P=0.39). No differences in any outcomes were noted based on the specific nurse delivering the intervention or the number of phone contacts received. CONCLUSION: A behavioural-educational intervention delivered in the early postpartum, in hospital, and in the first weeks at home, was ineffective in improving maternal and infant sleep or other health outcomes in the first months postpartum. TRIAL REGISTRATION: ISRCT No 13501166.

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  • For two studies the acceptance was unclear.

    “for a further two studies the acceptance was unclear [53, 63]”

    From Mental health-related telemedicine interventions for pregnant women and new mothers: a systematic literature review (2023) · cites this paper as [53]

    The cited trial does not leave participants’ acceptance of the trial unclear. In “Use of sleep advice, co-intervention, acceptability of trial” (page unavailable), it reports that 83% of intervention respondents liked receiving sleep information from the nurse, 79% liked the written material, and only 3.9% in each group said they probably would not participate again. The discussion raises uncertainty about acceptance of some individual strategies, but not about acceptance of the trial overall. (LLM, conf=0.82)

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  • Feasibility was unclear in two articles.

    “The feasibility was unclear in two articles [53, 58].”

    From Mental health-related telemedicine interventions for pregnant women and new mothers: a systematic literature review (2023) · cites this paper as [53]

    In “Meaning of the study and possible explanations” (page unavailable), the authors say they could not determine how closely women followed the recommended behaviours, leaving that aspect of implementation unclear. But “Strengths and weaknesses of this study” reports excellent compliance with receiving the intervention. The paper therefore supports a narrower uncertainty about putting the advice into practice, not an unqualified statement that feasibility was unclear. (LLM, conf=0.72)

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Research works printed but not linked: 1

  1. No commercial reuse: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe RESEARCH on 14 July 2023 by guest. Protected by copyright. http://www.bmj.com/ BMJ: first published as 10.1136/bmj.f1164 on 20 March 2013. Downloaded from of sleep restricted to 4-5 hours per night. Sleep 1997;20:267-77.

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Authors
Stremler, R., Hodnett, E., Kenton, L., Lee, K., Weiss, S., Weston, J., & Willan, A.
Affiliations
  • University of Toronto (CA)
  • University of San Francisco (US)
Corresponding author
Stremler, R.
ORCID
Venue
BMJ
Publisher
BMJ
Published
2013-03-20
Volume
346
Issue
mar20 1
Pages
f1164-f1164
ISSN
1756-1833 (ISSN-L)
DOI
10.1136/bmj.f1164
PMC
PMC3603553
OpenAlex
W1988562192
Cited by
145
References
46
Citations by year
2026: 5 · 2025: 12 · 2024: 9 · 2023: 13 · 2022: 9 · 2021: 14 · 2020: 11 · 2019: 19 · 2018: 11 · 2017: 7 · 2016: 9 · 2015: 10 · 2014: 7 · 2013: 8
FWCI
15.32
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
  • Canadian Institutes of Health Research (84658_1)
  • Ontario Ministry of Research and Innovation
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Health Professions › Pharmacy › Infant Health and Development
  • Health Sciences › Medicine › Epidemiology › Breastfeeding Practices and Influences
Keywords
postpartum sleep, maternal sleep, infant sleep, primiparous women, early postpartum period, nurse-led intervention, telephone follow-up, nocturnal sleep, nocturnal awakenings, postpartum depression, maternal fatigue, exclusive breastfeeding, intervention effectiveness, postpartum unit, home visits
MeSH terms
Adult, Behavior Therapy, Breast Feeding, Female, Follow-Up Studies, Health Promotion, Hospitals, University, Humans, Infant, Infant, Newborn, Ontario, Pregnancy, Surveys and Questionnaires, Sleep, Sleep Wake Disorders, Treatment Outcome, Depression, Postpartum, Gravidity, Postpartum Period

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