Effect of a sleep-support intervention program designed for primiparous women and infants up to 2 months postpartum: A non-randomized controlled trial

Abstract

Aim: Owing to nighttime breastfeeding, primiparous women often experience disrupted and poor-quality sleep for up to 2 months postpartum. To improve postpartum sleep, we developed a sleep-support program to adjust sleep–wake rhythms and reduce wake time during breastfeeding and evaluated its effectiveness using the primary outcome (Pittsburgh Sleep Quality Index; PSQI) and secondary outcomes (sleep quantity indices). Methods: This non-randomized controlled trial included 110 primiparous women (28–32 weeks gestation) assigned to intervention (n = 41) or control (n = 29) groups. The intervention comprised a childcare diary and pamphlets, two 1-h intrapartum educational sessions promoting postpartum sleep and breastfeeding techniques, and two 30-min postpartum follow-up interviews. The PSQI and Epworth Sleepiness Scale were administered at 2, 4, and 8 weeks postpartum. At 2 and 8 weeks, we also measured total sleep time, wake after sleep onset (WASO) time, number of awakenings, nap duration and frequency, bedtime, wake time (mother and infant), and maternal sleep efficiency. Results: The primary PSQI outcome showed no significant intergroup difference. However, subjective sleep quality (C1) was significantly lower, and sleep efficiency (C4) significantly higher, in the intervention group than in controls. One indicator (C1) improved, whereas another (C4) worsened. The intervention group had earlier bedtimes at 2 and 8 weeks, and their infants had shorter WASO. From 2 to 8 weeks, infant WASO significantly decreased in both groups and then stabilized. Conclusions: The postpartum sleep-support program may promote earlier maternal bedtimes and shorter WASO at 8 weeks postpartum, though qualitative sleep evaluations showed no improvement.