Trajectories of pain intensity, pain catastrophizing, and pain interference in the perinatal and postpartum period.

Introduction: Chronic pain (pain >3 months) is a growing epidemic. Normal pregnancy may give rise to recurrent and sometimes constant pain for women. Women with worse pain symptoms are more likely to report symptoms of anxiety, depression, and/or insomnia during the perinatal period, which may impact labor and delivery outcomes. We examined the relationship between demographic and psychological predictors of pain throughout pregnancy and into the postpartum. Objectives: To examine trajectories of pain intensity, pain catastrophizing, and pain interference during pregnancy and the early postpartum, and associated sociodemographic predictors of trajectory membership. Methods: One hundred forty-two pregnant women were assessed at 4 time points for measures of pain intensity, pain catastrophizing, pain interference, and symptoms of insomnia, depression, and generalized anxiety. Women completed the first survey before 20 weeks' gestation and were reassessed every 10 weeks. Surveys were completed on average at 15 weeks', 25 weeks', and 35 weeks' gestation, and at 6-week postpartum. Using latent class mixed models, trajectory analysis was used to determine trajectories of pain intensity, pain catastrophizing, and pain interference. Results: A 1-class pain intensity model, 2-class pain catastrophizing model, and 3-class pain interference model were identified. Adaptive lasso and imputation demonstrated model robustness. Individual associations with trajectories included baseline symptoms of anxiety, depression, and insomnia, and pain symptomology. Conclusion: These findings may help to identify women who are at high risk for experiencing pain symptoms during pregnancy and could aid in developing targeted management strategies to prevent mothers from developing chronic pain during their pregnancy and into the postpartum period.

Trait mindfulness and sleep: Interactions between observing and nonreactivity in the association with sleep health.

The current study investigated the associations between trait mindfulness and sleep health and examined the interactions between theoretically related mindfulness subscales. Participants (n = 162, Mage = 19.93) reported trait levels of mindfulness and sleep was assessed using questionnaires and actigraphy. Higher mindfulness scores in awareness, nonreactivity, and nonjudgment were associated with better sleep health. The associations between observing and sleep health were moderated by nonreactivity. Results indicate that observing is associated with better sleep health at higher levels of nonreactivity and worse sleep health at lower levels, helping to explain the often-contradictory findings between observing and health outcomes.

Trajectories and Correlates of Anger During the Perinatal Period.

OBJECTIVES: To investigate trajectories of anger during pregnancy and the early postpartum period; to identify baseline psychosocial predictors of anger trajectory group membership; and to examine correlates of anger trajectory group membership, including symptoms of depression, anxiety, insomnia, and social support, in the postpartum period. DESIGN: Longitudinal descriptive design. SETTING: We recruited participants from a maternity clinic in Calgary, Alberta, Canada. PARTICIPANTS: The sample included a convenience sample of 143 pregnant women who had basic fluency in English, were older than 17 years of age, and were less than 19 weeks gestation with a single fetus at the time of recruitment. METHODS: Participants completed online questionnaires at four time points: early, mid-, and late pregnancy and 2 months after birth. We used group-based semiparametric mixture modeling to estimate patterns of anger. We used multinomial logistic regression to explore associations between baseline predictors and trajectory membership. RESULTS: We identified four distinct trajectories of anger during pregnancy through 2 months after birth: minimal-stable anger (55%), mild-stable anger (24%), moderate-stable anger (14%), and high-decreasing anger (7%). Membership in the moderate-stable group was associated with greater baseline symptoms of depression, anxiety, and insomnia severity scores compared to the minimal-stable anger group. Moderate-stable trajectory group membership was also associated with greater symptoms of anxiety, depression, and insomnia at 2 months after birth. CONCLUSION: Higher levels of anger were associated with worse mental health in pregnancy and after childbirth in our participants. Women should be made aware of anger as a possible mood disturbance by clinicians, and researchers should investigate the consequences of anger during the perinatal period.

Trajectories of Insomnia Symptoms and Associations with Mood and Anxiety from Early Pregnancy to the Postpartum.

Objective/Background: The current study identified heterogeneous trajectories of insomnia symptoms from early pregnancy to early postpartum. The relationship between demographic and psychological predictors of trajectories and associations between trajectory group membership and symptoms of postpartum depression and anxiety were also explored.Participants: 142 pregnant women were enrolled in a prospective online survey.Method: Women were recruited from a maternity clinic in Calgary, AB and completed measures of insomnia symptoms, depression, generalized anxiety, and interpersonal support at four time-points. Women were recruited and completed the first survey before 20 weeks gestation and were reassessed every 10 weeks. Women were on average 15 weeks gestation, 25 weeks gestation, 35 weeks gestation, and 6 weeks postpartum at the respective time-points. Group-based trajectory analysis was used to determine trajectories of pregnancy insomnia symptoms.Results: Three trajectory groups were identified. A no insomnia group (42.3%) in which women reported consistently low insomnia symptoms. A subclinical insomnia group (44.3%) in which women reported subclinical symptoms which briefly elevated to clinical levels in late-pregnancy, and a clinical insomnia group (13.4%) in which women reported consistently elevated insomnia symptoms. Baseline predictors of membership group included anxiety, depression, and ethnicity such that members of the clinical insomnia group were more likely to also endorse anxiety and depression. Membership in the clinical insomnia group was associated with higher postpartum generalized anxiety and depressive symptoms. Additionally, the clinical insomnia group were more likely to experience symptoms indicative of clinically significant depression.Conclusions: A small group of pregnant women experienced consistently high and elevated insomnia symptoms throughout pregnancy and another larger group endorsed consistently elevated but subthreshold symptoms. Future studies should explore long-term consequences of experiencing high insomnia symptomatology during pregnancy and early postpartum, as well as safe and efficacious interventions.

Insomnia symptoms during pregnancy: A meta-analysis.

Reports of sleep disturbances are common during pregnancy, yet estimates of prevalence of insomnia symptoms during pregnancy vary widely. The goals of the current review were to summarize the existing data on prevalence of insomnia symptoms during pregnancy and to explore potential moderators, including trimester, gestational age, maternal age, symptoms of anxiety and symptoms of depression. A systematic search of PubMed, PsycInfo and Web of Science was conducted for articles published from inception up to June 2020. In total, 24 studies with a total of 15,564 participants were included in the analysis. The overall prevalence of insomnia symptoms during pregnancy was 38.2%. Trimester was a significant moderator, such that prevalence of insomnia symptoms was higher in the third trimester (39.7%) compared to first (25.3%) and second (27.2%) trimesters. No other variables significantly moderated the prevalence of insomnia symptoms. The results of the current meta-analysis suggest that the prevalence of insomnia symptoms is higher during pregnancy, particularly in the third trimester. Future research should examine the efficacy and safety of insomnia treatments with this population.

Couples' treatment preferences for insomnia experienced during pregnancy.

INTRODUCTION: Insomnia during pregnancy is prevalent, yet little is known about preferred treatments for the disorder. The current study investigated both pregnant women's and their partners' preferences for treatment of maternal insomnia, comparing the two most empirically supported therapies: cognitive-behavioral therapy for insomnia (CBT-I) and pharmacotherapy. METHOD: We recruited pregnant women and their partners (N = 212) from a low-risk maternity clinic in Calgary, AB, Canada. Participants read expert validated treatment descriptions of pharmacotherapy and CBT-I and indicated their preference for treatment of maternal insomnia. Participants also completed the Insomnia Severity Index and Edinburgh Postnatal Depression Scale. RESULTS: The majority of pregnant women (72.6%) and their partners (73.6%) selected CBT-I as their preferred choice for treatment of maternal insomnia, with a high concordance between partners. Correlates of maternal treatment choice included previous use of treatment and partner preference. DISCUSSION: Findings suggest that pregnant women and their partners prefer CBT-I to pharmacotherapy as a treatment for maternal insomnia. Partners' preference may be an important consideration for women selecting treatment for insomnia. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Sleep quality during pregnancy: A meta-analysis.

Women's sleep quality has been reported to change during pregnancy; prevalence estimates of poor sleep quality during pregnancy vary widely. To further understand the observed variation of findings, we conducted a meta-analysis to quantify the prevalence of poor sleep quality during pregnancy. Articles (N = 24) that reported prevalence of poor sleep quality as captured by the Pittsburgh sleep quality index (PSQI) ≥ 5 were included, with a total of 11,002 participants contributing data. PubMed, PsycINFO, and Web of Science databases were systematically searched. Results indicated that the average PSQI score during pregnancy was 6.07, 95% confidence interval (CI) [5.30, 6.85], and 45.7%, 95% CI [36.5%, 55.2%], of pregnant women experienced poor sleep quality. Longitudinal studies indicated that sleep quality decreased from second (M = 5.31, SE = 0.40) to third trimester (M = 7.03, SE = 0.85) by 1.68 points, 95% CI [0.42, 2.94]. Gestational age moderated the average PSQI scores and prevalence of PSQI scores ≥5; older samples reported higher mean PSQI scores and higher prevalence of poor sleep quality. Clinicians should be aware that some reduction in sleep quality is expected during pregnancy, but complaints of very poor sleep quality could require intervention. Future research should examine various factors underlying poor sleep quality during pregnancy.

What do dads want? Treatment preferences for paternal postpartum depression.

BACKGROUND: Postpartum depression (PPD) is prevalent, occurring in 8 to 13% of new fathers. Identifying effective and acceptable treatments for paternal PPD is important to prevent negative family outcomes. Participation in a patient preferred treatment for depression increases treatment adherence and effectiveness. Thus, developing and delivering interventions that are preferred by the target population is an important aspect of successful treatment. The current study investigated treatment preferences for paternal PPD. METHODS: Men (N=140) who were within the first year postpartum were recruited from low-risk maternity clinics, baby shows, and partner referrals. Participants completed a 20-minute online survey that included three expert validated treatment descriptions for depression and a series of questionnaires. RESULTS: Participants reported preferring individual and couple psychotherapy to pharmacotherapy for treatment of PPD. Men perceived both individual and couple psychotherapy as being more credible and reported more favourable personal reactions towards them when compared to pharmacotherapy. LIMITATIONS: Participants were not required to meet diagnostic criteria for depression. The majority of participants were asked to respond to a hypothetical scenario of what they would do if faced with PPD. CONCLUSIONS: These findings suggest that fathers prefer psychological interventions over pharmacotherapy for treatment of PPD. Future research should investigate efficacious treatment options for paternal PPD based on treatment preferences.

Insomnia Treatment Preferences During Pregnancy.

OBJECTIVE: To determine pregnant women's preferences for the treatment of insomnia: cognitive behavioral therapy (CBT-I), pharmacotherapy, or acupuncture. DESIGN: A cross-sectional survey of pregnant women. SETTING: We recruited participants in person at a low-risk maternity clinic and a pregnancy and infant trade show and invited them to complete an online questionnaire. PARTICIPANTS: The sample (N = 187) was primarily White (70%), married or common-law married (96%), and on average 31 years of age; the mean gestational age was 28 weeks. METHODS: Participants read expert-validated descriptions of CBT-I, pharmacotherapy, and acupuncture and then indicated their preferences and perceptions of each approach. RESULTS: Participants indicated that if they experienced insomnia, they preferred CBT-I to other approaches, χ2(2) = 38.10, p < .001. They rated CBT-I as the most credible treatment (η2partial = .22, p < .001) and had stronger positive reactions to it than to the other two approaches (η2partial = .37, p < .001). CONCLUSION: Participants preferred CBT-I for insomnia during pregnancy. This preference is similar to previously reported preferences for psychotherapy for treatment of depression and anxiety during pregnancy. It is important for clinicians to consider women's preferences when discussing possible treatment for insomnia.

Prevalence of paternal depression in pregnancy and the postpartum: An updated meta-analysis.

BACKGROUND: Research in paternal prenatal and postpartum depression has nearly doubled since prevalence rates were last meta-estimated in October 2009. An updated meta-analysis allows additional questions to be answered about moderators that influence risk. METHODS: Studies reporting paternal depression between the first trimester and one-year postpartum were obtained for the period from January 1980 to November 2015. In total 74 studies with 41,480 participants were included, and data was extracted independently by two authors. Moderator analyses included measurement method, timing of assessment, study location, publication year, age, education, parity, history of depression, and maternal depression. RESULTS: The meta-estimate for paternal depression was 8.4% (95% confidence interval [CI], 7.2-9.6%) with significant heterogeneity observed among prevalence rates. Prevalence significantly varied based on publication year, study location, measurement method, and maternal depression. Prevalence was not conditional on paternal age, education, parity, history of paternal depression, and timing of assessment. LIMITATIONS: Analyses were limited by variability in assessment measures, countries from which studies were available, extant data for the first trimester and 6- to 9-month postpartum, and method of reporting sociodemographic information. CONCLUSIONS: Paternal depression was present in 8% of men in the included studies. Future screening policies and interventions should consider moderating risk factors for depression throughout the transition to parenthood.