Mother-to-Infant Bonding is Associated with Maternal Insomnia, Snoring, Cognitive Arousal, and Infant Sleep Problems and Colic

Kalmbach, David A.; O’Brien, Louise M.; Pitts, D’Angela; Sagong, Chaewon; Arnett, Lily; Harb, Nicholas C; Cheng, Philip; Drake, Christopher L.

doi:10.1080/15402002.2021.1926249

Cited by 17 publications

(12 citation statements)

References 53 publications

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“…The PUMAS programme is unique in its promotion of maternal–fetal attachment via meditations (e.g., baby is a focus in ‘Loving Kindness’), engaging in mindful activities with one's baby (e.g., mindfully feeling baby kick), and bringing awareness to pleasant events that involve the baby. The present study preliminarily supports PUMAS for increasing maternal–fetal attachment, which precedes strong mother‐to‐infant bonding in postpartum (Kalmbach et al, 2021).…”

Section: Discussionsupporting

confidence: 84%

Preliminary evidence of psychological improvements and increased maternal–fetal attachment associated with a mindfulness sleep programme: secondary analysis of uncontrolled data in 11 pregnant women with insomnia disorder

Kalmbach,

Reffi,

Ong

et al. 2023

Journal of Sleep Research

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SummaryTreating insomnia during pregnancy improves sleep and depressed mood. However, given well‐established links between poor sleep and a broad spectrum of adverse maternal outcomes, the benefits of insomnia care may reach beyond sleep and depression. The present study evaluated the preliminary efficacy of ‘Perinatal Understanding of Mindful Awareness for Sleep’ (PUMAS)—a mindfulness sleep programme tailored to pregnancy that combines behavioural sleep strategies and meditation—for enhancing everyday mindfulness and maternal–fetal attachment, as well as for alleviating anxiety, repetitive thinking, and sleep‐related daytime impairment. We conducted a secondary analysis of a single‐arm proof‐of‐concept trial of 11 pregnant women with fifth edition of the Diagnostic and Statistical Manual of Mental Disorders diagnosed insomnia disorder who completed PUMAS (six sessions), which was delivered in an individual format via telemedicine video. Pre‐ and post‐treatment outcomes included the Cognitive and Affective Mindfulness Scale‐Revised (CAMS‐R), Maternal–Fetal Attachment Scale (MFAS), Generalised Anxiety Disorder seven‐item survey (GAD‐7), Perseverative Thinking Questionnaire (PTQ), Daytime Insomnia Symptoms Response Scale (DISRS), and the Patient‐Reported Outcomes Measurement Information System Sleep‐Related Impairment Scale (PROMIS‐SRI). Symptom changes were evaluated with paired‐samples t tests. Results showed PUMAS patients reported large increases in CAMS‐R (Cohen's dz = 1.81) and medium‐large increases in MFAS scores (Cohen's dz = 0.73). Moreover, PUMAS patients reported large reductions in scores on the GAD‐7 (Cohen's dz = 1.09), PTQ (Cohen's dz = 1.26), DISRS (Cohen's dz = 1.38), and PROMIS‐SRI (Cohen's dz = 1.53). Preliminary evidence suggests that a mindfulness‐based perinatal sleep programme may benefit several domains of maternal wellbeing beyond sleep and depression. PUMAS substantially enhanced patient ratings of everyday mindfulness and maternal–fetal attachment, while reporting alleviations in anxiety, perseverative thinking, insomnia‐focused rumination, and sleep‐related daytime impairment.

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Section: Discussionsupporting

confidence: 84%

Preliminary evidence of psychological improvements and increased maternal–fetal attachment associated with a mindfulness sleep programme: secondary analysis of uncontrolled data in 11 pregnant women with insomnia disorder

Kalmbach,

Reffi,

Ong

et al. 2023

Journal of Sleep Research

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“…Moreover, the former indirectly predicted parenting stress 18 months later, mediated by maternal attachment. Likewise, aiming to disentangle the temporal course of these effects, a recent study showed that poorer mother‐to‐infant bonding was associated with poor infant sleep, which led to maternal insomnia linked to further bonding impairments (Kalmbach et al., 2021). As the current study used cross‐sectional data, it did not allow suitable analyses to determine the direction of effects.…”

Section: Discussionmentioning

confidence: 99%

Linking maternal psychopathology to children's excessive crying and sleeping problems in a large representative German sample—The mediating role of social isolation and bonding difficulties

Lux

Müller

Reck

et al. 2022

Infancy

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Attaining self‐regulation is a major developmental task in infancy, in which many children show transient difficulties. Persistent, clinically relevant difficulties in self‐regulation include excessive crying or sleeping disorders. Many families with affected children are burdened with multiple psychosocial risk. This suggests that regulatory problems are best conceptualized as the maladaptive interplay of overly burdened parents and a dysfunctional parent–child interaction. The current study examines whether social isolation and bonding difficulties function as mediating mechanisms linking maternal psychopathology to (1) children's excessive crying and (2) sleeping problems. The sample comprised N = 6598 mothers (M = 31.51 years) of children between zero to three years of age (M = 14.08 months, 50.1% girls). In addition to socio demographic data, the written questionnaire included information on maternal depression/anxiety, isolation, bonding, and children's regulatory problems. Hypotheses were tested with a mediation model controlling for psychosocial risk and child characteristics. As expected, maternal symptoms of depression/anxiety were linked to infants‘ excessive crying and sleeping problems. Social isolation and bonding difficulties mediated this association for excessive crying as well as for sleeping problems, but social isolation was a single mediator for sleeping problems only. The findings provide important insights in the mediating pathways linking maternal psychopathology to children's regulatory problems.

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“…Several large-scale studies have shown that over half of women experience insomnia by the end of pregnancy [ 4–9 ]. Women who develop prenatal insomnia report reduced quality of life [ 10 , 11 ], and are at increased risk for preterm birth [ 12 ], maternal depression [ 8 , 13–15 ], suicidal ideation [ 16 ], postpartum pain [ 17 ], and impaired mother-to-infant bonding [ 18 , 19 ]. Although the literature offers clear evidence that prenatal insomnia corresponds to adverse outcomes for mothers and their children, the field has been hampered by an important methodological limitation: classification methods for identifying cases of prenatal insomnia have been highly variable [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

“…This is a missed opportunity because rapidly growing evidence demonstrates that nocturnal arousal—particularly in the cognitive domain—during peripartum plays a key role in insomnia development and persistence [ 13 ], and even in treatment response to insomnia therapy during pregnancy [ 30 , 31 ]. Moreover, nocturnal cognitive arousal influences depression [ 13 ], suicidal ideation [ 16 ], and mother-to-infant bonding [ 19 ] independently of insomnia. To be able to identify and intervene to improve perinatal health, psychometric data are needed to guide accurate case identification of perinatal women with high nocturnal cognitive arousal and high nocturnal somatic arousal.…”

Section: Introductionmentioning

confidence: 99%

DSM-5 insomnia disorder in pregnancy: associations with depression, suicidal ideation, and cognitive and somatic arousal, and identifying clinical cutoffs for detection

Kalmbach

Cheng

Roth³

et al. 2022

SLEEP Advances

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Study objectives The study had three primary goals. First, we estimated survey-assessed DSM-5 insomnia disorder rates in pregnancy, and described associated sociodemographics, and sleep-wake and mental health symptoms. Second, we derived cutoffs for detecting DSM-5 insomnia disorder using common self-report measures of sleep symptoms. Third, we identified clinically relevant cut-points on measures of nocturnal cognitive and somatic arousal. Methods Ninety-nine women (85.9% in the 2 nd trimester) completed online surveys including DSM-5 insomnia disorder criteria, the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Pre-Sleep Arousal Scale’s Cognitive (PSASC) and Somatic (PSASS) factors, and Edinburgh Postnatal Depression Scale. Results DSM-5 insomnia disorder rate was 19.2%. Insomnia was associated with depression, suicidality, nocturnal cognitive and somatic arousal, and daytime sleepiness. An ISI scoring method that aligns with DSM-5 criteria yielded excellent metrics for detecting insomnia disorder and good sleep. Regarding quantitative cutoffs, ISI ≥ 10 and ISI ≥ 11 (but not ISI ≥ 15) were supported for detecting DSM-5 insomnia, whereas the ISI ≤ 7 and ISI ≤ 9 performed well for detecting good sleep. PSQI cutoff of 5 was supported for detecting insomnia and good sleep. The optimal cutoff for nocturnal cognitive arousal was PSASC ≥ 18, whereas the optimal cutoff for somatic arousal was PSASS ≥ 13. Conclusions Insomnia disorder affects a large segment of pregnant women. Empirically derived cutoffs for insomnia, good sleep, cognitive arousal, and somatic arousal may inform case identification and future perinatal sleep research methodology.

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Mother-to-Infant Bonding is Associated with Maternal Insomnia, Snoring, Cognitive Arousal, and Infant Sleep Problems and Colic

Cited by 17 publications

References 53 publications

Preliminary evidence of psychological improvements and increased maternal–fetal attachment associated with a mindfulness sleep programme: secondary analysis of uncontrolled data in 11 pregnant women with insomnia disorder

Preliminary evidence of psychological improvements and increased maternal–fetal attachment associated with a mindfulness sleep programme: secondary analysis of uncontrolled data in 11 pregnant women with insomnia disorder

Linking maternal psychopathology to children's excessive crying and sleeping problems in a large representative German sample—The mediating role of social isolation and bonding difficulties

DSM-5 insomnia disorder in pregnancy: associations with depression, suicidal ideation, and cognitive and somatic arousal, and identifying clinical cutoffs for detection

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