Mindfulness-Based Cognitive Therapy in Pregnancy and Sleep Quality: Secondary Analysis from a Randomized Controlled Trial

Abstract

Poor sleep quality during pregnancy is prevalent, commonly persists into the postpartum period, and has been associated with poor maternal and child outcomes including risk of preterm birth and postpartum depression. Pregnant individuals are hesitant to take medication leaving many without evidence-based treatments for sleep problems. Mindfulness-based interventions have been shown to improve sleep in adults, but their impact on sleep in pregnancy has rarely been investigated. The current investigation comprises secondary analysis of a randomized controlled trial (RCT) of an 8-week modified Mindfulness-Based Cognitive Therapy for Perinatal Depression (MBCT-PD) group intervention for pregnant individuals experiencing psychological distress. A community sample of pregnant individuals who self-identified as experiencing high levels of psychological distress were randomized to MBCT-PD (n=28) or treatment as usual (n=32) conditions. Assessments comprised a sleep quality questionnaire, a sleep diary and actigraphy, at enrolment, post- intervention, and follow-up at 3 months postpartum. Multilevel modeling revealed a significant effect of MBCT-PD on overall sleep quality across time moderated by baseline levels, such that participants with initial worse sleep quality who received treatment had greater improvement from post intervention to follow-up. Sleep efficiency assessed by diary improved significantly among those who received MBCT-PD, but no other differential changes were observed in diary or actigraphy parameters. Among pregnant individuals with high levels of psychological distress, training in mindfulness was associated with secondary benefits for sleep. Further research is warranted to examine what MBCT-PD components are necessary and could be tailored to address sleep problems during pregnancy.