Magnitude and risk factors for postpartum symptoms: a literature review.

Objective. We investigated relations between deployment and new-onset depression among US service members recently deployed to the wars in Iraq and Afghanistan.Methods. We included 40 219 Millennium Cohort Study participants who completed baseline and follow-up questionnaires and met inclusion criteria. Participants were identified with depression if they met the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire criteria for depression at follow-up, but not at baseline.Results. Deployed men and women with combat exposures had the highest onset of depression, followed by those not deployed and those deployed without combat exposures. Combat-deployed men and women were at increased risk for new-onset depression compared with nondeployed men and women (men: adjusted odds ratio [AOR] = 1.32; 95% confidence interval [CI] = 1.13, 1.54; women: AOR = 2.13; 95% CI = 1.70, 2.65). Conversely, deployment without combat exposures led to decreased risk for new-onset depression compared with those...

A prospective study of depression following combat deployment in support of the wars in Iraq and Afghanistan.

Objective To determine the current knowledge of postpartum womens' sleep patterns, sleep disturbances, consequences of sleep disturbances, and known strategies for prevention in order to provide best practice recommendations for health care providers. Data Sources A literature search from 1969 through February 2008 was conducted using the CINHL, Index of Allied Health Literature, Ovid, PsycINFO, and PubMed electronic databases in addition to reference lists from selected articles and other key references. Search terms included sleep, postpartum, sleep deprivation, and sleep disturbance. Study Selection A critical review of all relevant articles from the data sources was conducted with attention to the needs of postpartum womens' sleep and implications for health care providers. Data Extraction Literature was reviewed and organized into groups with similar characteristics. Data Synthesis An integrative review of the literature summarized the current state of research related to sleep alterations in postpartum women. Conclusions Postpartum women experience altered sleep patterns that may lead to sleep disturbances. The most common reasons for sleep disturbances are related to newborn sleep and feeding patterns. Although present, the relationships among sleep disturbance, fatigue, and depression in postpartum women lack clarity due to their ambiguous definitions and the variety of the studies conducted. Providers should encourage prenatal education that assists the couple in developing strategies for decreasing postpartum sleep deprivation. Alterations of in-hospital care and home care should be incorporated to improve the new family's sleep patterns.

https://www.jognn.org/article/S0884-2175(15)30156-8/pdf

A Selective Review of Maternal Sleep Characteristics in the Postpartum Period

Chronic sleep loss during pregnancy as a determinant of stress: impact on pregnancy outcome

Changes in anxiety and cognition due to reproductive experience: a review of data from rodent and human mothers.

Background Postpartum sleep is a difficult and complicated concept to measure owing to the intrusive nature of research at a sensitive and private time for new families. Nurses often find themselves advising mothers on ways to improve sleep and reduce fatigue based on teachings that are not evidence based. The purpose of this secondary analysis of a larger study of postpartum fatigue patterns was to examine the relationship between sleep characteristics and postpartum fatigue during the first 6 weeks after delivery. Methods A prospective, longitudinal, descriptive study was conducted of 109 postpartum women. Sleep and fatigue were measured using a 16-item subjective sleep characteristics scale and a 30-statement subjective fatigue instrument. Three measurement points were used: 1) 1–2 days after delivery (before hospital discharge); 2) 2 weeks postpartum; and 3) 6 weeks postpartum. Results Fatigue had a positive correlation with sleep disturbance at all three measurement points, indicating that higher levels of fatigue are associated with more disturbed sleep. No association was found between levels of fatigue and sleep supplementation. Levels of fatigue had a negative correlation with sleep effectiveness at all measurement points, indicating that the women were more fatigued if they perceived their sleep quality and adequacy to be poor or if they perceived the time spent sleeping to be short. Conclusions To reduce fatigue, nurses should focus on exploring ways to reduce maternal sleep disturbance and improve maternal sleep effectiveness. It is unclear whether the age-old advice to “nap when your baby naps” is effective in reducing postpartum fatigue.

The relationship between sleep characteristics and fatigue in healthy postpartum women.

Objective (a) To describe fatigue levels in military active‐duty women, (b) to describe the relationship among selected predictor variables of fatigue, and (c) to examine the relationship between predictor variables, fatigue levels, and performance (as measured by functional status) after childbirth. Design Based on the Theory of Unpleasant Symptoms, a longitudinal, prospective design. Setting A large military medical facility in the southwest United States. Patients/Participants A convenience sample of 109 military active‐duty women. Main Outcome Measure Postpartum fatigue. Results Women were found to be moderately fatigued across time, with no change in fatigue levels from 2 to 6 weeks after delivery. All variables correlated with fatigue during hospitalization and at 2 weeks after delivery, and depression, anxiety, maternal sleep, and functional status correlated with fatigue at 6 weeks after delivery. Regression analyses indicated that maternal anxiety predicted fatigue at 6 weeks after delivery. Over half the women had not regained full functional status when they returned to work, and 40% still displayed symptoms of postpartum depression and anxiety. Conclusions Military women continue to experiencing postpartum fatigue when they return to the workplace. Future research is needed to examine issues surrounding fatigue and its associated variables during the first year after delivery.

/pdf/postpartum-fatigue-in-the-active-duty-military-woman-1x2gj85evu.pdf

Postpartum Fatigue in the Active‐Duty Military Woman

Each year, ∼16,000 women on active duty in the US military experience the birth of a child A descriptive, longitudinal, prospective design was used to gather data with the Postpartum Depression Screening Scale Depression was measured after delivery but before hospital discharge (time 1), 2 weeks after delivery (time 2), and 6 to 8 weeks after delivery (time 3) Mothers were found to be experiencing the greatest severity of symptoms in the category of sleeping and eating disturbances Almost one-half of the mothers in this study scored either significant postpartum depressive symptoms or positive screening for postpartum depression after delivery This number remained virtually unchanged at time 2 By time 3, 40% of women still reported depressive symptoms At 2 weeks and 6 weeks after delivery, 13% and 11% of mothers, respectively, had positive screening for postpartum depression, consistent with the national average of 10 to 15% Future research is needed to examine issues surrounding postpa

/pdf/screening-for-postpartum-depression-in-military-women-with-4b3fs7sltg.pdf

Jacqueline Rychnovsky

Papers

A Selective Review of Maternal Sleep Characteristics in the Postpartum Period

The relationship between sleep characteristics and fatigue in healthy postpartum women.

Postpartum Fatigue in the Active‐Duty Military Woman

Screening for postpartum depression in military women with the Postpartum Depression Screening Scale.

Choosing a postpartum depression screening instrument for your pediatric practice.