Cognitive Behavioral Therapy for Prenatal Insomnia

Manber, Rachel; Bei, Bei; Simpson, Norah; Asarnow, Lauren D.; Rangel, Elizabeth Ferreira; Sit, Anita; Lyell, Deirdre J.

doi:10.1097/aog.0000000000003216

Cited by 98 publications

(103 citation statements)

References 30 publications

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“…Given the potentially serious consequences of untreated anxiety and depression symptoms in pregnancy on physical and psychological outcomes, interventions are urgently needed to reduce symptoms and build resilience. Psychological interventions for preventing and treating depression and anxiety in pregnancy are effective, with cognitive behavior therapy (CBT) emerging as a front-line treatment and interpersonal therapy (IPT) potentially offering additional benefits to reduce depression and increase social support ( Field, 2017 ; Manber et al., 2019 ; O'Connor et al., 2019 ). Preliminary evidence also provides support for e-health interventions; however, trials to date are relatively small and scaling for widespread dissemination is urgently needed ( Felder et al., 2020 ; Heller et al., 2020 ; Loughnan et al., 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic

Lebel

MacKinnon

Bagshawe

et al. 2020

Journal of Affective Disorders

722

657

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Background Anxiety and depression symptoms in pregnancy typically affect between 10 and 25% of pregnant individuals. Elevated symptoms of depression and anxiety are associated with increased risk of preterm birth, postpartum depression, and behavioural difficulties in children. The current COVID-19 pandemic is a unique stressor with potentially wide-ranging consequences for pregnancy and beyond. Methods We assessed symptoms of anxiety and depression among pregnant individuals during the current COVID-19 pandemic and determined factors that were associated with psychological distress. 1987 pregnant participants in Canada were surveyed in April 2020. The assessment included questions about COVID-19-related stress and standardized measures of depression, anxiety, pregnancy-related anxiety, and social support. Results We found substantially elevated anxiety and depression symptoms compared to similar pre-pandemic pregnancy cohorts, with 37% reporting clinically relevant symptoms of depression and 57% reporting clinically relevant symptoms of anxiety. Higher symptoms of depression and anxiety were associated with more concern about threats of COVID-19 to the life of the mother and baby, as well as concerns about not getting the necessary prenatal care, relationship strain, and social isolation due to the COVID-19 pandemic. Higher levels of perceived social support and support effectiveness, as well as more physical activity, were associated with lower psychological symptoms. Conclusion This study shows concerningly elevated symptoms of anxiety and depression among pregnant individuals during the COVID-19 pandemic, that may have long-term impacts on their children. Potential protective factors include increased social support and exercise, as these were associated with lower symptoms and thus may help mitigate long-term negative outcomes.

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Section: Discussionmentioning

confidence: 99%

Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic

Lebel

MacKinnon

Bagshawe

et al. 2020

Journal of Affective Disorders

722

657

View full text Add to dashboard Cite

show abstract

“…Furthermore, antenatal insomnia is reported as a risk factor for experiencing insomnia postpartum (Dørheim et al, 2014). Hence, since cognitive behavioral therapy for insomnia (CBT-I) is not only associated with reduced symptoms of both insomnia and depression (Ballesio et al, 2017;Manber et al, 2019), but also reportedly safe and effective during pregnancy (Manber et al, 2018;Tomfohr-Madsen et al, 2017), it might improve symptoms of perinatal insomnia and depression when provided from mid-pregnancy on to women with insomnia, but more research on that topic remains necessary. Our results concerning associations between insomnia and depression did not differ significantly between primiparous and multiparous women, which suggests that parity plays a limited role in the interaction of perinatal sleep and mood (Coo Calcagni et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

Mid-Pregnancy Insomnia and its Association with Perinatal Depressive Symptoms: A Prospective Cohort Study

Osnes

Eberhard‐Gran

Follestad

et al. 2020

Behavioral Sleep Medicine

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Objective/Background: Insomnia and depression are disorders that affect many perinatal women and that often are interrelated. The present study aimed to examine concurrent and prospective associations between midpregnancy insomnia and depression during mid-pregnancy and 8 weeks postpartum. Furthermore, differences in depression and in the sleep-related characteristics insomnia, chronotype, and sleep efficiency were explored between the two time points (mid-pregnancy versus 8 weeks postpartum), and between primiparous and multiparous participants. Participants/Methods: The study was part of the Norwegian populationbased Depression and Anxiety in the Perinatal Period (DAPP) prospective cohort study. Among 539 women that were recruited for participation when receiving a routine ultrasound examination, we analyzed data from hospital birth records and questionnaire responses from pregnancy week 17 and postpartum week 8. We used the Edinburgh Postnatal Depression Scale to measure depression. The Bergen Insomnia Scale, the reduced Horne-Östberg Morningness-Eveningness Questionnaire, and three questions from the Pittsburgh Sleep Quality Index were used to measure the sleep-related characteristics. Results: Mid-pregnancy insomnia was significantly associated with concurrent depression (p < .001), but not with postpartum depression (p = .288), in a linear mixed model with adjustment for several reproductive and psychosocial variables. Sleep efficiency was reduced from mid-pregnancy to postpartum (from 88% to 77%), and primiparous women reported less efficient sleep than multiparous women after childbirth. Conclusions: The results indicate that mid-pregnancy insomnia may be a marker for concurrent depression but not a predictor of postpartum depression. Future research should examine the extent to which treatment of insomnia from mid-pregnancy on reduces both perinatal insomnia and depression.

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“…A recently published randomized controlled trial showed that pregnant women randomized to undergo CBT-I experienced a significantly greater reduction in insomnia severity and faster remission of insomnia compared with women assigned to a control intervention. 41 Preliminary evidence from a small trial showed improvement in symptoms of depression, pregnancy-specific anxiety, chestjournal.org and fatigue, following treatment with CBT-I. 42 The impact of interventions to treat insomnia on maternal or fetal outcomes remains to be examined, however.…”

Section: Treatment Considerations For Insomnia In Pregnancymentioning

confidence: 99%

Sleep Pharmacotherapy for Common Sleep Disorders in Pregnancy and Lactation

Miller

Mehta

Clark-Bilodeau

et al. 2020

Chest

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Sleep disturbances are common in pregnancy, and sleep disorders may worsen or present de novo in the course of gestation. Managing a pregnant patient is complicated by the risk of teratogenicity, pharmacokinetic changes, and the dynamic nature of pregnancy. Although nonpharmacologic interventions are likely safest, they are often ineffective, and a patient is left dealing with frustrations of the sleep disturbance, as well as the negative outcomes of poor sleep in pregnancy. As with any other condition in pregnancy, management requires an understanding of pregnancy physiology, knowledge of the impact of a given condition on pregnancy or fetal and neonatal outcomes, and an ability to weigh the risk of the exposure to an untreated, or poorly treated condition, against the risk of a given drug. In partnership with the pregnant patient or couple, options for therapy should be reviewed in the context of the impact of the condition on pregnancy and offspring outcomes, while understanding that data (positive or negative) on the impact of therapy on perinatal outcomes are lacking. This article reviews the epidemiology of sleep disorders in pregnancy, general principles of prescribing in pregnancy and lactation, and safety surrounding therapeutic options in pregnancy.CHEST 2020; 157(1): [184][185][186][187][188][189][190][191][192][193][194][195][196][197]

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Cognitive Behavioral Therapy for Prenatal Insomnia

Abstract: Cognitive behavioral therapy for insomnia is an effective treatment for prenatal insomnia disorder.

Cited by 98 publications

References 30 publications

Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic

Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic

Mid-Pregnancy Insomnia and its Association with Perinatal Depressive Symptoms: A Prospective Cohort Study

Sleep Pharmacotherapy for Common Sleep Disorders in Pregnancy and Lactation

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