Antenatal mental health requires at least as much attention and resourcing as mental health in the postpartum period. Services need to specifically target Māori women, young women and women with a prior history of depression.

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ObjectivesTo explore associations between features of sleep during pregnancy and adverse outcomes for the infant.SettingE Moe, Māmā is a cohort study in Aotearoa/New Zealand that investigates self-reported sleep and maternal health in late pregnancy and the postpartum period.ParticipantsWomen (N=633; 194 Māori) reported detailed information on their sleep duration, quality, disturbances, disorders (snoring, breathing pauses, twitching legs, restless legs) and daytime sleepiness between 35 and 37 weeks gestation.Outcome measuresBirthweight and fetal distress during labour were extracted from medical records. Associations between each sleep variable and small or large for gestational age (SGA/LGA) using customised birthweight centile or fetal distress were estimated using multinomial/logistic regression, controlling for potential confounders. Secondary analyses considered differences in associations between Māori and non-Māori women.ResultsThere was some indication that breathing pauses (a measure of sleep apnoea) were associated with both SGA (OR 2.8, 95% CI 0.9 to 9.0, p=0.08) and LGA (OR 2.0, 95% CI 0.7 to 5.7, p=0.20), with the association for LGA being stronger when only pregnancy-onset breathing pauses were considered (OR 3.5, 95% CI 1.3 to 9.6, p=0.01). There was also some evidence that pregnancy-onset leg twitching (OR 3.3, 95% CI 1.1 to 10.0, p=0.03) and frequent sleep disturbance due to feeling too hot or too cold (OR 1.7, 95% CI 0.9 to 3.6, p=0.13) were associated with higher risk of fetal distress. Other sleep measures, including snoring, were not associated with SGA, LGA or fetal distress. Many of the associations we observed were considerably stronger in Māori compared with non-Māori women.ConclusionsWe did not find evidence of previously reported associations between snoring and SGA. Our findings tentatively suggest that self-reported breathing pauses and leg twitching in late pregnancy are associated with infant outcomes, and highlight ethnic inequalities.

This study tested the acceptability and efficacy of a perinatally delivered behavioral-educational sleep intervention. Methods: Participants were 40 primiparous women assigned in late pregnancy to either an intervention (n = 20) or control (n = 20) group. The sleep intervention group (SIG) received prenatal anticipatory education and guidance regarding their own and their infant's sleep during the first 3 months postpartum. This was reinforced during phone calls within the first 6 weeks postpartum. The control group (CG) received brief sleep hygiene information at a prenatal session, followed by 2 phone calls during the same period. Mother-infant pairs wore actigraphs for 48 hours at 6 and 12 weeks postpartum, and mothers kept sleep diaries. Questionnaires completed in late pregnancy and 6 and 12 weeks postpartum related to sleep, newborn care, and mood. The main outcome measures included maternal sleep quantity, efficiency, and self-reported quality and infant sleep duration and consolidation. Results: Mothers reported high acceptability of the study processes. Sleep duration and quality increased for mothers and infants across time in both groups, with a significantly greater increase in nocturnal sleep duration for mothers in the SIG. Conclusions: Prenatal sleep guidance and postnatal follow-up seems to enhance nocturnal sleep of mothers, change their perceptions of their own sleep, and increase confidence in managing their infant's sleep. Follow-up at later intervals and replication with larger, more diverse samples may reveal further differences.

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