The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Sleep for Science Research Laboratory, Providence, Rhode Island, USA.
Department of Anthropology, Brown University, Providence, Rhode Island, USA.
Sleep Health. 2021 Jun;7(3):353-361. doi: 10.1016/j.sleh.2021.01.004. Epub 2021 Feb 25.
Pregnant and postpartum women experience significant sleep disruption, but the role of perinatal sleep disturbances in breastfeeding is understudied.
In this observational cohort study, we used mixed methods to examine associations between perinatal sleep and breastfeeding. Forty-eight women (mean age 28.2 ± 4.9 years) who were euthymic at enrollment but had a history of major depression (n = 43) or bipolar disorder (n = 5) had sleep recorded with wrist actigraphy. We determined feeding status through daily diaries and used semi-structured interviews to identify themes regarding participants' experiences, breastfeeding decisions, and behaviors. To examine whether sleep disturbance during pregnancy predicted breastfeeding (BF) rates, we defined "lower sleep efficiency" (LSE) and "higher sleep efficiency" (HSE) groups based on the median split of actigraphic SE at 33 weeks' gestation (cutoff SE = 84.9%) and classified mothers as No-BF, Mixed-BF (BF + formula), and Exclusive-BF at 2 weeks postpartum.
Percentages of women who did any breastfeeding were: Week 2 = 72.3%, Week 6 = 62.5%, Week 16 = 50%. LSE mothers were less likely than HSE mothers to initiate breastfeeding (percent No-BF: LSE = 45.8%, HSE = 16.7%, P < .05). Average actigraphic sleep onset, sleep offset, time in bed, sleep duration, and SE did not differ based on breastfeeding status at any time point. Qualitative themes included insufficient preparation for the demands of breastfeeding, interrupted and nonrestorative sleep, and unrelenting daytime tiredness.
In our sample, preserved actigraphic SE during pregnancy was associated with initiation and continuation of breastfeeding. Future work should examine whether improving sleep in pregnancy improves mothers' feeding experiences.
孕妇和产后妇女经历了明显的睡眠中断，但围产期睡眠障碍与母乳喂养的关系尚未得到充分研究。
在这项观察性队列研究中，我们使用混合方法研究了围产期睡眠与母乳喂养之间的关系。48 名女性（平均年龄 28.2±4.9 岁）在入组时处于轻躁期，但有重度抑郁症（n=43）或双相情感障碍（n=5）病史，手腕活动记录仪记录了她们的睡眠情况。我们通过每日日记确定了喂养状态，并使用半结构化访谈确定了参与者关于体验、母乳喂养决策和行为的主题。为了研究妊娠期间的睡眠障碍是否预测母乳喂养（BF）率，我们根据妊娠 33 周时活动记录仪睡眠效率（SE）的中位数（截距 SE=84.9%）将睡眠效率分为“低睡眠效率”（LSE）和“高睡眠效率”（HSE）组，并将母亲在产后 2 周时分为非母乳喂养（No-BF）、混合喂养（BF+配方奶）和纯母乳喂养（exclusive-BF）。
进行任何母乳喂养的女性百分比为：第 2 周=72.3%，第 6 周=62.5%，第 16 周=50%。与 HSE 母亲相比，LSE 母亲开始母乳喂养的可能性较低（百分比 No-BF：LSE=45.8%，HSE=16.7%，P<.05）。在任何时间点，基于母乳喂养状态，平均活动记录仪睡眠起始、睡眠结束、卧床时间、睡眠持续时间和 SE 均无差异。定性主题包括对母乳喂养需求准备不足、睡眠中断和非恢复性、持续的白天疲劳。
在我们的样本中，妊娠期间保持活动记录仪 SE 与开始和继续母乳喂养有关。未来的研究应研究在妊娠期间改善睡眠是否能改善母亲的喂养体验。
