Sleep Trajectories of Women Undergoing Elective Cesarean Section: Effects on Body Weight and Psychological Well-Being

Abstract

BackgroundAfter cesarean section (CS), women may be at great risk for sleep disturbance, but little is known about temporal changes in their sleep patterns and characteristics. We had two aims: 1) to identify distinct classes of sleep-disturbance trajectories in women considering elective CS from third-trimester pregnancy to 6 months post-CS and 2) to examine associations of sleep trajectories with body mass index (BMI), depressive symptoms, and fatigue scores.MethodsWe analyzed data from a prospective cohort study of 139 Taiwanese pregnant women who elected CS. Sleep components were assessed using the Pittsburgh Sleep Quality Index in third-trimester pregnancy, 1 day, 1 week, 1 month, and 6 months post-CS. Data were collected on depressive symptoms, fatigue symptoms, and BMI. Sleep-quality trajectories were identified by group-based trajectory modeling.ResultsWe identified three distinct trajectories: stable poor sleep (50 women, 36.0%), progressively worse sleep (67 women, 48.2%), and persistently poor sleep (22 women, 15.8%). Poor sleep was significantly associated with pre-pregnancy BMI and more baseline (third-trimester pregnancy) depressive and fatigue symptoms. At 6 months post-CS, women classified as progressively worse or persistently poor sleepers showed a trend toward higher BMI (p<0.03), more depressive symptoms (p<0.001), and higher fatigue scores (p<0.001) than those with stable poor sleep.ConclusionsWomen had three distinct sleep-disturbance trajectories before and after elective CS. These poor-sleep courses were associated with BMI and psychological well-being. Our findings suggest a need to continuously assess sleep quality among women considering elective CS and up to 6 months post-CS.

The Relationship between Constitution of Traditional Chinese Medicine in the First Trimester and Pregnancy Symptoms: A Longitudinal Observational Study

“…There is a long history of investigation into the implications of sleep loss and sleepiness of pregnant/postpartum women [ 37 – 39 ]. It was explored that sleep of pregnancy/postpartum was associated with prepregnancy BMI and depressive and fatigue symptoms during third-trimester pregnancy [ 40 ]. It has been reported that infant feeding methods were not associated with objective, subjective, or sleepiness/fatigue [ 41 ].…”

In-Hospital Newborn Falls Associated With a Sleeping Parent: The Case for a New Paradigm

“…48 In 1 study, researchers found sleep disturbances peaked on postpartum day 1 through the first week, with slowly decreasing levels of exhaustion over 1 to 6 months. 49 In another study, researchers found that the mean sleepiness levels were highest at 1 month and that 50% of the study subjects reported excessive sleepiness at 18 weeks. 50 Fathers experienced higher levels of measured sleepiness than mothers and, in some instances, had a higher propensity for falling asleep than mothers.…”

“…In studies on parents, it was found both mothers and fathers have critically high levels of fatigue after the birth of an infant. [43][44][45][46][47][48][49][50][51] Assuming care responsibilities for a newborn is associated with interrupted sleep, shorter sleep duration, subjectively poor sleep quality, high levels of reported fatigue, feelings of excessive daytime sleepiness, [43][44][45][46][47][48][49][50][51] decreased sensitivity toward the infant' s needs, 46 and impaired neurobehavioral performance. 43,52 Sleep is a complex phenomenon, and new parents start the pregnancy with their own sleep patterns, which result in different levels of restorative sleep and baseline feelings of fatigue.…”

“…43,52 Sleep is a complex phenomenon, and new parents start the pregnancy with their own sleep patterns, which result in different levels of restorative sleep and baseline feelings of fatigue. 49,52,53 As the pregnancy progresses, there are changes in sleep patterns, known as trajectories. Prepregnancy baseline sleep influences the trajectories, but, increasingly, disrupted sleep is a commonality across the trajectories.…”

“…Prepregnancy baseline sleep influences the trajectories, but, increasingly, disrupted sleep is a commonality across the trajectories. 46,49 Sleep disturbances include a decrease in total sleep time and efficiency and an increase in the time awake after sleep onset. 48 In 1 study, researchers found sleep disturbances peaked on postpartum day 1 through the first week, with slowly decreasing levels of exhaustion over 1 to 6 months.…”